摘要
目的 评估组织病理学工作者对人子宫颈非典型性不成熟化生及其类似病变诊断的一致性.方法 5位评估者分别对同一套87例宫颈活检标本进行独立评估.结果 分为不成熟化生、非典型性不成熟化生、湿疣、宫颈上皮内瘤变、Ⅱ和Ⅲ.Kappa检验分析对不同评估者的诊断结果 的一致性.结果 评估者总一致性弱（κ=0.332）;不成熟化生（κ=0.595）和CINⅢ（κ=0.434）高度一致性;非典型性不成熟化生的一致性弱（κ=0.219）;湿疣（κ=0.118）、CINⅠ（κ=0.109）和CINⅡ（κ=0.125）一致性微弱;评估者两两间一致性变异大（κ=0.149～0.532,均值0.336,加权0.582）.诊断中的最大问题在于非典型性不成熟化生和其它类似病变的鉴别.结论 组织病理学工作者对宫颈非典型性不成熟化生及其类似病变的诊断一致性差.
Objective To investigate variability in pathological diagnosis of atypical immature metaplasia （AIM） and other cervical similar lesions of cervical biopsy specimens reported by different histopathologists. Methods 87 cervical biopsy specimens were diagnozed independently by five histopathologists. By using traditional cervical intraepithelial neoplasia （CIN） grading system, the specimens were diagnozed as immature metaplasia, AIM, condyloma, CIN I , CIN ]1 and CIN m. The diagnosis consistency among these five histopathologists was assessed by Kappa test. Results The overall consistency was poor （ unweighted Kappa ： K = 0.332 ）. The consistency between different observers was the highest for immature metaplasia and CIN ]]I, and that was poor for AIM, condyloma, CIN I and CIN 1I （unweighted Kappa： K = 0.595, O. 434, 0. 219, 0. 118, 0. 109, 0. 125 respectively）. Compared between individual pairs of observers, the unweighted Kappa values and weighted Kappa values ranged from 0. 149 to 0. 532 （ average 0. 336） and from 0.470 to 0.726 （ average 0.582） respectively. The largest discrepancy in pathological diagnosis was differential diagnosis of AIM from other cervical similar lesions. Conclusion There are considerable interobserver variability in reporting pathological diagnoses of AIM and other cervical similar lesions of cervical biopsy specimens.
出处
《中国妇幼健康研究》
2010年第5期593-596,共4页
Chinese Journal of Woman and Child Health Research
基金
[基金项目]深圳市科技计划资助项目（200204068,200802033）
关键词
一致性
子宫颈
非典型性不成熟化生
宫颈上皮内瘤变
诊断
consistency
cervix uteri
atypical immature metaplasia （AIM）
cervical intraepithelial neoplasia（CIN）
diagnosis
