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To compare the performance of CT and MRI radiomics for predicting the malignant potential of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, and to investigate their value compared to the revised 2017 international consensus Fukuoka guidelines.Sixty patients with surgically confirmed IPMNs (37 malignant and 23 benign) were included. Radiomics features were extracted from arterial and venous phase images of CT and T2-weighted images of MRI, respectively. Intraclass correlation coefficients for the radiomics features were calculated to assess the interobserver reproducibility. The least absolute shrinkage and selection operator algorithm was used for feature selection. Radiomics models were constructed based on selected features with logistic regression (LR) and support vector machine (SVM). A clinical and imaging model was constructed based on independent predictors of the revised 2017 Fukuoka guidelines determined in multivariate logistic regression with forward elimination.The reproducibility of MRI radiomics features was higher than that of CT radiomics features, regardless of arterial or venous phase features (all p0.001). MRI radiomics models achieved improved AUCs (0.879 with LR and 0.940 with SVM, respectively), than that of CT radiomics models (0.811 with LR and 0.864 with SVM, respectively). All radiomics models provided better predictive performance than the clinical and imaging model (AUC = 0.764).The MRI radiomics models with higher reproducibility radiomics features performed better than CT radiomics models for predicting the malignant potential of IPMNs. The performance of radiomics models was superior to the clinical and imaging model based on Fukuoka guidelines.

Background: Quantitative flow ratio (QFR) is a tool for physiological lesion assessment based on invasive coronary angiography.Aims: We aimed to assess the reproducibility of QFR computed from the same angiograms as assessed by multiple observers from different, international sites.Methods: We included 50 patients previously enrolled in dedicated QFR studies. QFR was computed twice, one month apart by five blinded observers. The main analysis was the coefficient of variation (CV) as a measure of infra- and inter-observer reproducibility. Key secondary analysis was the identification of clinical and procedural characteristics predicting reproducibility.Results: The intra-observer CV ranged from 2.3% (1.5-2.8) to 10.2% (6.6-12.0) among the observers. The inter-observer CV was 9.4% (8.0-10.5). The QFR observer, low angiographic quality, and low fractional flow reserve (FFR) were independent predictors of a large absolute difference between repeated QFR measurements defined as a difference larger than the median difference (>0.03).Conclusions: The inter- and intra-observer reproducibility for QFR computed from the same angiograms ranged from high to poor among multiple observers from different sites with an average agreement of 0.01 +/--0.08 for repeated measurements. The reproducibility was dependent on the observer, angiographic quality and the coronary artery stenosis severity as assessed by FFR.

Background We aimed to determine whether the histopathological grading of dysplastic nevi is an objective endeavour, considering interobserver variability, according to 2018 World Health Organization (WHO) Criteria. Methods In total, 179 cases of dysplastic nevi, with high and moderate degree of atypia, diagnosed and graded according to the previous criteria were reviewed by three pathologists. Then the observers graded the dysplastic nevi as low or high according to 2018 WHO criteria. Results Grading of dysplastic nevi was in complete agreement in 99 of 179 cases across three observers with a fair level of overall interobserver agreement (multirater Kfree: 0.40). The observers showed moderate to good agreement for most of the architectural features, except for criteria regarding focal continuous basal proliferation of melanocytes, density of non- nested junctional melanocytes and presence of dyscohesive nests of intraepidermal melanocytes. Whereas fair agreement was achieved for the cytological criteria. Conclusions The 2018 WHO criteria for dysplastic nevus will ensure a common approach to diagnosis and grading of dysplastic nevi. However, histopathological criteria, such as cytological features and focal continuous basal proliferation of melanocytes, should be improved, so as to ensure a more accurate surgical approach and risk assessment. This article is protected by copyright. All rights reserved.

