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目的 探讨观察者间和观察者自身在结节性甲状腺肿和滤泡性腺瘤诊断中的重复性。方法 参照L ivolsi标准选择结节性甲状腺肿、滤泡性腺瘤、结节性甲状腺肿伴滤泡性腺瘤共 31例 ,随机编号 ,五位病理医师对相同切片独立进行两轮诊断 ,间隔一月。第二轮读片前病例重新编号并让五位病理医师在复习文献后应用统一的诊断标准。运用 Kappa分析对观察者间和观察者自身的诊断重复性进行统计分析并计算一致率。结果 第一轮观察者间诊断重复性中下 (合并 Kappa值 0 .36 0 0 )。第二轮应用统一的诊断标准后 ,观察者间诊断重复性有所提高 (合并 Kappa值 0 .4 4 82 )。五位中四位观察者自身的诊断重复性中等偏上 (Kappa值 0 .4 5 96～ 0 .71 1 2 ,一致率6 4 .5 2 %～ 80 .6 5 % )。纳入病例中伴有囊性变的病变诊断重复性最差 (第一轮 Kappa值 0 .1 375 ,第二轮 Kappa值0 .35 2 7)。结论 运用统一的诊断标准 ,增强对诊断标准的认识理解可促进两者的鉴别诊断 ,有利于提高诊断重复性和准确性。
Objective To investigate the repeatability of interobserver and observer themselves in the diagnosis of nodular goiter and follicular adenoma. Methods Thirty-one cases of nodular goiter, follicular adenoma and nodular goiter with follicular adenoma were selected according to L ivolsi standard. Randomly numbered, five pathologists performed two independent rounds of diagnosis on the same section at intervals of January . The second pre-reading case was renumbered and five pathologists applied a uniform diagnostic criteria after reviewing the literature. The Kappa analysis was used to statistically analyze the diagnostic repeatability between observers and observers themselves and calculate the agreement rate. Results The first round of interobserver diagnosis was repetitive (median Kappa 0.3600). After the second round of application of uniform diagnostic criteria, the interobserver diagnostic repeatability was improved (Kappa combined with 0.442 82). Four of the five observers had their own diagnostic median repeatability (Kappa value of 0.5476 to 0.7112, a concordance rate of 6.42% to 80.65%). The lesions diagnosed with cystic degeneration included the worst repeatability (first-round Kappa value of 0.175 and second-round Kappa value of 0.3527). Conclusion The use of a unified diagnostic criteria to enhance understanding of diagnostic criteria can promote the differential diagnosis between the two, is conducive to improving diagnostic repeatability and accuracy.