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Histologic estimation of coronary artery stenoses: reproducibility and the effect of training
J C Ford1, K O'Rourke, J P Veinot
1Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Insights
Histologic assessment of coronary artery stenosis (CAS) showed excellent reproducibility among pathologists, regardless of experience level. Training did not significantly impact the accuracy of CAS measurements in this study.
Area of Science:
- Pathology
- Cardiovascular Medicine
- Medical Education
Background:
- Histologic estimation of coronary artery stenoses (CAS) is the gold standard for clinicopathologic correlations and medicolegal cases.
- Reproducibility of histologic CAS assessment is not well-established, and the impact of training is unknown.
Purpose of the Study:
- To evaluate the inter- and intraobserver reproducibility of histologic CAS assessment.
- To determine the effect of training on the reproducibility of CAS assessment among different pathologist groups.
Main Methods:
- Twenty Movat-stained coronary artery cross-sections were reviewed three times by clinical pathologists, residents, anatomic pathologists, and cardiovascular pathologists.
- Inter- and intraobserver reproducibility were assessed using interclass correlation coefficients (ICC).
- A training guide was provided before the third review iteration.
Main Results:
- All groups demonstrated excellent interobserver reproducibility (ICC > 0.76) both before and after training.
- Intraobserver reproducibility was good to excellent across all pathologist groups.
- Statistical analysis revealed no significant effect of training or experience on observer reproducibility.
Conclusions:
- Histologic assessment of CAS exhibits high inter- and intraobserver reproducibility.
- Training and experience did not significantly alter the reproducibility of CAS assessment in this cohort.
Abstract:
Histologic estimation of coronary artery stenoses (CAS) provides the 'gold-standard' for clinicopathologic correlations and medicolegal investigations, yet little evidence supports histology as a reproducible diagnostic measure, and none addresses the effect of training on its use. To study these questions, 20 randomly selected Movat-stained coronary artery cross-sections were reviewed 3 times, at 3-month intervals, by six clinical pathologists (CPs), six pathology residents (Res), seven anatomic pathologists (APs), and two cardiovascular pathologists (CVPs). Before the third iteration, a guide to CAS assessment with illustrations was provided. Inter- and intraobserver reproducibility were determined using interclass correlation coefficients (ICC) (0.40-0.75 = fair-good; > or = 0.76 = excellent agreement beyond chance). Surprisingly, all study groups had excellent interobserver reproducibility. Before training, at Time 1, the scores were CPs, 0.77; Res, 0.89; APs, 0.93; and CVPs, 0.93. After training, at Time 3, the results were CPs, 0.81; Res, 0.91; APs, 0.86; and CVPs, 0.88. Intraobserver reproducibility for CPs overall was good (ICC, 0.74), and excellent for Res, APs, and CVPs (0.89, 0.94, and 0.97, respectively). In conclusion, statistical analysis failed to demonstrate any significant effect of training or experience on observer reproducibility.