Pathologic Interpretation of Transbronchial Biopsy for Acute Rejection of Lung Allograft Is Highly Variable
Despite the standardization of pathologic grading of acute rejection in transbronchial lung biopsies following lung transplantation, the reproducibility of pathologic diagnosis has not been adequately evaluated. To determine the interobserver variability for pathologic grading of acute rejection, 15...
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description | Despite the standardization of pathologic grading of acute rejection in transbronchial lung biopsies following lung transplantation, the reproducibility of pathologic diagnosis has not been adequately evaluated. To determine the interobserver variability for pathologic grading of acute rejection, 1566 biopsies from 845 subjects in the Lung Allograft Rejection Gene Expression Observational study were regraded by a pathology panel blinded to the original diagnosis and compared to the grade of acute rejection assigned by individual center pathologists. The study panel confirmed 49.1% of center pathologists’ A0 grades, but upgraded 5.7% to A1 and 2.7% to grade ≥ A2 rejection; 42.5% were regraded as AX. Of 268 grade A1 samples, 21.2% were confirmed by the pathology panel; 18.7% were upgraded to ≥ A2 and 35.8% were downgraded to A0 with 24.3% being regraded as AX. Lastly, 53.5% of ≥ A2 cases were confirmed, but 15.7% were downgraded to grade A0 and 18.4% cases to A1, while 12.4% were regraded as AX. The kappa value for interobserver agreement was 0.183 (95%CI 0.147–0.220, p < 0.001). The results for B grade interpretation were similar. Suboptimal sampling is common and a high degree of variability exists in the pathologic interpretation of acute rejection in transbronchial biopsies.
This study shows that the histopathologic diagnosis of acute lung allograft rejection is highly variable in a large, international and multicenter cohort. |
doi_str_mv | 10.1111/j.1600-6143.2010.03382.x |
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This study shows that the histopathologic diagnosis of acute lung allograft rejection is highly variable in a large, international and multicenter cohort.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/j.1600-6143.2010.03382.x</identifier><identifier>PMID: 21219569</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Acute Disease ; Adult ; Biological and medical sciences ; Biopsy ; Biopsy - methods ; Bronchi ; Diagnostic Errors ; Female ; Gene expression ; Graft rejection ; Graft Rejection - diagnosis ; Graft Rejection - pathology ; Humans ; Lung - pathology ; Lung transplantation ; Lung Transplantation - adverse effects ; Lung Transplantation - pathology ; Male ; Medical sciences ; Middle Aged ; Observer Variation ; pathology ; rejection ; Sampling ; Standardization ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><ispartof>American journal of transplantation, 2011-02, Vol.11 (2), p.320-328</ispartof><rights>©</rights><rights>2015 INIST-CNRS</rights><rights>2011 The Authors Journal compilation©2011 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5462-8aeacf86995ae81febf833f5508dda5aa91d4a218434a843cc6f46c6cfa9010b3</citedby><cites>FETCH-LOGICAL-c5462-8aeacf86995ae81febf833f5508dda5aa91d4a218434a843cc6f46c6cfa9010b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1600-6143.2010.03382.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1600-6143.2010.03382.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23939157$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21219569$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Arcasoy, S. M.</creatorcontrib><creatorcontrib>Berry, G.</creatorcontrib><creatorcontrib>Marboe, C. C.</creatorcontrib><creatorcontrib>Tazelaar, H. D.</creatorcontrib><creatorcontrib>Zamora, M. R.</creatorcontrib><creatorcontrib>Wolters, H. J.</creatorcontrib><creatorcontrib>Fang, K. C.</creatorcontrib><creatorcontrib>Keshavjee, S.</creatorcontrib><title>Pathologic Interpretation of Transbronchial Biopsy for Acute Rejection of Lung Allograft Is Highly Variable</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>Despite the standardization of pathologic grading of acute rejection in transbronchial lung biopsies following lung transplantation, the reproducibility of pathologic diagnosis has not been adequately evaluated. To determine the interobserver variability for pathologic grading of acute rejection, 1566 biopsies from 845 subjects in the Lung Allograft Rejection Gene Expression Observational study were regraded by a pathology panel blinded to the original diagnosis and compared to the grade of acute rejection assigned by individual center pathologists. The study panel confirmed 49.1% of center pathologists’ A0 grades, but upgraded 5.7% to A1 and 2.7% to grade ≥ A2 rejection; 42.5% were regraded as AX. Of 268 grade A1 samples, 21.2% were confirmed by the pathology panel; 18.7% were upgraded to ≥ A2 and 35.8% were downgraded to A0 with 24.3% being regraded as AX. Lastly, 53.5% of ≥ A2 cases were confirmed, but 15.7% were downgraded to grade A0 and 18.4% cases to A1, while 12.4% were regraded as AX. The kappa value for interobserver agreement was 0.183 (95%CI 0.147–0.220, p < 0.001). The results for B grade interpretation were similar. Suboptimal sampling is common and a high degree of variability exists in the pathologic interpretation of acute rejection in transbronchial biopsies.
