Helton Estrela Ramos1,2, João Vale3, Sara Lopes4, Ana Marques3,5, Jorge Pinheiro3,5, Fabyan Esberard de Lima Beltrão6, Gabriel Rodrigues6, Pedro Resende Ferreira Rende6, Fabio Hecht7, Catarina Eloy3,8. 1. Bioregulation Department, Health and Science Institute, Federal University of Bahia, Salvador, Brazil. ramoshelton@gmail.com. 2. Postgraduate Program in Medicine and Health, Medical School of Medicine, Federal University of Bahia, Salvador, Brazil. ramoshelton@gmail.com. 3. Pathology Laboratory of the Institute of Molecular Pathology and Immunology of the University of Porto - IPATIMUP, Porto, Portugal. 4. Department of Endocrinology, Hospital de Braga, Braga, Portugal. 5. Serviço de Anatomia Patológica, Centro Hospitalar Universitário de São João, Porto, Portugal. 6. Bioregulation Department, Health and Science Institute, Federal University of Bahia, Salvador, Brazil. 7. The Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. 8. Faculty of Medicine of the University of Porto, Porto, Portugal.
Abstract
INTRODUCTION: The subjective evaluation of nuclear features in follicular-patterned lesions of the thyroid is a reason for diagnosis discordance. The assessment of nuclear features also varies whether the observation is performed optically or digitally. Our objective was to study the concordance among pathologists regarding the nuclear score (NS) evaluation in a series of follicular-patterned lesions, using optical versus three digital scanning protocols. METHODS: Three pathologists evaluated the NS in a 3mm2 area randomly selected from 20 hematoxylin-eosin slides representative of the respective 20 follicular-patterned thyroid lesions. The NS evaluation was performed using optical and three different scanning protocols in two scanners: P1000_20x, P1000_40x and DP200_20x. Kappa statistic (κ) and intraclass correlation coefficient (ICC) were obtained for intra- and interpathologist concordance. RESULTS: We recorded a good agreement among pathologists in the optical evaluation of the NS (ICC of 0.73). The concordance between optical versus digital observation had an almost perfect agreement for P1000_20x [κ = 0.85 (0.67-1.02); p < 0.0001] and a substantial agreement for both P1000_40x [κ = 0.69 (0.43-0.95) p = 0.002] and DP200_20x [κ = 0.77 (0.57-0.97); p = 0.001]. The P1000_20x protocol had the best intrapathologist concordance with the optical method, classified as almost perfect agreement for pathologists A (80%) and B (85%), and substantial agreement for pathologist C (70%). CONCLUSION: Digital observation of the WSI is valid for the NS evaluation in follicular-patterned thyroid lesions, with good agreement among pathologists and between optical and scanning protocols. Performance studies and validation procedures cannot be avoided in this setting to prevent diagnostic discordance due to the scanning process.
INTRODUCTION: The subjective evaluation of nuclear features in follicular-patterned lesions of the thyroid is a reason for diagnosis discordance. The assessment of nuclear features also varies whether the observation is performed optically or digitally. Our objective was to study the concordance among pathologists regarding the nuclear score (NS) evaluation in a series of follicular-patterned lesions, using optical versus three digital scanning protocols. METHODS: Three pathologists evaluated the NS in a 3mm2 area randomly selected from 20 hematoxylin-eosin slides representative of the respective 20 follicular-patterned thyroid lesions. The NS evaluation was performed using optical and three different scanning protocols in two scanners: P1000_20x, P1000_40x and DP200_20x. Kappa statistic (κ) and intraclass correlation coefficient (ICC) were obtained for intra- and interpathologist concordance. RESULTS: We recorded a good agreement among pathologists in the optical evaluation of the NS (ICC of 0.73). The concordance between optical versus digital observation had an almost perfect agreement for P1000_20x [κ = 0.85 (0.67-1.02); p < 0.0001] and a substantial agreement for both P1000_40x [κ = 0.69 (0.43-0.95) p = 0.002] and DP200_20x [κ = 0.77 (0.57-0.97); p = 0.001]. The P1000_20x protocol had the best intrapathologist concordance with the optical method, classified as almost perfect agreement for pathologists A (80%) and B (85%), and substantial agreement for pathologist C (70%). CONCLUSION: Digital observation of the WSI is valid for the NS evaluation in follicular-patterned thyroid lesions, with good agreement among pathologists and between optical and scanning protocols. Performance studies and validation procedures cannot be avoided in this setting to prevent diagnostic discordance due to the scanning process.
Authors: Joseph M Rohr; Maheswari Mukherjee; Amber Donnelly; Sarah Sprinkle; Ernesto Martinez Duarte; Ana Yuil Valdes Journal: J Pathol Inform Date: 2022-07-05