Diagnostic alignment to optimize inter-rater reliability among lung transplant pathologists

IF 6.4 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Heart and Lung Transplantation Pub Date : 2025-02-01 DOI:10.1016/j.healun.2024.10.007

Elizabeth N. Pavlisko MD , Megan L. Neely PhD , Kathryn A. Wikenheiser-Brokamp MD, PhD , Gregory A. Fishbein MD , Leslie Litzky MD , Carol F. Farver MD , Prodipto Pal MD, PhD , Mai He MD , Peter B. Illei MD , Charuhas Deshpande MD , Mark A. Robien MD , Jerry Kirchner BS , Courtney W. Frankel PT, MS , Jason E. Lang MD, MPH , John A. Belperio MD , Scott M. Palmer MD, MPH , Stuart C. Sweet MD, PhD , On behalf of the Clinical Trials and Organ Transplantation (CTOT)-47 consortium

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引用次数: 0

Abstract

Background

Poor agreement among lung transplant (LTx) pathologists has been reported in the assessment of rejection. In addition to acute rejection (AR) and lymphocytic bronchiolitis (LB), acute lung injury (ALI) and organizing pneumonia (OP) were recently identified as histopathologic risk factors for chronic lung allograft dysfunction (CLAD). Therefore, maximizing inter-rater reliability (IRR) for identifying these histopathologic risk factors is important to guide individual patient care and to support incorporating them in inclusion criteria for clinical trials in lung transplantation.

Methods

Nine pathologists across 8 North American LTx centers were surveyed for practices in the assessment of LTx transbronchial biopsies. We conducted 7 diagnostic alignment sessions with pathologists discussing histomorphologic features of CLAD high-risk histopathology. Then, each pathologist blindly scored 75 digitized slides. Fleiss’ kappa, accounting for agreement across numerous observers, was used to determine IRR across all raters for the presence of any high-risk finding and each individual entity.

Results

IRR (95% confidence intervals) and % agreement for any high-risk finding (AR, LB, ALI, and/or OP) and each individual finding is as follows: Any Finding, k = 0.578 (0.487, 0.668), 78.9%; AR, k = 0.582 (0.481, 0.651), 79.1%; LB, k = 0.683 (0.585, 0.764), 83.5%; ALI, k = 0.418 (0.312, 0.494), 70.9%; and OP, k = 0.621 (0.560, 0.714), 81.0%.

Conclusions

After prestudy diagnostic alignment sessions, a multicenter group of LTx pathologists seeking to identify histopathology high-risk for CLAD achieved good IRR.

查看原文本刊更多论文

肺移植病理学家之间的诊断调整以优化评分者之间的可靠性。

背景据报道，肺移植病理学家在评估排斥反应时意见不统一。除了急性排斥反应（AR）和淋巴细胞性支气管炎（LB）外，急性肺损伤（ALI）和组织性肺炎（OP）最近也被确定为慢性肺移植功能障碍（CLAD）的组织病理学风险因素。因此，最大限度地提高鉴定这些组织病理学风险因素的评分者间可靠性（IRR）对于指导患者的个体治疗和支持将其纳入肺移植临床试验的纳入标准非常重要。方法我们对北美八个肺移植中心的九位病理学家进行了调查，了解他们在评估肺移植经支气管活检组织病理学方面的做法。我们与病理学家进行了七次诊断对齐会议，讨论 CLAD 高风险组织病理学的组织形态学特征。然后，每位病理学家对 75 张数字化切片进行盲法评分。结果任何高风险发现（AR、LB、ALI和/或OP）和每个单独发现的IRR（95%置信区间）和一致性百分比如下：任何发现，k = 0.578 (0.487, 0.668)，78.9%；AR，k = 0.582 (0.481, 0.651)，79.1%；LB，k = 0.683 (0.585, 0.764)，83.5%；ALI，k = 0.418 (0.312, 0.494)，70.9%；OP，k = 0.621 (0.560, 0.714)，81.0%。0%.结论经过研究前的诊断对齐会议，一组多中心肺移植病理学家在寻求识别 CLAD 高风险组织病理学时取得了良好的 IRR。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Heart and Lung Transplantation 医学-呼吸系统

CiteScore

10.10

自引率

6.70%

发文量

1667

审稿时长

69 days

期刊介绍： The Journal of Heart and Lung Transplantation, the official publication of the International Society for Heart and Lung Transplantation, brings readers essential scholarly and timely information in the field of cardio-pulmonary transplantation, mechanical and biological support of the failing heart, advanced lung disease (including pulmonary vascular disease) and cell replacement therapy. Importantly, the journal also serves as a medium of communication of pre-clinical sciences in all these rapidly expanding areas.