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

• Published in: Oral surgery, oral medicine, oral pathology and oral radiology oral medicine, oral pathology and oral radiology, 2015-10, Vol.120 (4), p.474-482.e2
• Main Authors: Speight, Paul M., PhD, BDS, FDSRCPS, FDSRCS (Eng), FDSRCS (Edin), FRCPath, Abram, Timothy J., MS, Floriano, Pierre N., PhD, James, Robert, BS, Vick, Julie, CCRP, Thornhill, Martin H., MBBS, BDS, PhD, MSc, FDSRCS (Edin), FDSRCSI, FDSRCS (Eng), Murdoch, Craig, BSc, PhD, Freeman, Christine, BDS, FDSRCS (Eng), MMedSci, MPhil, Hegarty, Anne M., BA, BDentSci, MSc, MBBS, MFD RCSI, FDS (OM) RCS, D'Apice, Katy, BS, Kerr, A. Ross, DDS, MSD, Phelan, Joan, DDS, Corby, Patricia, DDS, MS, Khouly, Ismael, DDS, MS, PhD, Vigneswaran, Nadarajah, DMD, Dr Med Dent, Bouquot, Jerry, DDS, MSD, Demian, Nagi M., DDS, MD, Weinstock, Y. Etan, MD, Redding, Spencer W., DDS, Med, Rowan, Stephanie, RN, MSN, Yeh, Chih-Ko, BDS, PhD, McGuff, H. Stan, DDS, Miller, Frank R., MD, FACS, McDevitt, John T., PhD
• Format: Article
• Language: English
• Subjects: Biopsy; Carcinoma in Situ - pathology; Cell Transformation, Neoplastic - pathology; Clinical Trials as Topic; Dentistry; Humans; Mouth Mucosa - pathology; Mouth Neoplasms - pathology; Observer Variation; Pathology, Clinical - methods; Precancerous Conditions - pathology; Surgery
• ISSN: 2212-4403; 2212-4411
• DOI: 10.1016/j.oooo.2015.05.023

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.