James S Lewis1, Yaman Tarabishy2, Jingqin Luo3, Haresh Mani4, Justin A Bishop5, Marino E Leon6, Manju L Prasad7, Haodong Xu8, Silvana Di Palma9. 1. Vanderbilt University Medical Center, Department of Pathology, Microbiology, and Immunology, Nashville, TN, United States; Vanderbilt University Medical Center, Department of Otolaryngology, Nashville, TN, United States; Washington University, Department of Pathology and Immunology, St. Louis, MO, United States. Electronic address: james.lewis@vanderbilt.edu. 2. Washington University, Department of Pathology and Immunology, St. Louis, MO, United States. 3. Washington University, Division of Biostatistics, St. Louis, MO, United States. 4. Inova Fairfax Hospital, Department of Pathology, Falls Church, VA, United States. 5. Johns Hopkins University, Department of Pathology, Baltimore, MD, United States. 6. H. Lee Moffitt Cancer Center, Department of Pathology and Cell Biology, Tampa, FL, United States. 7. Yale University, Department of Pathology, New Haven, CT, United States. 8. UCLA, Department of Pathology and Laboratory Medicine, Los Angeles, CA, United States. 9. Royal Surrey County Hospital, Department of Histopathology, Guildford, Surrey, United Kingdom.
Abstract
OBJECTIVE: Discern inter- and intra-observer variability in the classification of extracapsular extension (ECE) in p16+ oropharyngeal (OP) SCC comparing pathologists' own criteria versus those of a well-defined classification system. METHODS: Five pathologists reviewed 50 digitally scanned nodal metastasis slides in three Rounds. Round One was by their own criteria as ECE present or absent, and Rounds Two and Three were with a defined ECE system: Grade 0 (no ECE), 0c (no ECE - thick capsule; no infiltration), 1 (ECE - cells beyond capsule), and 2 (soft tissue metastasis - cells in soft tissue without residual node). Round Three assessed intra-observer variability after an 8 month washout period. RESULTS: In Round One, all five agreed on only 48% of cases (n=24). Fleiss's Kappa value was 0.508 (95% CI: 0.357-0.644). For Rounds Two and Three, Grades 0 and 0c and Grades 1 and 2 were separately grouped as ECE absent or present. In Round Two, all five agreed on 68% of cases (n=34). Fleiss' Kappa was 0.635 (95% CI: 0.472-0.783), indicating statistically significantly better agreement. In Round Three, all five agreed on 64% of cases (n=32) giving a Fleiss's Kappa of 0.639. Pathologists agreed with their prior reads in approximately 90% of cases (average n=45.4, range n=42-49), an average intra-observer Cohen's Kappa of 0.8 (range: 0.68-0.95). Inter- and intra-observer variability rates for classification of soft tissue metastasis (ECE2) were substantially worse. CONCLUSION: There is substantial inter-, and modest intra-, observer variability among head and neck pathologists for ECE in p16+ OPSCC, which is modestly improved by a defined system.
OBJECTIVE: Discern inter- and intra-observer variability in the classification of extracapsular extension (ECE) in p16+ oropharyngeal (OP) SCC comparing pathologists' own criteria versus those of a well-defined classification system. METHODS: Five pathologists reviewed 50 digitally scanned nodal metastasis slides in three Rounds. Round One was by their own criteria as ECE present or absent, and Rounds Two and Three were with a defined ECE system: Grade 0 (no ECE), 0c (no ECE - thick capsule; no infiltration), 1 (ECE - cells beyond capsule), and 2 (soft tissue metastasis - cells in soft tissue without residual node). Round Three assessed intra-observer variability after an 8 month washout period. RESULTS: In Round One, all five agreed on only 48% of cases (n=24). Fleiss's Kappa value was 0.508 (95% CI: 0.357-0.644). For Rounds Two and Three, Grades 0 and 0c and Grades 1 and 2 were separately grouped as ECE absent or present. In Round Two, all five agreed on 68% of cases (n=34). Fleiss' Kappa was 0.635 (95% CI: 0.472-0.783), indicating statistically significantly better agreement. In Round Three, all five agreed on 64% of cases (n=32) giving a Fleiss's Kappa of 0.639. Pathologists agreed with their prior reads in approximately 90% of cases (average n=45.4, range n=42-49), an average intra-observer Cohen's Kappa of 0.8 (range: 0.68-0.95). Inter- and intra-observer variability rates for classification of soft tissue metastasis (ECE2) were substantially worse. CONCLUSION: There is substantial inter-, and modest intra-, observer variability among head and neck pathologists for ECE in p16+ OPSCC, which is modestly improved by a defined system.
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