PURPOSE: The reliability and reproducibility of T2-weighted imaging/fluid-attenuated inversion recovery (T2/FLAIR) mismatch were investigated in the diagnosis of isocitrate dehydrogenase (IDH) mutant astrocytoma between WHO grade II and III diffuse hemispheric gliomas. METHODS: WHO grade II and grade III diffuse hemispheric gliomas (n=133) treated in our institute were included in the study. Pathological findings and molecular markers of the cases were reviewed with the criteria of WHO 2016. The finding of mismatch between T2-weighted and FLAIR images in preoperative magnetic resonance imaging (MRI) of the cases was evaluated by two different radiologists. The readers reviewed MRIs independently, blinded to the histopathologic diagnosis or molecular subset of tumors. The cases were classified as IDH-mutant astrocytoma, oligodendroglioma and IDH-wildtype (IDH-wt) astrocytoma according to molecular and genetic features. RESULTS: T2/FLAIR mismatch positivity was observed in 46 patients (34.6%). T2/FLAIR mismatch positivity was observed in 42 of 75 IDH-mutant astrocytomas (56%) and 4 of 43 oligodendrogliomas (9.30%), while it was not seen among IDH-wt astrocytomas (0/15, 0%). The T2/FLAIR mismatch ratio was significantly different between IDH-mutant astrocytomas (WHO grade II and grade III) and oligodendrogliomas (chi-square, p

Background The Mitosis-Karyorrhexis Index (MKI) score is important in neuroblastoma evaluation and in the application of the International Neuroblastoma Pathology Classification (INPC). Currently, it is not standardized for smears. Hence, the aim of this study was to devise and validate methods for MKI evaluation in fine-needle aspiration biopsy (FNAB) of neuroblastoma. Methods A total of 50 cases of neuroblastoma diagnosed by FNAB from January 2017 to December 2019 were retrieved, and detailed cytomorphological evaluations were performed. The MKI was evaluated, and the eyeball visual assessment score (EVAS) was compared with the digital image visual analysis score (DIVAS) on cytology smears and corresponding histology sections of cell blocks. The interobserver reproducibility and concordance were calculated. INPC subtyping into favorable and unfavorable groups was performed by the collation of age, MKI, and cytomorphology and was correlated to clinical outcomes. Results Neuroblastoma was categorized as undifferentiated (22 of 50) or poorly differentiated (28 of 50) on cytomorphology. The overall concordance for the MKI by 3 observers was 86% (κ = 0.85), and this increased to 98% in the high MKI category. MKI evaluations on smears showed 96% concordance with cell block histology, and the EVAS was concordant with the DIVAS in 86% of the cases. Overall, the MKI was high in 39 cases, intermediate in 4 cases, and low in 7 cases. The INPC category was unfavorable in 90% (n = 45) and favorable in 10% (n = 5) and had significant correlations with outcomes (P = .029). Conclusions An MKI assessment on smears by digital image visual analysis is accurate, reproducible, and objective and should be incorporated into the routine reporting of neuroblastoma FNAB for diagnostic schemas as per the INPC.

AIM: Patient Specific Instrumentation (PSI) with 3D bone models have been used to improve the outcomes of Total Knee Arthroplasty (TKA). The PSI, however, needs a CT (Computed tomography)/MRI scan to reproduce a bone-based model. However, CT is not a routine imaging method in the TKA and has challenges such as high radiation exposure and increased investigation cost. Any technology or software which could accurately recreate 3D bone models using X-ray would be a cheaper and safer tool. This study is based on one such technology (XrayTo3D(®)) using X-ray to 3D as an alternative to other image-based 3D bone models and PSI available in the market. This study compares the accuracy of XrayTo3D(®) versus a Conventional CT to 3D, in the reconstruction of lower limb bones (femur and tibia). METHOD: In an analysis of 45 lower limbs, 11 anatomical parameters were measured [Medial Proximal Tibial Angle—MPTA, Tibial(T)-torsion, T-slope, T-length, Mechanical Lateral Distal Femoral Angle (mLDFA), F-version, F-length, Distal femoral Medio lateral width (F-ML), Distal Femoral Antero Posterior (F-AP), Proximal Tibia Antero Posterior (T-AP), Proximal Tibia Medio Lateral (T-ML) based on landmarks selected by three orthopaedic surgeons(numbers of the authors superscript), on two groups of 3D models, one reconstructed using XrayTo3D(®) and the other using CT. Mean and standard-deviation values were measured for all the parameters in both the groups. Statistical association between both the groups was measured by Pearson's correlation coefficient. Two-sided t tests of the mean values were calculated to compare the two measurement methods. The interobserver reproducibility within each group was measured by the intraclass correlation coefficient (ICC). Point-to-surface (P2S) error, in the distal femur and proximal tibia regions of the models reconstructed using XrayTo3D(®), were also measured. RESULTS: For all the 11 parameters, no statistically significant difference was found between the 2 groups (p > 0.05). Pearson's correlation coefficients for all the parameters were not significant. The interobserver reproducibility was ranging from 0.90 to 1.00 and 0.90 to 1.00 for the XrayTo3D(®) and CT groups, respectively. The mean P2S distance was 1.0 mm in distal femur and 1.1 mm in proximal tibia which was within the acceptable limits. CONCLUSION: The reconstruction accuracy of the XrayTo3D(®) is an accurate, safe and cost effective as compared to a CT-based method.

