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Interobserver variation in the classification of thymic lesions including biopsies and resection specimens in an international digital microscopy panel.

ABSTRACT: AIMS:Thymic tumours are rare in routine pathology practice. Although the World Health Organization (WHO) classification describes a number of well-defined categories, the classification remains challenging. The aim of this study was to investigate the reproducibility of the WHO classification among a large group of international pathologists with expertise in thymic pathology and by using whole slide imaging to facilitate rapid diagnostic turnover. METHODS AND RESULTS:Three hundred and five tumours, consisting of 90 biopsies and 215 resection specimens, were reviewed with a panel-based virtual microscopy approach by a group of 13 pathologists with expertise in thymic tumours over a period of 6 years. The specimens were classified according to the WHO 2015 classification. The data were subjected to statistical analysis, and interobserver concordance (Fleiss kappa) was calculated. All cases were diagnosed within a time frame of 2 weeks. The overall level of agreement was substantial (? = 0.6762), and differed slightly between resection specimens (? = 0.7281) and biopsies (? = 0.5955). When analysis was limited to thymomas only, and they were grouped according to the European Society for Medical Oncology Clinical Practice Guidelines into B2, B3 versus A, AB, B1 and B3 versus A, AB, B1, B2, the level of agreement decreased slightly (? = 0.5506 and ? = 0.4929, respectively). Difficulties arose in distinguishing thymoma from thymic carcinoma. Within the thymoma subgroup, difficulties in distinction were seen within the B group. CONCLUSIONS:Agreement in diagnosing thymic lesions is substantial when they are assessed by pathologists with experience of these rare tumours. Digital pathology decreases the turnaround time and facilitates access to what is essentially a multinational resource. This platform provides a template for dealing with rare tumours for which expertise is sparse.

SUBMITTER: Wolf JL

PROVIDER: S-EPMC7702114 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Interobserver variation in the classification of thymic lesions including biopsies and resection specimens in an international digital microscopy panel.

Wolf Janina L JL van Nederveen Francien F Blaauwgeers Hans H Marx Alexander A Nicholson Andrew G AG Roden Anja C AC Ströbel Philipp P Timens Wim W Weissferdt Annika A von der Thüsen Jan J den Bakker Michael A MA

Histopathology 20200924 5

<h4>Aims</h4>Thymic tumours are rare in routine pathology practice. Although the World Health Organization (WHO) classification describes a number of well-defined categories, the classification remains challenging. The aim of this study was to investigate the reproducibility of the WHO classification among a large group of international pathologists with expertise in thymic pathology and by using whole slide imaging to facilitate rapid diagnostic turnover.<h4>Methods and results</h4>Three hundre ...[more]

PMID: 32506527

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Project description:To treat lupus nephritis effectively, proper identification of the histologic class is essential. Although the classification system for lupus nephritis is nearly 40 years old, remarkably few studies have investigated interobserver agreement. Interobserver agreement among nephropathologists was studied, particularly with respect to the recognition of class III/IV lupus nephritis lesions, and possible causes of disagreement were determined.A link to a survey containing pictures of 30 glomeruli was provided to all 360 members of the Renal Pathology Society; 34 responses were received from 12 countries (a response rate of 9.4%). The nephropathologist was asked whether glomerular lesions were present that would categorize the biopsy as class III/IV. If so, additional parameters were scored. To determine the interobserver agreement among the participants, ? or intraclass correlation values were calculated. The intraclass correlation or ?-value was also calculated for two separate levels of experience (specifically, nephropathologists who were new to the field or moderately experienced [less experienced] and nephropathologists who were highly experienced).Intraclass correlation for the presence of a class III/IV lesion was 0.39 (poor). The ?/intraclass correlation values for the additional parameters were as follows: active, chronic, or both: 0.36; segmental versus global: 0.39; endocapillary proliferation: 0.46; influx of inflammatory cells: 0.32; swelling of endothelial cells: 0.46; extracapillary proliferation: 0.57; type of crescent: 0.46; and wire loops: 0.35. The highly experienced nephropathologists had significantly less interobserver variability compared with the less experienced nephropathologists (P=0.004).There is generally poor agreement in terms of recognizing class III/IV lesions. Because experience clearly increases interobserver agreement, this agreement may be improved by training nephropathologists. These results also underscore the importance of a central review by experienced nephropathologists in clinical trials.

Dataset Information

Interobserver variation in the classification of thymic lesions including biopsies and resection specimens in an international digital microscopy panel.

Publications

Interobserver variation in the classification of thymic lesions including biopsies and resection specimens in an international digital microscopy panel.

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