Reliability of histopathologic diagnosis of fibrotic interstitial lung disease: an international collaborative standardization project

BMC Pulmonary Medicine

Richard Attanoos¹  Anja C. Roden²  Brandon T. Larsen³  Maxwell L. Smith³  Alexandre Todorovic Fabro⁴  Andre L. Moreira⁵  Carol Farver⁶  Irene Sansano⁷  Raghavendra Pillappa⁸  Robert Camp⁹  Robert J. Homer^1,10 

[1] Department of Cellular Pathology, School of Medicine, University Hospital of Wales, Cardiff University, CF14 4XW, Cardiff, UK;Department of Laboratory Medicine and Pathology, Mayo Clinic, 55902, Rochester, MN, USA;Department of Laboratory Medicine and Pathology, Mayo Clinic, 85259, Scottsdale, AZ, USA;Department of Pathology and Legal Medicine, Ribeirão Preto Medical School, University of São Paulo, 14049-900, Ribeirão Preto, São Paulo, Brazil;Department of Pathology, New York University School of Medicine, 10016, New York, NY, USA;Department of Pathology, University of Michigan, 48109, Ann Arbor, MI, USA;Department of Pathology, Vall d’Hebron Hospital, 08035, Barcelona, Spain;Department of Pathology, Virginia Commonwealth University School of Medicine, 23298, Richmond, VA, USA;Department of Pathology, Yale University School of Medicine, 06510, New Haven, CT, USA;Department of Pathology, Yale University School of Medicine, 06510, New Haven, CT, USA;Pathology and Laboratory Medicine Service, VA Connecticut HealthCare System, 06516, West Haven, CT, USA;

关键词: Interstitial lung disease;    Pulmonary fibrosis;    Usual interstitial pneumonia;   

DOI  :  10.1186/s12890-021-01522-6

来源: Springer

【 摘 要 】

BackgroundCurrent interstitial lung disease (ILD) diagnostic guidelines assess criteria across clinical, radiologic and pathologic domains. Significant interobserver variation in histopathologic evaluation has previously been shown but the specific source of these discrepancies is poorly documented. We sought to document specific areas of difficulty and develop improved criteria that would reduce overall interobserver variation.MethodsUsing an internet-based approach, we reviewed selected images of specific diagnostic features of ILD histopathology and whole slide images of fibrotic ILD. After an initial round of review, we confirmed the presence of interobserver variation among our group.We then developed refined criteria and reviewed a second set of cases.ResultsThe initial round reproduced the existing literature on interobserver variation in diagnosis of ILD. Cases which were pre-selected as inconsistent with usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF) were confirmed as such by multi-observer review. Cases which were thought to be in the spectrum of chronic fibrotic ILD for which UIP/IPF were in the differential showed marked variation in nearly all aspects of ILD evaluation including extent of inflammation and extent and pattern of fibrosis. A proposed set of more explicit criteria had only modest effects on this outcome. While we were only modestly successful in reducing interobserver variation, we did identify specific reasons that current histopathologic criteria of fibrotic ILD are not well defined in practice.ConclusionsAny additional classification scheme must address interobserver variation in histopathologic diagnosis of fibrotic ILD order to remain clinically relevant. Improvements to tissue-based diagnostics may require substantial resources such as larger datasets or novel technologies to improve reproducibility. Benchmarks should be established for expected outcomes among clinically defined subgroups as a quality metric.

【 授权许可】

CC BY