BACKGROUND R2* estimation reflects the paramagnetism of the tumor tissue, which may be used to differentiate between benign and malignant liver lesions when contrast agents are contraindicated. AIM To investigate whether R2* derived from multi-echo Dixon imaging can aid differentiating benign from malignant focal liver lesions (FLLs) and the impact of 2D region of interest (2D-ROI) and volume of interest (VOI) on the outcomes. METHODS We retrospectively enrolled 73 patients with 108 benign or malignant FLLs. All patients underwent conventional abdominal magnetic resonance imaging and multi-echo Dixon imaging. Two radiologists independently measured the mean R2* values of lesions using 2D-ROI and VOI approaches. The Bland–Altman plot was used to determine the interobserver agreement between R2* measurements. Intraclass correlation coefficient (ICC) was used to determine the reliability between the two readers. Mean R2* values were compared between benign and malignant FFLs using the nonparametric Mann–Whitney test. Receiver operating characteristic curve analysis was used to determine the diagnostic performance of R2* in differentiation between benign and malignant FFLs. We compared the diagnostic performance of R2* measured by 2D-ROI and VOI approaches. RESULTS This study included 30 benign and 78 malignant FLLs. The interobserver reproducibility of R2* measurements was excellent for the 2D-ROI (ICC = 0.994) and VOI (ICC = 0.998) methods. Bland–Altman analysis also demonstrated excellent agreement. Mean R2* was significantly higher for malignant than benign FFLs as measured by 2D-ROI (P < 0.001) and VOI (P < 0.001). The area under the curve (AUC) of R2* measured by 2D-ROI was 0.884 at a cut-off of 25.2/s, with a sensitivity of 84.6% and specificity of 80.0% for differentiating benign from malignant FFLs. R2* measured by VOI yielded an AUC of 0.875 at a cut-off of 26.7/s in distinguishing benign from malignant FFLs, with a sensitivity of 85.9% and specificity of 76.7%. The AUCs of R2* were not significantly different between the 2D-ROI and VOI methods. CONCLUSION R2* derived from multi-echo Dixon imaging whether by 2D-ROI or VOI can aid in differentiation between benign and malignant FLLs.

The objective of this article was to study the reproducibility and reliability of the fetal corpus callosum measurements between two-dimensional (2D) and three-dimensional (3D) acquisitions. This prospective study enrolled 475 fetuses, monitored between 18 and 38 weeks of gestation by two operators. Starting from a transcerebellar axial plane, 3D and 2D mid-sagittal views of the corpus callosum were obtained. Measurements of length and thickness were performed and underwent quality control by independent reviewers. The acquisition time of the two methods was measured. Means, differences, and linear correlations were analyzed using t-test, regression and Pearson's correlation coefficients, and Bland–Altman's plots. This analysis was performed for each operator to test the interobserver reproducibility. Among the 432 cases measured using both methods, 380 (88%) were validated by quality control. The mean corpus callosum length and thickness were essentially the same using 2D and 3D measurements (2D: 33.8 ± 8.7 vs. 3D: 33.7 ± 8.7 mm, 2D: 2.2 ± 0.4 vs. 3D: 2.2 ± 0.4 mm, respectively; mean ± standard deviation [SD]). Linear regression coefficients and Pearson's coefficients were similar for length (2D: 0.8283 and 0.9191 vs. 3D: 0.8271 and 0.9095), but slightly different regarding thickness (2D: 0.6775 and 0.8231 vs. 3D: 0.5831 and 0.7636). Differences between 2D and 3D measurements, considering Bland–Altman's plots and correlated with gestational age, were acceptable (2D: 0.097 ± 0.559 mm, 3D: 0.004 ± 0.111 mm). The acquisition time required was significantly lower for 3D acquisitions (3D: 25.2 ± 14.5 seconds vs. 2D: 35.1 ± 19.4 seconds, p