This study shows that the histopathologic diagnosis of acute lung allograft rejection is highly variable in a large, international and multicenter cohort.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Biopsy</subject><subject>Biopsy - methods</subject><subject>Bronchi</subject><subject>Diagnostic Errors</subject><subject>Female</subject><subject>Gene expression</subject><subject>Graft rejection</subject><subject>Graft Rejection - diagnosis</subject><subject>Graft Rejection - pathology</subject><subject>Humans</subject><subject>Lung - pathology</subject><subject>Lung transplantation</subject><subject>Lung Transplantation - adverse effects</subject><subject>Lung Transplantation - pathology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Observer Variation</subject><subject>pathology</subject><subject>rejection</subject><subject>Sampling</subject><subject>Standardization</subject><subject>Surgery (general aspects). 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R.</creator><creator>Wolters, H. J.</creator><creator>Fang, K. C.</creator><creator>Keshavjee, S.</creator><general>Blackwell Publishing Inc</general><general>Wiley</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7T5</scope><scope>H94</scope></search><sort><creationdate>201102</creationdate><title>Pathologic Interpretation of Transbronchial Biopsy for Acute Rejection of Lung Allograft Is Highly Variable</title><author>Arcasoy, S. M. ; Berry, G. ; Marboe, C. C. ; Tazelaar, H. D. ; Zamora, M. R. ; Wolters, H. J. ; Fang, K. 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C.</au><au>Keshavjee, S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pathologic Interpretation of Transbronchial Biopsy for Acute Rejection of Lung Allograft Is Highly Variable</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2011-02</date><risdate>2011</risdate><volume>11</volume><issue>2</issue><spage>320</spage><epage>328</epage><pages>320-328</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>Despite the standardization of pathologic grading of acute rejection in transbronchial lung biopsies following lung transplantation, the reproducibility of pathologic diagnosis has not been adequately evaluated. To determine the interobserver variability for pathologic grading of acute rejection, 1566 biopsies from 845 subjects in the Lung Allograft Rejection Gene Expression Observational study were regraded by a pathology panel blinded to the original diagnosis and compared to the grade of acute rejection assigned by individual center pathologists. The study panel confirmed 49.1% of center pathologists’ A0 grades, but upgraded 5.7% to A1 and 2.7% to grade ≥ A2 rejection; 42.5% were regraded as AX. Of 268 grade A1 samples, 21.2% were confirmed by the pathology panel; 18.7% were upgraded to ≥ A2 and 35.8% were downgraded to A0 with 24.3% being regraded as AX. Lastly, 53.5% of ≥ A2 cases were confirmed, but 15.7% were downgraded to grade A0 and 18.4% cases to A1, while 12.4% were regraded as AX. The kappa value for interobserver agreement was 0.183 (95%CI 0.147–0.220, p < 0.001). The results for B grade interpretation were similar. Suboptimal sampling is common and a high degree of variability exists in the pathologic interpretation of acute rejection in transbronchial biopsies.
This study shows that the histopathologic diagnosis of acute lung allograft rejection is highly variable in a large, international and multicenter cohort.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>21219569</pmid><doi>10.1111/j.1600-6143.2010.03382.x</doi><tpages>20</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Acute Disease Adult Biological and medical sciences Biopsy Biopsy - methods Bronchi Diagnostic Errors Female Gene expression Graft rejection Graft Rejection - diagnosis Graft Rejection - pathology Humans Lung - pathology Lung transplantation Lung Transplantation - adverse effects Lung Transplantation - pathology Male Medical sciences Middle Aged Observer Variation pathology rejection Sampling Standardization Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases |
title | Pathologic Interpretation of Transbronchial Biopsy for Acute Rejection of Lung Allograft Is Highly Variable |
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