The pathologist's mean grade is constant and individualizes the prognostic value of bladder cancer grading.
Eur Urol
; 57(6): 1052-7, 2010 Jun.
Article
em En
| MEDLINE
| ID: mdl-19765886
ABSTRACT
BACKGROUND:
A new grading system for bladder cancer (BCa) was adopted in 2004 to reduce observer variability and provide better prognostic information.OBJECTIVE:
We compared the World Health Organization (WHO) 1973 and 2004 systems for observer variability and prognosis. DESIGN, SETTING, ANDPARTICIPANTS:
Slides of 173 primary non-muscle-invasive BCa were reviewed two times by four pathologists. MEASUREMENTS Intra- and interobserver variability were assessed using κ statistics. We determined the mean grade (eg, G1/low malignant potential is 1 grade point, G2/low grade is 2 grade points) of the pathologists per grading cycle. Kaplan-Meier analyses were applied for prediction of recurrence and progression. RESULTS ANDLIMITATIONS:
For WHO 2004 and 1973 grading, the agreement between the pathologists was 39-74% (κ 0.14-0.58) and 39-64% (κ 0.15-0.41), respectively. The intraobserver agreement varied from 71% to 88% (κ 0.55-0.81). The mean grade of a pathologist was constant (difference below 0.1 grade point) irrespective of the grading system. Conversely, mean-grade differences among the pathologists were high, up to 0.7 grade point. The mean grades for the WHO 2004 system were 0.3-0.5 grade point higher than those of WHO 1973. Mean grade distinguished low and high graders among the pathologists and was strongly linked with risk of progression in each grade category.CONCLUSIONS:
The variation in mean grade among individual pathologists exceeded the grade shift caused by WHO 2004 grading. Knowledge of the pathologist's mean grade allows a better assessment of the prognostic value of grading. Mean grade has the potential to become a tool for quality assurance in pathology.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Neoplasias da Bexiga Urinária
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Carcinoma
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Progressão da Doença
Tipo de estudo:
Etiology_studies
/
Prognostic_studies
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Risk_factors_studies
Limite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Ano de publicação:
2010
Tipo de documento:
Article