Objective: To evaluate the interobserver agreement of the new AOSpine classification for subaxial cervical fractures. Methods: A descriptive study, which11 traumatic lesions of the subaxial cervical spine (through radiographic and tomographic images), were evaluated by 16 observers being: 6 senior surgeons, 4 fellows in spinal surgery and 6 physicians residents in Orthopedics and Traumatology by the new AOSpine classification, with subsequent statistical analysis of the results. An agreement analysis was performed using the Kappa coefficient, both individually and in combination, with an interpretation of the index performed using the standardized model for Landis and Koch. To determine the level of significance of the analyzes, values less than 0.05 were considered statistically significant. Results: In general, the level of agreement among the examiners was considered reasonable. The lesions “A0 (F3)”, “A4 (F3)”, “B1”, “B3”, “B3 (F3)”, “C”, “C (F3)” and “F3”showed a low level of agreement between the examiners. The level of reasonable agreement was obtained between fractures “A0”, “A1”, “A4”, “B2” and “C (F4)”. The only fracture that presented a moderate level of agreement was the “C (F4 BL)” lesion. This result indicates that the referred injury was the fracture of the subaxial column that presented the best level of agreement among the 16 examiners in the present study. Conclusions: The results of the study indicate an intermediate agreement of the new AOSpine classification for subaxial cervical lesion and point to the need to carry out studies that seek to evaluate this new classification in order to better evaluate its strengths and weaknesses, contributing for its improvement. Level of evidence III; Diagnostic study - investigation of a diagnostic test.

Background: Urine cytology remains to be the test of choice in the detection of high-grade urothelial carcinomas (HGUC) due to its favorable sensitivity. However, a significant rate of cases is reported under atypical/indeterminate categories, which result in a decrease in its specificity. Providing standardized cytologic criteria, one of the aims of The Paris System (TPS) is to reduce the use of indeterminate diagnoses and provide a higher predictive value in these categories. Aims: We compared the diagnostic performances of TPS and our original reporting system, and also investigated the interobserver reproducibility of the cytologic criteria used. Materials and Methods: A total of 386 urine samples were reviewed retrospectively. Original cytologic diagnoses have been made using similar cytologic features proposed by TPS. All slides were recategorized after the use of the cytologic criteria as described by TPS guideline. Results: After TPS, specificity of the test increased from 39.6% to 63.5, sensitivity decreased from 92.5% to 88.8%, and diagnostic accuracy increased from 63.6% to 75%. The use of negative category increased threefold. Frequencies of indeterminate categories of atypical urothelial cells (AUC) and suspicious for HGUC (SHGUC) decreased by 36% and 56.5%, respectively. A subsequent detection of HGUC after AUC and SHGUC categories increased by 38% and 64%, respectively. Interobserver agreement for TPS categorization was 39%. Conclusions: TPS improved diagnostic accuracy of urine cytology by reducing the use of indeterminate categories, and resulted in increase in their predictive value for subsequent diagnosis of HGUC. However, reproducibility of diagnostic categories seemed to be imperfect.

To evaluate the reproducibility of mid-trimester intracranial anatomy assessment. Women undergoing mid-trimester scan (between 18th to 25th gestational weeks) for fetal anatomy assessment were included in the study. Measurements of lateral ventricle (LV), cisterna magna (CM) and transverse cerebellar diameter (TCD) were obtained for reproducibility analyses. Inter-observer reproducibility analysis was made with correlation coefficients. A total of 162 women were included in the analysis while one woman was excluded from the study due to diagnosis of vermian agenesis. Correlation coefficient (CC) of cisterna magna measurements have shown weak to moderate interclass correlation (r=0.28, P=0.001). Measurements of lateral ventricle have shown moderate to strong interclass correlation (r=0.73, P, NA

