Observer variation and reliability of the histopathological diagnosis of mesothelioma

Our plain-English summary of Observer variation and reliability of the histopathological diagnosis of mesothelioma, by H.T. Planteydt (Annals of the New York Academy of Sciences, 1979).

The study

• Author: H.T. Planteydt
• Journal: Annals of the New York Academy of Sciences
• Published: 1979;330:761-4
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003991).

In plain English

This paper described how pathologists in the Netherlands and on European panels graded their certainty when diagnosing malignant mesothelioma from tissue slides. It did not examine asbestos exposure. The panels used a five-category scale, from A (definite malignant mesothelioma) to E (not a malignant mesothelioma). In the Dutch Mesothelioma Panel, three pathologists graded slides without knowing each other's opinions. They graded 67 consecutive cases that the original pathologist had diagnosed as mesothelioma. In the first round there was major disagreement in 18 cases. The pathologist whose opinion differed most then re-examined those cases, usually about a year later and without knowing the earlier opinion. After that, only 4 of the 67 cases still showed gross disagreement. Nearly all 'dubious' cases had been diagnosed on a needle biopsy rather than on larger tissue samples. Examples from the Commission of the European Communities panel and a United Kingdom panel often showed wider agreement after discussion or a second review. The author concluded that the system usually led to good or reasonable agreement among panel members, especially when used in panel discussion.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Observer-variation study of histopathological diagnosis by a three-pathologist panel using a five-category probability scale, plus illustrative case examples from two other panels
• Who was studied: 67 consecutive cases diagnosed as mesothelioma by the original pathologist, from the Rotterdam area and the northeastern Netherlands, reviewed by the Dutch Mesothelioma Panel (system adopted 1973). Selected cases from the Commission of the European Communities panel and the IARC Mesothelioma Panel of the United Kingdom were also described.
• Exposure: Not studied in this article, which concerns diagnostic agreement. The same 67 cases were used in a separate study of occupational history.
• Main results:
  • In the first round of Dutch panel review, major disagreement among the three pathologists occurred in 18 cases. Complete agreement occurred in 13.
  • After the most divergent pathologist re-reviewed the disagreement cases without knowing the earlier opinion, results were: complete agreement in 16, nearly complete agreement in 40, reasonable agreement in 7, and disagreement in 4.
  • After revision, 4 of 67 cases showed gross disagreement.
  • Nearly all cases the panel judged 'dubious' had been diagnosed on a needle biopsy. The dubious category did not occur where larger pieces of tissue were available.
  • The 4 cases of gross disagreement occurred in both autopsy and biopsy material.
  • In one example (case MP 34/76), the UK panel showed gross disagreement in 1976 (A A B B C D E). On review in 1977 the same panel graded it A A A B B B.
  • When the UK panel discussed a case on two consecutive days, it concluded that seeing many similar tumors in a short period increased confidence in the diagnosis.
• The authors' conclusion: The author concluded that using the voting system, especially in panel discussions, usually leads to good or reasonable agreement among panel members.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma.

Related studies

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• Radiological and pathological correlations in asbestosis in the Republic of South Africa and the United Kingdom. II. A preliminary study of observer variation in the classification of radiographs of asbestos-exposed workers and the relation of pathology and x-ray appearances — A. Caplan, J.C. Gilson, et al. (1965)
• The histopathological diagnosis of malignant mesothelioma v. pulmonary adenocarcinoma: reproducibility of the histopathological diagnosis — B.G. Skov, A.F. Lauritzen, et al. (1994)
• Variation in number of general practitioner consultations before hospital referral for cancer: findings from the 2010 National Cancer Patient Experience Survey in England — G. Lyratzopoulos, R.D. Neal, et al. (2012)
• The clinical utility and reliability of asbestos bodies in bronchoalveolar fluid — D.A. Schwartz, J.R. Galvin, et al. (1991)
• The reliability of measures of amphibole fiber concentration in water — A.L. Brown, W.F. Taylor, et al. (1976)

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