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Published on: July 21, 2016
Chronic deciduitis in the placental basal plate: definition and interobserver reliability
T Y Khong1, R W Bendon, F Qureshi
1Department of Obstetrics and Gynaecology, University of Adelaide, Australia.
Insights
Pathologists achieved high concordance in diagnosing chronic deciduitis (inflammation) in placental tissues. Defining criteria improved diagnostic agreement, aiding clinical studies.
Area of Science:
- Pathology
- Obstetrics
- Reproductive Medicine
Background:
- Chronic deciduitis, an inflammatory condition of the basal decidua, is crucial in placental pathology.
- Accurate diagnosis is essential for understanding pregnancy complications and outcomes.
Purpose of the Study:
- To assess inter-observer concordance among experienced pathologists for diagnosing chronic deciduitis.
- To identify factors influencing diagnostic agreement and to improve diagnostic reliability.
Main Methods:
- Six experienced placental pathologists evaluated 30 placental slides for chronic deciduitis.
- Pathologists scored inflammation severity, extent, and presence of plasma cells.
- Re-evaluation occurred after sharing initial results and providing consensus criteria.
Main Results:
- Initial concordance (5/6 or 6/6 agreement) was 76% (23/30 cases).
- Diagnosis strongly correlated with inflammation severity, influenced by extent and plasma cells.
- Post-consensus re-evaluation improved concordance to 83% in remaining cases.
Conclusions:
- Establishing clear diagnostic criteria, including severity, extent, and plasma cell presence, enhances pathologist agreement.
- Sufficient concordance for chronic deciduitis diagnosis is achievable, supporting its clinical utility.
- Standardized criteria are vital for reliable interpretation of placental inflammation.
Abstract:
This study tested whether concordance could be achieved for abnormal inflammation in the basal decidua of placental specimens among 6 pathologists experienced in placental pathology. Thirty microscope slides were evaluated by the pathologists for chronic deciduitis. They also scored the severity and extent of inflammation and the presence of plasma cells. No definition of chronic deciduitis was provided. Concordance (5/6 or 6/6 agreement) was achieved in 23 cases (76%). Spearman's rank correlation showed that the diagnosis of chronic deciduitis was almost identical to the assessment of the severity of the inflammation. A regression analysis showed that the perception of severity (and hence chronic deciduitis) was influenced by the other 2 variables, extent and plasma cells. The results were shared with the pathologists, and 25 cases (excluding those with previous 6/6 consensus) were reevaluated. Concordance was now achieved in the 83% of those remaining cases. Using a threshold based on the severity and the extent of lymphocytes, and the presence of plasma cells, pathologists are able to diagnose chronic deciduitis with sufficient concordance to be of value in clinical correlation studies.
