统一诊断标准对乳腺导管增生性病变病理诊断重复性的影响  

Inter-observer Reproducibility in the Pathologic Diagnosis of Breast Intraductal Proliferative Lesions Using the Same Criteria

作　　者：魏兵[1] 张红英[1] 王玉芳[2] 步宏[1] 陈卉娇[1] 郭华[1] 戴晴晴 汤曦 郎志强[1] 李新军[1] 

机构地区：[1]四川大学华西医院病理科,成都610041 [2]四川大学华西医院消化内科 [3]四川大学华西临床医学院

出　　处：《中国循证医学杂志》2004年第11期766-770,共5页Chinese Journal of Evidence-based Medicine

摘　　要：目的　探讨统一诊断标准对乳腺导管增生性病变诊断重复性的影响 ,寻求提高病理诊断可重复性和准确性的措施。方法　参照Page标准收集 4 3例乳腺导管增生性病变 ,每例选取一张切片并随机排序。 10位病理医师两两配对后随机进入试验组 (统一诊断标准组 )和对照组 ,各自独立读片后从轻度普通型增生、中 重度普通型增生、轻度非典型增生、中 重度非典型增生、导管原位癌和导管原位癌伴浸润这 6种诊断中选取一种 ,并采用STA TA统计软件对两组病理医师间的诊断重复性进行Kappa分析。同时以两位乳腺专科病理医师按照Page标准确认的诊断作为参照 ,对两组病理医师诊断的准确性和过度诊断进行统计学分析。结果　统一使用Page标准的试验组的诊断重复性和准确性均高于对照组 (两组 6种、3种和 2种诊断时的总K值分别为 0 2 893,0 3371,0 4 92 8和0 10 0 3,0 15 0 3,0 340 5 ) ,说明统一诊断标准有利于提高诊断重复性。同时 ,诊断类别简化也提高了诊断的可重复性。试验组医师仍存在不同程度的过度诊断。结论　统一诊断标准是提高病理诊断可重复性和准确性的重要措施 ;Objective To investigate inter-observer reproducibility in the pathologic diagnosis of breast intraductal proliferative lesions (BDPL).Methods Forty three BDPL patients were diagnosed by criterion of Page. Every specimen from each case was sorted randomly. All slides were classified as mild usual hyperplasia, moderate-severe usual hyperplasia, mild atypical hyperplasia, moderate-severe atypical hyperplasia, ductal carcinoma in situ, or ductal carcinoma in situ with invasion. Inter-observer agreement of the two groups was statistically analyzed using Kappa test. Then we compared all the diagnoses of individual pathologist with the consensus opinion confirmed by two breast pathologists to analyze the diagnostic accuracy and undue diagnosis. ”HZResults Inter-observer reproducibility of the trial group was higher than that of the control group(The total K value of 6, 3, and 2 diagnoses in the two groups were 0.289 3, 0.337 1, 0.492 8, 0.100 3, 0.150 3 and 0.340 3, respectively). When the categories were simplified, inter-observer reproducibility increased. There were still undue diagnoses of different degrees among pathologists of the trial group. Conclusion ”B3Using the same criteria is an important method to increase the diagnostic reproducibility and accuracy. More practice is needed to familiarize with these criteria.

关 键 词：乳腺导管增生性病变 病理诊断 诊断标准 观察者间的重复性 

分 类 号：R655.8[医药卫生—外科学]