计算机定量辅助在提高乳腺导管原位癌分级一致性的应用价值

The value on computer-aided quantitative analysis in improving the reproducibility of histological grade in ductal carcinoma in situ of breast

目的探讨不同病理医师间乳腺导管原位癌(ductal carcinoma in situ,DCIS)分级的一致性,明确计算机定量辅助对提高乳腺DCIS分级一致性的价值。方法收集四川大学华西医院存档的453例乳腺DCIS样本,每例选取一张具有代表性的HE切片。由三位病理医师分别按常规工作状态、培训交流后、计算机定量辅助三个阶段对所有乳腺DICS病例独立进行低、中、高级别分级。采用Fleiss Kappa值对不同病理医师间的诊断一致性进行分析。结果常规工作状态下,三位病理医师对乳腺DCIS诊断一致性较低(Kappa=0.360),特别是中核级乳腺DCIS(Kappa=0.181);经统一诊断标准培训后,三位医师诊断的一致性略有提升(Kappa=0.362),其中中核级乳腺DCIS诊断的Kappa=0.227;经计算机定量辅助测量肿瘤细胞核直径,三位医师诊断的一致性明显升高(Kappa=0.638),特别是对中核级乳腺DCIS的诊断(Kappa=0.550)。结论计算机定量辅助方法能够提高乳腺DCIS诊断的一致性。

Purpose To investigate the reproducibility of grade of ductal carcinoma in situ(DCIS)among pathologists,and to clarify the value of computer-aided quantitative analysis in improving the reproducibility of grade of DCIS.Methods A total of 453 pure DCIS cases were collected from West China Hospital,Sichuan University,and one representative slide was selected for each case.Three pathologists classified these cases into low,intermediate and high groups in three phases,the first phase was the same as routine diagnosis,then they received a unified training,the third round with computer-aided.Inter-observer agreement was statistically analyzed using Fleiss Kappa index.Results Low reproducibility among pathologists at first phase(Kappa value 0.360),especially for intermediate DCIS(Kappa value 0.181).The reproducibility was slightly higher after training,with Kappa value 0.362,among which the intermediate Kappa value was 0.227.Noteworthy,with the computer-aided quantitative analysis,agreement among pathologists was significantly improved,received a Kappa index of 0.638,the Kappa value of intermediate DCIS was 0.550.Conclusion Computer-aided quantitative analysis can improve the reproducibility of histological grade of DCIS.