Ilaria Girolami1, Giovanni Gambaro2, Claudio Ghimenton1, Serena Beccari1, Anna Caliò1, Matteo Brunelli1, Luca Novelli3, Ugo Boggi4, Daniela Campani5, Gianluigi Zaza2, Luigino Boschiero6, José Ignacio López7, Guido Martignoni1,8, Antonia D'Errico9, Dorry Segev10, Desley Neil11, Albino Eccher12. 1. Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy. 2. Renal Unit, University and Hospital Trust of Verona, Verona, Italy. 3. Institute for Histopathology and Molecular Diagnosis, Careggi University Hospital, Florence, Italy. 4. Division of General and Transplant Surgery, University of Pisa, Pisa, Italy. 5. Department of Pathology, University of Pisa, Pisa, Italy. 6. Department of Surgical Sciences, Kidney Transplant Center, University and Hospital Trust of Verona, Verona, Italy. 7. Department of Pathology, Biocruces-Bizkaia Institute, Cruces University Hospital, University of the Basque Country (UPV/EHU), Barakaldo, Bizkaia, Spain. 8. Pathology Unit, Pederzoli Hospital, Peschiera del Garda, Italy. 9. Pathology Unit, S.Orsola-Malpighi University Hospital of Bologna, Bologna, Italy. 10. Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA. 11. Department of Histopathology, University Hospital Birmingham, NHS Foundation Trust, Birmingham, UK. 12. Department of Pathology and Diagnostics, University and Hospital Trust of Verona, P.le Stefani n. 1, 37126, Verona, Italy. albino.eccher@aovr.veneto.it.
Abstract
BACKGROUND: Evidence about the reliability of pre-implantation biopsy is still conflicting, depending on both biopsy type and pathologist's expertise. Aim of the study is to evaluate the agreement of general v specialist pathologists and to compare scores on biopsy and whole organs in a set of discarded kidneys. METHODS: 46 discarded kidneys were identified with their corresponding biopsies. The biopsies were reviewed by three general and two specialist pathologists, blinded to the original report, according to Remuzzi score. The intraclass correlation coefficient (ICC) was calculated for both groups. Discarded kidneys were scored according to Remuzzi score by a single specialist pathologist. Biopsies and organs were compared by Wilcoxon signed rank test. Weighted κ coefficients between biopsy and organ scores were also calculated. RESULTS: Specialist pathologists achieved higher values of ICC, reaching excellent or good agreement in most of the parameters, while general pathologists values were mainly fair or good. On whole organs, scores were consistently lower than biopsies, with a significant difference in most of the parameters. Weighted κ coefficient was slight or fair for most of the parameters. CONCLUSIONS: Our data suggests that the creation of a pool of specialist pathologists would improve organ utilization. Moreover, biopsies are not representative of the whole organ. As the Remuzzi score on biopsy is a major reasons for discard, a quota of transplantable kidneys may be erroneously discarded. Refinement in Remuzzi cut-offs based on expert reporting and recognition of sampling error of biopsies in correlation with clinical outcome data should be undertaken.
BACKGROUND: Evidence about the reliability of pre-implantation biopsy is still conflicting, depending on both biopsy type and pathologist's expertise. Aim of the study is to evaluate the agreement of general v specialist pathologists and to compare scores on biopsy and whole organs in a set of discarded kidneys. METHODS: 46 discarded kidneys were identified with their corresponding biopsies. The biopsies were reviewed by three general and two specialist pathologists, blinded to the original report, according to Remuzzi score. The intraclass correlation coefficient (ICC) was calculated for both groups. Discarded kidneys were scored according to Remuzzi score by a single specialist pathologist. Biopsies and organs were compared by Wilcoxon signed rank test. Weighted κ coefficients between biopsy and organ scores were also calculated. RESULTS: Specialist pathologists achieved higher values of ICC, reaching excellent or good agreement in most of the parameters, while general pathologists values were mainly fair or good. On whole organs, scores were consistently lower than biopsies, with a significant difference in most of the parameters. Weighted κ coefficient was slight or fair for most of the parameters. CONCLUSIONS: Our data suggests that the creation of a pool of specialist pathologists would improve organ utilization. Moreover, biopsies are not representative of the whole organ. As the Remuzzi score on biopsy is a major reasons for discard, a quota of transplantable kidneys may be erroneously discarded. Refinement in Remuzzi cut-offs based on expert reporting and recognition of sampling error of biopsies in correlation with clinical outcome data should be undertaken.
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