Universität zu Köln

Angelini, Annalisa, Andersen, Claus Boegelund, Bartoloni, Giovanni, Black, Fiona, Bishop, Paul, Doran, Helen, Fedrigo, Marny, Fries, Jochen W. U., Goddard, Martin, Goebel, Heike, Neil, Desley ORCID: 0000-0001-9800-6811, Leone, Ornella, Marzullo, Andrea ORCID: 0000-0003-1265-3685, Ortmann, Monika, Paraf, Francois ORCID: 0000-0002-3930-2618, Rotman, Samuel ORCID: 0000-0002-2508-3725, Turhan, Nesrin, Bruneval, Patrick, Frigo, Anna Chiara, Grigoletto, Francesco, Gasparetto, Alessio, Mencarelli, Roberto, Thiene, Gaetano and Burke, Margaret (2011). A web-based pilot study of inter-pathologist reproducibility using the ISHLT 2004 working formulation for biopsy diagnosis of cardiac allograft rejection: The European experience. J. Heart Lung Transplant., 30 (11). S. 1214 - 1221. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1557-3117

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Abstract

BACKGROUND: The aim of this study was to assess, at the European level and using digital technology, the inter-pathologist reproducibility of the ISHLT 2004 system and to compare it with the 1990 system We also assessed the reproducibility of the morphologic criteria for diagnosis of antibody-mediated rejection detailed in the 2004 grading system. METHODS: The hematoxylin eosin-stained sections of 20 sets of endomyocardial biopsies were pre-selected and graded by two pathologists (A.A. and M.B.) and digitized using a telepathology digital pathology system (Aperio ImageScope System; for details refer to http://aperio.com/). Their diagnoses were considered the index diagnoses, which covered all grades of acute cellular rejection (ACR), early ischemic lesions, Quilty lesions, late ischemic lesions and (in the 2005 system) antibody-mediated rejection (AMR). Eighteen pathologists from 16 heart transplant centers in 7 European countries participated in the study. Inter-observer reproducibility was assessed using Fleiss's kappa and Krippendorff's alpha statistics. RESULTS: The combined kappa value of all grades diagnosed by all 18 pathologists was 0.31 for the 1990 grading system and 0.39 for the 2005 grading system, with alpha statistics at 0.57 and 0.55, respectively. Kappa values by grade for 1990/2005, respectively, were: 0 = 0.52/0.51; 1A/1R = 0.24/0.36; 1B = 0.15; 2 = 0.13; 3A/2R = 0.29/0.29; 3B/3R = 0.13/0.23; and 4 = 0.18. For the 2 cases of AMR, 6 of 18 pathologists correctly suspected AMR on the hematoxylin eosin slides, whereas, in each of 17 of the 18 AMR-negative cases a small percentage of pathologists (range 5% to 33%) overinterpreted the findings as suggestive for AMR. CONCLUSIONS: Reproducibility studies of cardiac biopsies by pathologists in different centers at the international level were feasible using digitized slides rather than conventional hi histology glass slides. There was a small improvement in interobserver agreement between pathologists of different European centers when moving from the 1990 ISHLT classification to the new 2005 ISHLT classification. Morphologic suspicion of AMR in the 2004 system on hematoxylin eosin-stained slides only was poor, highlighting the need for better standardization of morphologic criteria for AMR. Ongoing educational programs are needed to ensure standardization of diagnosis of both acute cellular and antibody-mediated rejection. J Heart Lung Transplant 2011;30:1214-20 (C) 2011 International Society for Heart and Lung Transplantation All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Angelini, Annalisa UNSPECIFIED UNSPECIFIED UNSPECIFIED Andersen, Claus Boegelund UNSPECIFIED UNSPECIFIED UNSPECIFIED Bartoloni, Giovanni UNSPECIFIED UNSPECIFIED UNSPECIFIED Black, Fiona UNSPECIFIED UNSPECIFIED UNSPECIFIED Bishop, Paul UNSPECIFIED UNSPECIFIED UNSPECIFIED Doran, Helen UNSPECIFIED UNSPECIFIED UNSPECIFIED Fedrigo, Marny UNSPECIFIED UNSPECIFIED UNSPECIFIED Fries, Jochen W. U. UNSPECIFIED UNSPECIFIED UNSPECIFIED Goddard, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Goebel, Heike UNSPECIFIED UNSPECIFIED UNSPECIFIED Neil, Desley UNSPECIFIED orcid.org/0000-0001-9800-6811 UNSPECIFIED Leone, Ornella UNSPECIFIED UNSPECIFIED UNSPECIFIED Marzullo, Andrea UNSPECIFIED orcid.org/0000-0003-1265-3685 UNSPECIFIED Ortmann, Monika UNSPECIFIED UNSPECIFIED UNSPECIFIED Paraf, Francois UNSPECIFIED orcid.org/0000-0002-3930-2618 UNSPECIFIED Rotman, Samuel UNSPECIFIED orcid.org/0000-0002-2508-3725 UNSPECIFIED Turhan, Nesrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruneval, Patrick UNSPECIFIED UNSPECIFIED UNSPECIFIED Frigo, Anna Chiara UNSPECIFIED UNSPECIFIED UNSPECIFIED Grigoletto, Francesco UNSPECIFIED UNSPECIFIED UNSPECIFIED Gasparetto, Alessio UNSPECIFIED UNSPECIFIED UNSPECIFIED Mencarelli, Roberto UNSPECIFIED UNSPECIFIED UNSPECIFIED Thiene, Gaetano UNSPECIFIED UNSPECIFIED UNSPECIFIED Burke, Margaret UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-486325
DOI:	10.1016/j.healun.2011.05.011
Journal or Publication Title:	J. Heart Lung Transplant.
Volume:	30
Number:	11
Page Range:	S. 1214 - 1221
Date:	2011
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1557-3117
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ANTIBODY-MEDIATED REJECTION; INTERNATIONAL-SOCIETY; CATEGORICAL DATA; HEART REJECTION; TRANSPLANTATION; PATHOLOGY; GRADE-2; C4D; INTEROBSERVER; COMPLEMENT Multiple languages Cardiac & Cardiovascular Systems; Respiratory System; Surgery; Transplantation Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/48632