Summary Intraductal biopsy is commonly used for preoperative evaluation of the etiology of biliary strictures. Interpretation of intraductal biopsies is frequently challenging. The diagnosis often suffers from interobserver disagreement, which has not been studied in the literature. We sought to assess interobserver concordance in the interpretation of intraductal biopsies. Eighty-five biopsies were retrieved, falling into five diagnostic categories: negative for dysplasia (NED), indefinite for dysplasia (IND), low-grade dysplasia (LGD), high-grade dysplasia (HGD), and carcinoma (CA). Eight gastrointestinal pathologists blindly reviewed all the slides. Agreement among pathologists was analyzed using Fleiss κ and weighted concordance coefficient S∗. A face-to-face consensus/training session was held to discuss the classification criteria, followed by a second round review. The overall interobserver agreement was fair in the first round review (κ = 0.39; S∗ = 0.56) and improved to moderate in the second round review (κ = 0.48; S∗ = 0.69). The agreement before and after consensus meeting was substantial to nearly perfect for CA (κ = 0.65, S∗ = 0.83; and κ = 0.80, S∗ = 0.91), fair for HGD (κ = 0.28, S∗ = 0.69; and κ = 0.40, S∗ = 0.63), and moderate for NED (κ = 0.47, S∗ = 0.50; and κ = 0.47, S∗ = 0.53). Agreement improved from fair to moderate for LGD (κ = 0.36, S∗ = 0.61; and κ = 0.49, S∗ = 0.71) and slight to fair for IND (κ = 0.16, S∗ = 0.51; and κ = 0.33, S∗ = 0.50). Compared with Hollande's fixed specimens, the agreement was higher in almost all diagnostic categories in formalin-fixed biopsies. Overall, interobserver concordance was improved after a consensus/training session. Interobserver reproducibility was high at the end of the diagnostic spectrum (CA) but fair to moderate for other diagnostic categories.

Background Immunocytochemical staining with p16/Ki67 has been suggested as a promising triage biomarker in cervical cancer screening. As dual staining is a subjective method, proper training may be required to ensure safe implementation in routine laboratories and reduce risk of misclassification. We determined concordance between novice evaluators and an expert, stratified by number of slides reviewed at three reading points. Methods The study was conducted at the Department of Pathology, Randers, Denmark. Women were eligible if they were aged ≥45, had been enrolled in one of two ongoing clinical studies, and had a dual stain slide available. Dual staining was performed using the CINtec plus assay. Slides were randomly selected from three reading points at which novice evaluators had reviewed, As training and experience in p16/Ki67 dual stain interpretation may affect concordance and possibly diagnostic accuracy of cervical precancer, it is important that future studies accurately describe any training and previous experience among evaluators to allow for a meaningful comparison of dual stain accuracy across studies. Furthermore, setting up proper dual stain training programs in routine screening laboratories is advisable to ensure sufficient interpretation skills among novice evaluators.

BACKGROUND The Paris System of Reporting Urine Cytology aims to screen samples for HGUC and to provide a universally acceptable reporting format for urine cytology specimens. However, studies detailing the reproducibility of this system, especially on cyto-centrifuge preparations, are lacking. METHODS 149 voided urine samples received in Department of Pathology were reviewed independently by five cytopathologists. To estimate the overall agreement, Gwet's AC and AC1statistics between each pair of raters were used. To measure the random error component, polychoric correlations were used. To assess the systematic error, Friedman test was used. RESULTS There was moderately good inter-rater agreement between the raters. Gwets AC2 ranged between 0.67 and 0.89 for the classification of the cases once the sample was found adequate for assessment, while the Gwet's AC1 ranged between 0.61 and 0.94 in assessing for adequacy. There were significant systematic differences between raters in their thresholds for the different categories as well as in differentiating between an adequate and inadequate sample (P value by Friedman test

Although the prognostic significance of grade in endometrial cancer is well known, grade 2 cases have not been evaluated separately in most of the previous studies. In this study, we aim to investigate whether the oncologic outcomes of grade 2 endometrioid endometrial carcinomas trend towards grade 1 or 3 tumors. Patients' records and pathological reports were reviewed retrospectively and eligible patients with endometrioid endometrial carcinoma were determined and distributed into 3 groups according to their 1988 International Federation of Gynecology and Obstetrics (FIGO) grade. Groups' characteristics and oncologic outcomes were compared. Differences between grades were tested with z-test and adjusted by Bonferroni method. Kaplan-Meier method was performed for the survival analysis. In total, 776 patients of endometrioid endometrial carcinoma were included in this study. Mean follow-up time was 52 ± 14 months. Patients' mean age was 56.3 ± 10.8 years. Even though grade 2 endometrioid endometrial carcinomas were different from both grade 1 and 3 in terms of the pathological features, survival analyses demonstrated that their oncologic outcomes trended towards grade 1. The grade was determined as an independent prognostic factor for overall survival (OS). The interobserver reproducibility will be improved among pathologists by combining FIGO grade 1 and 2 endometrioid endometrial carcinomas, while prognosis prediction is not likely to be affected.

