Interobserver agreement in dysplasia grading: Toward an enhanced gold standard for clinical pathology trials

Paul M. Speight, Timothy J. Abram, Pierre N. Floriano, Robert James, Julie Vick, Martin H. Thornhill, Craig Murdoch, Christine Freeman, Anne M. Hegarty, Katy D'Apice, A. Ross Kerr, Joan Phelan, Patricia Corby, Ismael Khouly, Nadarajah Vigneswaran, Jerry Bouquot, Nagi M. Demian, Y. Etan Weinstock, Spencer W. Redding, Stephanie RowanChih Ko Yeh, H. Stan McGuff, Frank R. Miller, John T. McDevitt

Research output: Contribution to journalArticlepeer-review

31 Scopus citations

Abstract

Objective. Interobserver agreement in the context of oral epithelial dysplasia (OED) grading has been notoriously unreliable and can impose barriers for developing new molecular markers and diagnostic technologies. This paper aimed to report the details of a 3-stage histopathology review and adjudication process with the goal of achieving a consensus histopathologic diagnosis of each biopsy. Study Design. Two adjacent serial histologic sections of oral lesions from 846 patients were independently scored by 2 different pathologists from a pool of 4. In instances where the original 2 pathologists disagreed, a third, independent adjudicating pathologist conducted a review of both sections. If a majority agreement was not achieved, the third stage involved a face-to-face consensus review. Results. Individual pathologist pair κ values ranged from 0.251 to 0.706 (fair-good) before the 3-stage review process. During the initial review phase, the 2 pathologists agreed on a diagnosis for 69.9% of the cases. After the adjudication review by a third pathologist, an additional 22.8% of cases were given a consensus diagnosis (agreement of 2 out of 3 pathologists). After the face-to-face review, the remaining 7.3% of cases had a consensus diagnosis. Conclusions. The use of the defined protocol resulted in a substantial increase (30%) in diagnostic agreement and has the potential to improve the level of agreement for establishing gold standards for studies based on histopathologic diagnosis.

Original languageEnglish (US)
Pages (from-to)474-482.e2
JournalOral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Volume120
Issue number4
DOIs
StatePublished - Oct 1 2015

ASJC Scopus subject areas

  • Surgery
  • Oral Surgery
  • Pathology and Forensic Medicine
  • Dentistry (miscellaneous)
  • Radiology Nuclear Medicine and imaging

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