Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013 Oct 29:4:30.
doi: 10.4103/2153-3539.120747. eCollection 2013.

Inter-reader variability in follicular lymphoma grading: Conventional and digital reading

Gerard Lozanski  1 , Michael Pennell  2 , Arwa Shana'ah  1 , Weiqiang Zhao  1 , Amy Gewirtz  1 , Frederick Racke  1 , Eric Hsi  3 , Sabrina Simpson  4 , Claudio Mosse  5 , Shadia Alam  6 , Sharon Swierczynski  7 , Robert P Hasserjian  8 , Metin N Gurcan  9
Affiliations

Inter-reader variability in follicular lymphoma grading: Conventional and digital reading

Gerard Lozanski et al. J Pathol Inform. .

Abstract

Context: Pathologists grade follicular lymphoma (FL) cases by selecting 10, random high power fields (HPFs), counting the number of centroblasts (CBs) in these HPFs under the microscope and then calculating the average CB count for the whole slide. Previous studies have demonstrated that there is high inter-reader variability among pathologists using this methodology in grading.

Aims: The objective of this study was to explore if newly available digital reading technologies can reduce inter-reader variability.

Settings and design: IN THIS STUDY, WE CONSIDERED THREE DIFFERENT READING CONDITIONS (RCS) IN GRADING FL: (1) Conventional (glass-slide based) to establish the baseline, (2) digital whole slide viewing, (3) digital whole slide viewing with selected HPFs. Six board-certified pathologists from five different institutions read 17 FL slides in these three different RCs.

Results: Although there was relative poor consensus in conventional reading, with lack of consensus in 41.2% of cases, which was similar to previously reported studies; we found that digital reading with pre-selected fields improved the inter-reader agreement, with only 5.9% lacking consensus among pathologists.

Conclusions: Digital whole slide RC resulted in the worst concordance among pathologists while digital whole slide reading selected HPFs improved the concordance. Further studies are underway to determine if this performance can be sustained with a larger dataset and our automated HPF and CB detection algorithms can be employed to further improve the concordance.

Keywords: Centroblast; follicular lymphoma; inter-reader variability; whole-slide images.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Three different reading conditions (RCs): RC1 is conventional reading; in RC2, whole slide digital images are read by the pathologist; in RC3, selected high-power-fields are read by the pathologist
Figure 2
Figure 2
Screen shot of the freely available commercial program (Imagescope, Aperio, Vista, CA) used for the digital evaluation slides for this study (reading condition 2 - RC2)
Figure 3
Figure 3
Centroblast (CB) marker: The program to mark the locations of CBs on a high power field image reading condition 3
Figure 4
Figure 4
Graphical representation of difference in Kappa coefficients between reading condition (RC1) and RC3 readings: Agreement on grades I, II and III
Figure 5
Figure 5
Agreement on clinically significant grade
Figure 6
Figure 6
Histograms of range in number of centroblasts/high power field across pathologists
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Anderson JR, Armitage JO, Weisenburger DD. Epidemiology of the non-Hodgkin's lymphomas: Distributions of the major subtypes differ by geographic locations. Non-Hodgkin's Lymphoma Classification Project. Ann Oncol. 1998;9:717–20. - PubMed
    1. López-Guillermo A, Caballero D, Canales M, Provencio M, Rueda A, Salar A, et al. Clinical practice guidelines for first-line/after-relapse treatment of patients with follicular lymphoma. Leuk Lymphoma. 2011;52(Suppl 3):1–14. - PubMed
    1. Ardeshna KM, Smith P, Norton A, Hancock BW, Hoskin PJ, MacLennan KA, et al. Long-term effect of a watch and wait policy versus immediate systemic treatment for asymptomatic advanced-stage non-Hodgkin lymphoma: A randomised controlled trial. Lancet. 2003;362:516–22. - PubMed
    1. Horning SJ, Rosenberg SA. The natural history of initially untreated low-grade non-Hodgkin's lymphomas. N Engl J Med. 1984;311:1471–5. - PubMed
    1. Brice P, Bastion Y, Lepage E, Brousse N, Haïoun C, Moreau P, et al. Comparison in low-tumor-burden follicular lymphomas between an initial no-treatment policy, prednimustine, or interferon alfa: A randomized study from the Groupe d’Etude des Lymphomes Folliculaires. Groupe d’Etude des Lymphomes de l’Adulte. J Clin Oncol. 1997;15:1110–7. - PubMed