統一診斷標準對乳腺導管增生性病變病理診斷重復性的影響_《中國循證醫學雜志》

作者：

魏兵 ¹ , 張紅英 ¹ , 王玉芳 ² , 步宏 ¹ , 陳卉嬌 ¹ , 郭華 ¹ , 戴晴晴 ³ , 湯曦 ³ , 郎志強 ¹ , 李新軍 ¹

1. 四川大學華西醫院病理科,成都,6100412. 四川大學華西醫院消化內科3. 四川大學華西臨床醫學院;

關鍵詞：

乳腺導管增生性病變病理診斷診斷標準觀察者間的重復性

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目的　探討統一診斷標準對乳腺導管增生性病變診斷重復性的影響,尋求提高病理診斷可重復性和準確性的措施.
方法　參照Page標準收集43例乳腺導管增生性病變,每例選取一張切片并隨機排序.10位病理醫師兩兩配對后隨機進入試驗組(統一診斷標準組)和對照組,各自獨立讀片后從輕度普通型增生、中-重度普通型增生、輕度非典型增生、中-重度非典型增生、導管原位癌和導管原位癌伴浸潤這6種診斷中選取一種,并采用STATA統計軟件對兩組病理醫師間的診斷重復性進行Kappa分析.同時以兩位乳腺專科病理醫師按照Page標準確認的診斷作為參照,對兩組病理醫師診斷的準確性和過度診斷進行統計學分析.
結果　統一使用Page標準的試驗組的診斷重復性和準確性均高于對照組(兩組6種、3種和2種診斷時的總K值分別為0.289 3,0.337 1,0.492 8和0.100 3,0.150 3,0.340 5),說明統一診斷標準有利于提高診斷重復性.同時,診斷類別簡化也提高了診斷的可重復性.試驗組醫師仍存在不同程度的過度診斷.
結論　統一診斷標準是提高病理診斷可重復性和準確性的重要措施;對診斷標準的掌握需要在實踐中進一步提高.

引用本文： 魏兵,張紅英,王玉芳,步宏,陳卉嬌,郭華,戴晴晴,湯曦,郎志強,李新軍. 統一診斷標準對乳腺導管增生性病變病理診斷重復性的影響. 中國循證醫學雜志, 2004, 04(11): 766-770. doi: 復制

1.	［1］Wang JY. Diagnostic test. In: Wang JY. Evidence-based medicine and clinical practice [M]. 1st ed. Beijing: Science Publishing House; 2002.p.122141.
2.	王吉耀.診斷試驗. 見:王吉耀,主編.循證醫學與臨床實踐[M].第1版.北京:科學出版社; 2002. p.122～141.
3.	［2］Greenhalgh T. How to read a paper. Papers that report diagnostic or screening tests[J]. BMJ, 1997; 315(7107):540-543.
4.	［3］Wang JS. Research and evaluation of diagnostic test[A]. See: Wang JL. Clinical epidemiology[M]. 2st ed. Shanghai: Shanghai science and Technology Publishing House; 2001. p.258-272.
5.	王覺生.診斷性試驗的研究與評價[A]. 見:王家良,主編.臨床流行病學[M]. 第2版.上海:上海科學技術出版社; 2001. p.258～272.
6.	［4］Bu H, Wei B. Reproducibility and limitation in pathological diagnosis[J]. Chinese Journal of Clinical and Experimental Pathology, 2003; 19(1): 349-350.
7.	步宏, 魏兵.病理學診斷的重復性與局限性[J]. 臨床與實驗病理學雜志, 2003; 19(1): 349～350.
8.	［5］Creagh T, Bridger JE, Kupek E, Fish DE, Martin-Bates E, Wilkins MJ. Pathologist variation in reporting cervical borderline epithelial abnormalities and cervical intraepithelial neoplasia[J].J Clin Pathol,1995; 48(1): 59-60.
9.	［6］Bergeron C, Nogales FF, Masseroli M, Abeler V, Duvillard P, Muller-Holzner E, Pickartz H, Wells M. A multicentric European study testing the reproducibility of the WHO classification of endometrial hyperplasia with a proposal of a simplified working classification for biopsy and curettage specimens[J]. Am J Surg Pathol,1999; 23(9): 1 102-1 108.
10.	［7］Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnoses of mammary atypical ductal hyperplasia[J]. Hum Pathol, 1992; 23(10): 1 095-1 097.
11.	［8］Schnitt SJ, Connolly JL, Tavassoli FA, Fechner RE, Kempson RL, Gelman R, Page DL. inter-observer reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria[J]. Am J Surg Pathol, 1992; 16(12): 1 133-1 143.
12.	［9］Rosai J. Borderline epithelial lesions of the breast[J]. Am J Surg Pathol, 1991; 15(3): 209-221.
13.	［10］Rosai J. The continuing role of morphology in the molecular age[J]. Mod Pathol, 2001; 14(3): 258-260.
14.	［11］Tavassoli FA,Hoefler H,Rosai J. Intraductal proliferaive lesions.In: Tavassoli FA,eds. Pathology and Genetics of Tumours of the Breast and Female Genital Organs[M], Lyron: IARC Press; 2003. p.64.
15.	［12］Silverberg SG. Misconception About Mammary Intraepithelial Neoplasia (MIN)[J]. Breast J,1999; 5(1): 73-74.
16.	［13］Bu H, Wei B. Evidence-based medicine and pathological practice[J]. Chinese Journal of Pathology, 2003; 32(1): 92-94.
17.	步宏, 魏兵.循證醫學與病理學實踐.中華病理學雜志[J], 2003; 32(1): 92～94.

