具有乳头样核特征的非浸润性甲状腺滤泡性肿瘤细胞核特征判读一致性研究

Interobserver variation in the morphological evaluation of nuclear features of noninvasive follicular thyroid neoplasm with papillary like nuclear features

目的拟评价病理医生对于"具有乳头样核特征的非浸润性甲状腺滤泡性肿瘤(non-invasive follicular thyroid neoplasm with papillary-like nuclear features,NIFTP)"判读的一致性。方法选取我国不同地区9位病理医生对30例NIFTP的数字切片进行判读。评分内容包括三点:细胞核大小和形状,核膜不规则度,核染色质特点。以上各项指标,有,评分为1;无,评分为0;将结果相加,得出的总分0~3。总评分2~3,判读为NIFTP。结果我国病理医生判读总体具有微弱的一致性(Kappa值为0.0814),其中对核膜不规则度的判定一致性最佳(Kappa值为0.1936),对细胞核大小和形状的判定一致性最差(Kappa值为0.1022)。7名高年资病理医生判读总体一致性优于9位医生,但总体结果仍为微弱(Kappa值为0.1341)。对核膜不规则度(Kappa值为0.2674)和核染色质特征(Kappa值为0.2573)判读的一致性弱,但仍高于对细胞核大小和形状的判读一致性(Kappa值为0.0730)。本研究判读一致性总体略低于亚洲研究,高年资病理医生对于核膜不规则度的判读一致性优于亚洲研究。结论对于NIFTP细胞核特点观察者间的差异可能是由教育程度、工作经验、个人对判读标准的理解、地理差异甚至一些不确定的原因造成。我国病理医生在判读NIFTP细胞核特征方面一致性低,应进一步推广并细化NIFTP细胞核判定标准。对于形态学提示NIFTP的病例,应推荐采用免疫组化或者分子生物学方法排除高危基因突变。

Objective To evaluate the interobserver variation of pathologists in the morphological evaluation of non-invasive follicular thyroid neoplasm with papillary-like nuclear features(NIFTP).Methods Nine pathologists from different regions in China were selected to evaluate the digital slides of 30 cases of NIFTP.Three score system was applied,including nuclear size and shape,membrane irregularity,and chromatin features.Individual histologic features were scored as either present(1)or absent(0).A total score of 0 or 1 was considered inadequate for the diagnosis of NIFTP and a total score of 2 or 3 was considered sufficient for the diagnosis of NIFTP.Results Overall,9 doctors had weak consistency in the interpretation of the 30 cases(Kappa value 0.0814),in which the interpretation of the membrane irregularity had the best consistency(Kappa value 0.1936)and the interpretation of nuclear size and shape revealed the worst consistency(Kappa value 0.1022).The overall consistency of the evaluation from the 7 senior pathologists was better than that of all the pathologists(Kappa value 0.1341),but it was still weak.The consistency of nuclear membrane irregularity(Kappa value 0.2674)and nuclear chromatin features(Kappa value 0.2573)was weak,but much better than that of nuclear size and shape(Kappa value 0.0730).The interobserver consistency in our study was lower than that in Asian study generally.However,the judgement on membrane irregularity in our senior pathologists was better than that in Asian study.Conclusion The interobserver variation on the evaluation of the nuclear features of NIFTP is probably due to the education level,working experience,personal understanding of the diagnostic criteria,the regional difference,and some uncertain reasons.There is overall a weak consistency in the interpretation of NIFTP by Chinese pathologists,and it is necessary to popularize the diagnostic criteria and specify the criteria in detail.It is important to exclude high-risk genetic mutation using immunohistochemical staining or molecular examination on those patients with morphology of NIFTP.