Introduction Prior to the 2018 publication of the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), a Web-based interobserver study was performed to evaluate MSRSGC reporting categories, identify cytomorphologic features that represent poor sources of agreement, and establish a baseline for future studies. Material and methods Study participants evaluated 75 images chosen from the MSRSGC image set, prior to the release of the Milan Atlas. Images spanned all diagnostic categories including typical and borderline cytomorphology. Participant demographics were collected on level of training, practice patterns, and experience. Results A total of 647 persons attempted access to the survey. Of these, 555 correctly answered the qualifying questions. Participants included: 16.5% ASCP Certified Cytotechnologists, 2.8% Specialist Cytotechnologists, 5.8% IAC Certified individuals, 14.3% Anatomic (AP) Certified Pathologists, 38.9% AP and Cytopathology Certified Pathologists, and 15.3% pathology trainees. Length of participant practice varied from 0 to 54 years. In our sample, 43.4% of participants came from academic centers, 17.6% from private hospitals; and 13.3% from commercial/private laboratories. Overall, 42% of respondents agreed with the reference interpretations of salivary gland lesions. The best agreement was seen in cytopathology certified pathologists. Among the MSRSGC categories, best agreement was found in Neoplasm-Benign (58.9%) and Non-Diagnostic (49.2%) categories, followed by Malignant (48.4%). The agreement rates for Salivary Gland Lesion of Uncertain Malignant Potential (SUMP) and Suspicious For Malignancy (SFM) were 23.6% and 22.7%, respectively. Conclusions Similar to the reproducibility studies conducted for gynecologic and urinary cytopathology, the most important factor in diagnostic reproducibility was a priori classification of image difficulty, although people with higher certifications performed better.

Purpose To compare the capabilities of intravoxel incoherent motion (IVIM) to those of monoexponential diffusion-weighted imaging for differentiating benign from malignant non-vascular, non-fatty soft tissue tumors (NVSFSTT). Material and methods A total of 64 patients with 64 histologically confirmed soft-tissue tumors were retrospectively included. There were 23 men and 41 women with a mean age of 52 ± 17 (SD) (range: 18–92 years). IVIM parameters, including molecular diffusion restriction coefficient (ADCtrue), perfusion fraction, and tissue perfusion related coefficient were compared to mean monoexponential ADC (ADCstd) values. Two readers calculated all parameters, which were compared to histopathological findings that were used as standard of reference. Results The overall performance of ADCtrue and ADCstd was similar for the benign-malignant differentiation of NFNVSTT with accuracies ranging from 73% to 75% for both readers (P = 0.3). Interobserver reproducibility was considered excellent for both ADCstd and all IVIM parameters (ICC = 0.81–0.96). When myxoid tumors were excluded from morphological analysis, an increase in sensitivity of 16–21% of ADCtrue was observed, with no changes in specificity values. The use of perfusion related IVIM parameters in association with ADCtrue did not improve tumor characterization. Conclusion The use of IVIM parameters does not improve the characterization of NVNFSTT by comparison with conventional monoexponential ADC calculation.

Purpose In asymmetrical mandibles, it is often challenging to identify the mandibular midline. The median lingual foramen (MLF) is located at the midline of the anterior mandible. The purpose of this study is to evaluate the reproducibility of identifying the MLF compared to conventional landmarks on cone beam computed tomography's (CBCT's) to mark the mandibular midline. Material and Methods Ten symmetrical class II, 10 symmetrical class III, ten asymmetrical class II and 10 asymmetrical class III patients were included. On CBCTs, the cephalometric landmarks menton, pogonion, genial tubercle and MLF were identified twice by two observers. Results A high intra‐ and interobserver reproducibility was found for all landmarks, the highest being the MLF. The gain in accuracy is 0.998 mm, 0.824 mm and 0.361 mm compared to pogonion, genial tubercle and menton, respectively (P‐value

