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Good interobserver and intraobserver agreement in the evaluation of the new ILAE classification of focal cortical dysplasias

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单位: [1]Univ Hosp Erlangen, Dept Neuropathol, D-91054 Erlangen, Germany [2]Univ Amsterdam, Acad Med Ctr, Dept Pathol, NL-1105 AZ Amsterdam, Netherlands [3]Baylor Coll Med, Houston, TX 77030 USA [4]Texas Childrens Hosp, Houston, TX 77030 USA [5]Univ Hosp Bonn, Dept Neuropathol, Bonn, Germany [6]Great Ormond St Hosp NHS Trust, London, England [7]UCL Inst Child Hlth, London, England [8]Res Inst Brain & Blood Vessels, Dept Neuropathol, Akita, Japan [9]UCL, Inst Neurol, Dept Neuropathol, London, England [10]Univ Calif Los Angeles, Med Ctr, Dept Pathol & Lab Med Neuropathol, Los Angeles, CA 90024 USA [11]Univ Calif Los Angeles, Med Ctr, Dept Neurol, Los Angeles, CA 90024 USA [12]Univ Calif Los Angeles, David Geffen Sch Med, Los Angeles, CA 90095 USA [13]IRCCS Fdn Neurol Inst Carlo Besta, Dept Epilepsy Clin & Expt Neurophysiol, Milan, Italy [14]Istanbul Univ, Cerrahpasa Med Fac, Dept Pathol, Istanbul, Turkey [15]Univ Bologna, Bellaria Hosp, Sect Pathol, Bologna, Italy [16]EPE Hosp Santa Maria, CHLN, Dept Neurol, Neuropathol Lab, Lisbon, Portugal [17]Med Univ Vienna, Inst Neurol, Vienna, Austria [18]Med Univ Vienna, Dept Pediat, Vienna, Austria [19]Charles Univ Prague, Fac Med 2, Dept Pathol & Mol Med, Prague, Czech Republic [20]Fac Hosp Motol, Prague, Czech Republic [21]Univ Florence, Pathol Lab, Childrens Hosp Meyer, Florence, Italy [22]Univ Estadual Campinas, Fac Med Sci, Dept Pathol, Campinas, Brazil [23]Univ Lyon, Neuropathol Lab, Lyon, France [24]Tokyo Metropolitan Inst Med Sci, Brain Pathol Res Ctr, Tokyo 113, Japan [25]Vrije Univ Amsterdam, Med Ctr, Dept Pathol & Pediat Child Neurol, Amsterdam, Netherlands [26]Ernst Moritz Arndt Univ Greifswald, Dept Neuropathol, Greifswald, Germany [27]Dalhousie Univ, Dept Pathol, Halifax, NS, Canada [28]Univ Hosp Grenoble, Dept Pathol, Grenoble, France [29]Evangel Krankenhaus Bielefeld, Inst Neuropathol, Bielefeld, Germany [30]Lariboisiere Hosp, Dept Pathol, Paris, France [31]Neuromed Inst, Dept Neurol Sci, Pozzilli, Italy [32]Airlangga Univ, Dept Pathol, Surabaya, Indonesia [33]Ajou Univ, Sch Med, Dept Pathol, Suwon 441749, South Korea [34]Capital Med Univ, Beijing Friendship Hosp, Dept Neurol, Beijing, Peoples R China [35]Tsinghua Univ, Dept Pathol, Yuquan Hosp, Beijing 100084, Peoples R China [36]Beijing Union Med Coll Hosp, Dept Neurol, Beijing, Peoples R China [37]Univ Amsterdam, Acad Med Ctr, Dept Neuro Pathol, NL-1012 WX Amsterdam, Netherlands
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关键词: Brain Epilepsy Neuropathology Classification Agreement Reproducibility

摘要:
Purpose: An International League Against Epilepsy (ILAE) consensus classification system for focal cortical dysplasias (FCDs) has been published in 2011 specifying clinicopathologic FCD variants. The aim of the present work was to microscopically assess interobserver agreement and intraobserver reproducibility for FCD categories among an international group of neuropathologists with different levels of experience and access to epilepsy surgery tissue. Methods: Surgical FCD specimens covering a broad histopathology spectrum were retrieved from 22 patients with epilepsy. Three surgical nonepilepsy specimens served as controls. A total of 188 slides with routine or immunohistochemical stainings were digitalized with a slide scanner to allow Internet-based microscopy review. Nine experienced neuropathologists were invited to review these cases twice at a time gap of 3 months and different orders of case presentation. The 2011 ILAE FCD consensus classification served as instruction. Kappa analysis was calculated to estimate interobserver and intraobserver agreement levels. In a third evaluation round, 21 additional neuropathologists with different experience and access to epilepsy surgery reviewed the same case series. Key Findings: Interobserver agreement was good (kappa = 0.6360), with 84% consensus of diagnoses during the first evaluation (21 of 25 cases). Kappa values increased to 0.6532 after reevaluation, and consensus was obtained in 24 (96%) of 25 cases. Overall intraobserver reproducibility was also good (kappa = 0.7824, ranging from 0.4991 to 1.000). Fewest changes in the classification were made in the FCD type II group (2.2% of 225 original diagnoses), whereas the majority of changes occurred in FCD type III (13.7% of 225 original diagnoses). In the third evaluation round, interobserver agreement was reflected by the level of experience of each neuropathologist, with kappa values ranging from moderate (0.5056; high level of experience >40 cases/year) to low (0.3265; low level of experience <10 cases/year). Significance: Our study achieved a good and reliable interobserver agreement among the group of expert neuropathologists originally involved in the ILAE FCD consensus classification system. Intraobserver reproducibility in this group was even more robust. These results showed considerable improvement compared to a previous study evaluating the 2004 Palmini FCD classification. Agreement levels were lower in our second group of neuropathologists and were related to their level of access and experience with epilepsy surgery specimens. These results suggested that the more precise ILAE definition of FCD histopathology patterns improves operational procedures in the diagnosis of FCDs. On the other hand, microscopic assessment of FCD is a challenge and requires sustained experience and teaching. The virtual slide review system allowed testing of this hypothesis and reached a widespread group of participating colleagues from different centers all over the world. We propose to further use this tool as a teaching device and also to address other epilepsy-associated entities still difficult to classify such as hippocampal sclerosis, long-term epilepsy-associated tumors, or mild malformations of cortical development (mMCDs), which were not yet covered by current ILAE classification systems.

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出版当年[2011]版:
大类 | 2 区 医学
小类 | 2 区 临床神经病学
最新[2025]版:
大类 | 1 区 医学
小类 | 1 区 临床神经病学
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出版当年[2010]版:
Q1 CLINICAL NEUROLOGY
最新[2023]版:
Q1 CLINICAL NEUROLOGY

影响因子: 最新[2023版] 最新五年平均[2021-2025] 出版当年[2010版] 出版当年五年平均[2006-2010] 出版前一年[2009版] 出版后一年[2011版]

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第一作者单位: [1]Univ Hosp Erlangen, Dept Neuropathol, D-91054 Erlangen, Germany [*1]Univ Hosp Erlangen, Dept Neuropathol, Schwabachanlage 6, D-91054 Erlangen, Germany
通讯作者:
通讯机构: [1]Univ Hosp Erlangen, Dept Neuropathol, D-91054 Erlangen, Germany [*1]Univ Hosp Erlangen, Dept Neuropathol, Schwabachanlage 6, D-91054 Erlangen, Germany
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