Inter-reader variability in follicular lymphoma grading: Conventional and digital reading

Area of Science:

• Hematopathology
• Digital Pathology
• Oncology

Background:

• Follicular lymphoma (FL) grading traditionally involves manual counting of centroblasts (CBs) in selected high power fields (HPFs).
• Existing grading methods show significant inter-reader variability among pathologists.
• This variability can impact diagnostic accuracy and patient management.

Purpose of the Study:

• To evaluate the impact of digital reading technologies on inter-reader variability in FL grading.
• To compare the concordance of FL grading under different reading conditions.

Main Methods:

• Six pathologists graded 17 FL slides under three conditions: conventional microscopy, digital whole slide viewing, and digital whole slide viewing with pre-selected HPFs.
• Inter-reader agreement was assessed for each reading condition.

Main Results:

• Conventional grading showed poor consensus, with 41.2% of cases lacking agreement.
• Digital whole slide viewing alone resulted in the worst concordance.
• Digital whole slide viewing with pre-selected HPFs significantly improved inter-reader agreement, with only 5.9% of cases lacking consensus.

Conclusions:

• Digital whole slide reading with pre-selected HPFs enhances concordance in FL grading.
• Further research with larger datasets and automated algorithms is warranted to optimize digital grading concordance.
• Digital pathology offers a promising avenue to reduce diagnostic variability in FL.