Purpose The proliferation marker Ki67 has prognostic and predictive values in breast cancer, and the cutoff of the Ki67 label index (LI) is a key index for chemotherapy. However, poor interobserver consistency in Ki67 assessment has limited the clinical use of Ki67, especially in luminal cancers. Here, we reported a modified Ki67 assessment method, size-set semiautomatic counting (SSSAC) and investigated its interobserver reproducibility. Methods One hundred invasive breast cancer tissues were set immunostained for Ki67 in one laboratory, scanned as digital slides, and sent to 41 pathologists at the laboratories of 16 hospitals for Ki67 LI assessment using size-set semiautomatic counting (SSSAC), size-set visual assessment (SSVA) and size-set digital image analysis (SSDIA) with a specific image viewing software (Aperio Image Scope, Leica, Germany). The intraclass correlation coefficient (ICC) and Bland-Altman plot were used to evaluate interobserver reproducibility. The Wilcoxon signed-rank test was used to analyze the difference in the Ki67 values assessed by SSSAC and SSDIA. Results SSSAC demonstrated better interobserver reproducibility (ICC = 0.942) than SSVA (ICC = 0.802). The interobserver reproducibility was better in Ki67 homogeneously stained slides and centralized hot-spot slides than in scattered hot-spot slides. The Ki67 value assessed with SSSAC was obviously higher than that assessed with SSDIA (negative ranks (SSDIA SSSAC): N = 17, sum of ranks = 478.50; Z = −6.837; P, Highlights • A modified method for Ki67 LI assessment based on digital image, size-set semiautomatic counting (SSSAC). • Investigated the interobserver reproducibility of SSSAC for Ki67 LI assessment of 100 cases in 41 pathologists of 16 hospitals. • SSSAC has better interobserver reproducibility than current visual assessment and was more accurate than DIA in Ki67 assessment. • SSSAC is a better choice for Ki67 LI assessment.

Background: A number of guidelines have been developed to improve standardization of the terminology and criteria for cytologic specimens obtained from the thyroid, pancreas, lung, and salivary glands. A major goal of these guidelines is to improve reproducibility and understanding of the reporting of diagnostic results among cytopathologists and between cytopathologists and clinicians. The International Academy of Cytology Yokohama System for Reporting Breast Fine-Needle Aspiration Biopsy Cytopathology (IAC YSRB) is the most recent of these guidelines. The value of this system is, in part, dependent upon interobserver reproducibility. Design: Ninety consecutive fine-needle aspiration biopsies (FNAB) of the breast, performed over a 6-year period, were independently evaluated by 4 board-certified pathologists blinded to the original diagnoses. The 5 diagnostic categories used were those of the IAC YSRB according to published criteria for these categories. Observed agreement and chance corrected agreement (Fliess κ) were calculated. Differences in κ values were evaluated using the T statistic of Gwent. Statistical calculations were performed using STATA v16.0 (STATA Corp., College Station, TX, USA). Results: Overall agreement between observers was good. Observed unweighted agreement was 69% and weighted agreement was 91%. The majority of diagnoses were concordant (68.6%). Conclusions: Interobserver agreement of 4 cytopathologists was good using the 5 categories of the IAC YRSB (69%). Agreement was greater among pathologists with more years of experience. The IAC YSRB system appears to provide greater agreement among viewers than guidelines for cytologic specimens obtained from some other body sites (salivary gland and lung). Most discrepancies were only by a single category, with only 22/113 (19%) differing by more than one category.

Response evaluation criteria in solid tumours (RECIST) v1.1 are currently the reference standard for evaluating efficacy of therapies in patients with solid tumours who are included in clinical trials, and they are widely used and accepted by regulatory agencies. This expert statement discusses the principles underlying RECIST, as well as their reproducibility and limitations. While the RECIST framework may not be perfect, the scientific bases for the anticancer drugs that have been approved using a RECIST-based surrogate endpoint remain valid. Importantly, changes in measurement have to meet thresholds defined by RECIST for response classification within thus partly circumventing the problems of measurement variability. The RECIST framework also applies to clinical patients in individual settings even though the relationship between tumour size changes and outcome from cohort studies is not necessarily translatable to individual cases. As reproducibility of RECIST measurements is impacted by reader experience, choice of target lesions and detection/interpretation of new lesions, it can result in patients changing response categories when measurements are near threshold values or if new lesions are missed or incorrectly interpreted. There are several situations where RECIST will fail to evaluate treatment-induced changes correctly; knowledge and understanding of these is crucial for correct interpretation. Also, some patterns of response/progression cannot be correctly documented by RECIST, particularly in relation to organ-site (e.g. bone without associated soft-tissue lesion) and treatment type (e.g. focal therapies). These require specialist reader experience and communication with oncologists to determine the actual impact of the therapy and best evaluation strategy. In such situations, alternative imaging markers for tumour response may be used but the sources of variability of individual imaging techniques need to be known and accounted for. Communication between imaging experts and oncologists regarding the level of confidence in a biomarker is essential for the correct interpretation of a biomarker and its application to clinical decision-making. Though measurement automation is desirable and potentially reduces the variability of results, associated technical difficulties must be overcome, and human adjudications may be required.

