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Modern Pathology
Article
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Radboud Repository
Article . 2013
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Modern Pathology
Article . 2013 . Peer-reviewed
License: Elsevier Non-Commercial
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Modern Pathology
Article . 2014
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Interobserver variability and the effect of education in the histopathological diagnosis of differentiated vulvar intraepithelial neoplasia

Authors: Einden, L.C.G. van den; Hullu, J.A. de; Massuger, L.F.A.G.; Grefte, J.M.M.; Bult, P.; Wiersma, A.; Engen-van Grunsven, A.C.H. van; +4 Authors

Interobserver variability and the effect of education in the histopathological diagnosis of differentiated vulvar intraepithelial neoplasia

Abstract

No published data concerning intraobserver and interobserver variability in the histopathological diagnosis of differentiated vulvar intraepithelial neoplasia (DVIN) are available, although it is widely accepted to be a subtle and difficult histopathological diagnosis. In this study, the reproducibility of the histopathological diagnosis of DVIN is evaluated. Furthermore, we investigated the possible improvement of the reproducibility after providing guidelines with histological characteristics and tried to identify histological characteristics that are most important in the recognition of DVIN. A total number of 34 hematoxylin and eosin-stained slides were included in this study and were analyzed by six pathologists each with a different level of education. Slides were reviewed before and after studying a guideline with histological characteristics of DVIN. Kappa statistics were used to compare the interobserver variability. Pathologists with a substantial agreement were asked to rank items by usefulness in the recognition of DVIN. The interobserver agreement during the first session varied between 0.08 and 0.54, which slightly increased during the second session toward an agreement between -0.01 and 0.75. Pathologists specialized in gynecopathology reached a substantial agreement (kappa 0.75). The top five of criteria indicated to be the most useful in the diagnosis of DVIN included: atypical mitosis in the basal layer, basal cellular atypia, dyskeratosis, prominent nucleoli and elongation and anastomosis of rete ridges. In conclusion, the histopathological diagnosis of DVIN is difficult, which is expressed by low interobserver agreement. Only in experienced pathologists with training in gynecopathology, kappa values reached a substantial agreement after providing strict guidelines. Therefore, it should be considered that specimens with an unclear diagnosis and/or clinical suspicion for DVIN should be revised by a pathologist specialized in gynecopathology. When adhering to suggested criteria the diagnosis of DVIN can be made easier.

Country
Netherlands
Keywords

EXPRESSION, HPV, Education, Continuing, Biopsy, ONCOL 1: Hereditary cancer and cancer-related syndromes, Predictive Value of Tests, Humans, TERMINOLOGY, Netherlands, Observer Variation, LESIONS, MIB1, Pathology, Clinical, Staining and Labeling, Vulvar Neoplasms, PATHWAYS, Reproducibility of Results, Cell Differentiation, ONCOL 5: Aetiology, screening and detection, vulvar carcinoma, PATHOLOGY, ONCOL 3: Translational research, VIN, Practice Guidelines as Topic, Female, ONCOL 5: Aetiology, screening and detection NCMLS 2: Immune Regulation, interobserver agreement, SQUAMOUS-CELL CARCINOMA, Clinical Competence, Guideline Adherence, Carcinoma in Situ

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    selected citations
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    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    84
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 10%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
84
Top 10%
Top 10%
Top 10%
Green
bronze