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Grading variability of urothelial carcinoma: experience from a single academic medical center
New York University Langone Medical Center, New York, New York, USA
Aug 2014 (Vol. 21, Issue 4, Pages( 7374 - 7378)
PMID: 25171282

Abstract

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  • INTRODUCTION:

    Tumor grade plays a critical role in the management of papillary non-invasive urothelial carcinoma (UC). Since grading of UC relies on morphologic criteria, variability in interpretation exists among pathologists. The objective of this study was to examine inter-observer variability in the grading of papillary non-invasive UC at a single academic medical center.

    MATERIALS AND METHODS:

    One general pathologist and two genitourinary pathologists were blinded to patient identity and graded 98 consecutive UC specimens using the 1973 and 2004 classification systems. Kappa statistics (&b.kappa;) were used to measure inter-observer reproducibility to account for agreement expected purely by chance. By convention, &b.kappav; values from 0.21-0.4 represent 'fair', from 0.41-0.6 represent 'moderate', and > 0.6 represent 'substantial' agreement.

    RESULTS:

    Raw percentage agreement among all three pathologists was only 26% using the 1973 system and 47% using the 2004 system. When measured by kappa, overall agreement was only 'fair' for both systems and while higher for the 2004 system than the 1973, this was not significant (&b.kappav;: 0.38 versus 0.26, respectively). There were no significant differences in agreement when comparing the specialists agreement between themselves with agreement between each specialist and the generalist (&b.kappav;: 0.31-0.37 versus &b.kappav;: 0.18-0.46).

    CONCLUSIONS:

    The current grading system continues to demonstrate challenges in reproducibility among general and specialized pathologists. The degree of variability has significant implications on management decisions for non-invasive UC. Our findings underscore the need to identify molecular markers that can provide a more objective and reliable risk stratification system to guide patient management.

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