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宫细胞学和组织学解释的观察者间可重复性:来自ASCUS-LSIL选研究的现实估计.

M H Stoler1, M Schiffman,

  • 1University of Virginia Health System, Division of Surgical Pathology and Cytopathology, Box 800214, Charlottesville, VA 22908, USA. mhs2e@virginia.edu

JAMA
|March 23, 2001
PubMed
概括

宫病理样本的解释显示病理学家之间存在显著的变化. 对细胞学和细胞病理学来说,可复制性是适度的,这凸显了在宫癌查中需要现实的性能预期的需要.

科学领域:

  • 妇科病理学 妇科病理学
  • 细胞病理学 细胞病理学
  • 诊断的准确性 诊断的准确性

背景情况:

  • 宫病理学解释的间病理学家协议标准尚未明确定义.
  • 宫样本解释的可靠性对于患者管理至关重要.

研究的目的:

  • 在多位专家病理学家中评估宫样本解释的可重现性.
  • 为了比较细胞学,肠镜活检和循环电术切除手术 (LEEP) 组织学解释的可靠性.

主要方法:

  • 利用了来自非典型状细胞未确定重要性低度状内皮损伤 (ASCUS-LSIL) 位研究 (ALTS) 的数据.
  • 分析了4948个细胞学幻灯片,2237个结肠镜活检和535个LEEP标本.
  • 计算了卡帕值,以比较临床中心病理学家和质量控制 (QC) 审核人员的解释.

主要成果:

  • 病理学家在解释宫样本方面表现出显著的变异性,临床中心病理学家提供更严重的解释.
  • 在单层细胞学 (kappa=0.46),穿孔活检组织病理学 (kappa=0.46) 和LEEP组织病理学 (kappa=0.49) 中,可复制性中度且相似.
  • 组织病理学解释的变异性在较不严重的诊断中最为明显.

结论:

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  • 对于所有宫样品类型,存在大量的解释性变异性.
  • 宫活检的组织病理学并不比单层细胞学更可复制.
  • 即使LEEP样本的解释也显示出变化,需要病理学家的现实性绩效预期.