Pathologist Interobserver Variability of Histologic Features in Childhood Brain Tumors: Results from the CCG-945 Study

In the Children's Cancer Group–945 trial, study design allowed estimation of overall interpathologist observational agreement for 6 histologic features frequently used in brain tumor diagnoses. We evaluated agreement between pairs of 5 experienced neuropathologists, who had knowledge of the gen...

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Veröffentlicht in:Pediatric and developmental pathology 2008-03, Vol.11 (2), p.108-117
Hauptverfasser: Gilles, Floyd H., Tavaré, C. Jane, Laurence, E. Becker, Burger, Peter C., Yates, Allan J., Pollack, Ian F., Finlay, Jonathan L.
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container_end_page 117
container_issue 2
container_start_page 108
container_title Pediatric and developmental pathology
container_volume 11
creator Gilles, Floyd H.
Tavaré, C. Jane
Laurence, E. Becker
Burger, Peter C.
Yates, Allan J.
Pollack, Ian F.
Finlay, Jonathan L.
description In the Children's Cancer Group–945 trial, study design allowed estimation of overall interpathologist observational agreement for 6 histologic features frequently used in brain tumor diagnoses. We evaluated agreement between pairs of 5 experienced neuropathologists, who had knowledge of the general diagnoses prior to slide readings. We performed this study in an attempt to further improve pathologist interinstitutional agreement. The features mitosis, necrosis, and giant cells had “fair” overall kappa estimates of reproducibility of around 0.5, while endothelial proliferation had only a “poor” overall kappa of 0.35. The Rogot reproducibility index averaged 0.5 for pleomorphism and hyperchromia. The upper bounds for the 10 pair summary agreement estimates were at best 0.65 (“good”) for all 6 features. These relatively low-reproducibility estimates for the very small number of histologic features being assessed in tumors institutionally diagnosed as high-grade gliomas indicate that neuropathologists either used different operational definitions or interpreted them differently. We found that we could rank the histologic features from best to worst agreement among study pathologists as necrosis, giant cells, mitosis, endothelial proliferation, hyperchromic nuclei, and pleomorphic cells. We suggest that neuropathologists involved in multi-institutional studies of putative therapies not discard these traditional histologic features, but rather develop standardized operational definitions and measure their variability before beginning the studies. Only after such histologic feature variability studies are conducted will we have the data to identify specific histologic features of value to clinicians and researchers. Agreement and strict adherence to improved nonsubjective diagnostic criteria would improve histologic feature reliability and, consequently, their usefulness in studies.
doi_str_mv 10.2350/07-06-0303.1
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subjects Adolescent
Brain Neoplasms - classification
Brain Neoplasms - pathology
Cell Proliferation
Child
Child, Preschool
Clinical Trials as Topic
Endothelial Cells - pathology
Glioma - classification
Glioma - pathology
Humans
Mitosis
Necrosis - diagnosis
Observer Variation
Pathology, Surgical
Reproducibility of Results
title Pathologist Interobserver Variability of Histologic Features in Childhood Brain Tumors: Results from the CCG-945 Study
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