1. ［1］Wang JY. Diagnostic test. In: Wang JY. Evidence-based medicine and clinical practice [M]. 1st ed. Beijing: Science Publishing House; 2002.p.122141.
2. 王吉耀.診斷試驗. 見:王吉耀,主編.循證醫學與臨床實踐[M].第1版.北京:科學出版社; 2002. p.122～141.
3. ［2］Greenhalgh T. How to read a paper. Papers that report diagnostic or screening tests[J]. BMJ, 1997; 315(7107):540-543.
4. ［3］Wang JS. Research and evaluation of diagnostic test[A]. See: Wang JL. Clinical epidemiology[M]. 2st ed. Shanghai: Shanghai science and Technology Publishing House; 2001. p.258-272.
5. 王覺生.診斷性試驗的研究與評價[A]. 見:王家良,主編.臨床流行病學[M]. 第2版.上海:上海科學技術出版社; 2001. p.258～272.
6. ［4］Bu H, Wei B. Reproducibility and limitation in pathological diagnosis[J]. Chinese Journal of Clinical and Experimental Pathology, 2003; 19(1): 349-350.
7. 步宏, 魏兵.病理學診斷的重復性與局限性[J]. 臨床與實驗病理學雜志, 2003; 19(1): 349～350.
8. ［5］Creagh T, Bridger JE, Kupek E, Fish DE, Martin-Bates E, Wilkins MJ. Pathologist variation in reporting cervical borderline epithelial abnormalities and cervical intraepithelial neoplasia[J].J Clin Pathol,1995; 48(1): 59-60.
9. ［6］Bergeron C, Nogales FF, Masseroli M, Abeler V, Duvillard P, Muller-Holzner E, Pickartz H, Wells M. A multicentric European study testing the reproducibility of the WHO classification of endometrial hyperplasia with a proposal of a simplified working classification for biopsy and curettage specimens[J]. Am J Surg Pathol,1999; 23(9): 1 102-1 108.
10. ［7］Page DL, Rogers LW. Combined histologic and cytologic criteria for the diagnoses of mammary atypical ductal hyperplasia[J]. Hum Pathol, 1992; 23(10): 1 095-1 097.
11. ［8］Schnitt SJ, Connolly JL, Tavassoli FA, Fechner RE, Kempson RL, Gelman R, Page DL. inter-observer reproducibility in the diagnosis of ductal proliferative breast lesions using standardized criteria[J]. Am J Surg Pathol, 1992; 16(12): 1 133-1 143.
12. ［9］Rosai J. Borderline epithelial lesions of the breast[J]. Am J Surg Pathol, 1991; 15(3): 209-221.
13. ［10］Rosai J. The continuing role of morphology in the molecular age[J]. Mod Pathol, 2001; 14(3): 258-260.
14. ［11］Tavassoli FA,Hoefler H,Rosai J. Intraductal proliferaive lesions.In: Tavassoli FA,eds. Pathology and Genetics of Tumours of the Breast and Female Genital Organs[M], Lyron: IARC Press; 2003. p.64.
15. ［12］Silverberg SG. Misconception About Mammary Intraepithelial Neoplasia (MIN)[J]. Breast J,1999; 5(1): 73-74.
16. ［13］Bu H, Wei B. Evidence-based medicine and pathological practice[J]. Chinese Journal of Pathology, 2003; 32(1): 92-94.
17. 步宏, 魏兵.循證醫學與病理學實踐.中華病理學雜志[J], 2003; 32(1): 92～94.

《中國循證醫學雜志》

統一診斷標準對乳腺導管增生性病變病理診斷重復性的影響

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《中國循證醫學雜志》

統一診斷標準對乳腺導管增生性病變病理診斷重復性的影響

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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