Response evaluation criteria in solid tumours (RECIST) v1.1 are currently the reference standard for evaluating efficacy of therapies in patients with solid tumours who are included in clinical trials, and they are widely used and accepted by regulatory agencies. This expert statement discusses the principles underlying RECIST, as well as their reproducibility and limitations. While the RECIST framework may not be perfect, the scientific bases for the anticancer drugs that have been approved using a RECIST-based surrogate endpoint remain valid. Importantly, changes in measurement have to meet thresholds defined by RECIST for response classification within thus partly circumventing the problems of measurement variability. The RECIST framework also applies to clinical patients in individual settings even though the relationship between tumour size changes and outcome from cohort studies is not necessarily translatable to individual cases. As reproducibility of RECIST measurements is impacted by reader experience, choice of target lesions and detection/interpretation of new lesions, it can result in patients changing response categories when measurements are near threshold values or if new lesions are missed or incorrectly interpreted. There are several situations where RECIST will fail to evaluate treatment-induced changes correctly; knowledge and understanding of these is crucial for correct interpretation. Also, some patterns of response/progression cannot be correctly documented by RECIST, particularly in relation to organ-site (e.g. bone without associated soft-tissue lesion) and treatment type (e.g. focal therapies). These require specialist reader experience and communication with oncologists to determine the actual impact of the therapy and best evaluation strategy. In such situations, alternative imaging markers for tumour response may be used but the sources of variability of individual imaging techniques need to be known and accounted for. Communication between imaging experts and oncologists regarding the level of confidence in a biomarker is essential for the correct interpretation of a biomarker and its application to clinical decision-making. Though measurement automation is desirable and potentially reduces the variability of results, associated technical difficulties must be overcome, and human adjudications may be required., peer-reviewed

Objective: To evaluate the intra- and interobserver reproducibility of radiographic cranial parameters. Method: A study of the reproducibility of the radiographic cranial parameters (cranial incidence, cranial tilt, cranial slope and spinocervical angle) of 40 patients by 4 observers with different levels of experience. Results: Cranial incidence (CI) showed poor intraobserver concordance; for the other cranial parameters, good to excellent concordance was observed. In the assessment of interobserver concordance, all the parameters analyzed showed statistical significance, with good CI concordance. Conclusion: Cranial parameters are easily reproducible by orthopedists with different levels of experience. CI showed good interobserver concordance, but only reasonable intraobserver concordance among more experienced observers. Level of evidence IV; Diagnostic Study.

Introduction/Background* Molecular/genomic profiling is the most accurate method to assess prognosis of endometrial cancer patients. Similarly, the adoption of radiomics showed important results for screening, diagnosis and prognosis, across various radiological systems and oncologic specialties. Here, we aim to correlate radiomic features obtained from ultrasound images with the molecular/genomic profiling to identify new hallmarks for stratification of endometrial cancer patients into different classes of risk. Methodology This prospective single-arm observational study Patients with newly diagnosed endometrial cancer will have ultrasonographic evaluation and radiomic analysis of the ultrasonographic images. Then patients will have surgery followed by molecular/genomic evaluation. We will correlate radiomic features with molecular/genomic profiling to classify prognosis. Major Inclusion/Exclusion Criteria : Consecutive patients (aged 18 years or more) with newly diagnosed endometrial cancer. Patients should have preoperative ultrasonographic evaluation followed by surgery. Result(s)* The central hypothesis is that combining radiomic features with molecular features might allow identifying various classes of risk for endometrial cancer, e.g. predicting unfavorable molecular/genomic profiling. The rationale for the proposed research is that once validated, radiomics applied to ultrasonographic images would be an effective, innovative and cheap method for tailor operative and postoperative treatment modality in endometrial cancer. Primary Endpoint : The main endpoints will: (i) to define the mechanism by which radiomic features predict the classification of endometrial cancer into various classes of risk e.g. predicting unfavorable molecular/genomic profiling as defined by molecular classification; (ii) to determinate the scaled impact of radiomic features assessed on ultrasonographic images of endometrial tumors; and (iii) to assess the intraobserver and interobserver reproducibility of radiomic features on ultrasonographic images of endometrial tumors. Overall, 100 patients for study cohort and 40 for the validation cohort. Conclusion* We expect that the radiomic analysis of ultrasonographic images by means of radiomic classifier of risks will provide comparable results to molecular/genomic. (Trial Registration: GR-2019-12370566 Bando per la Ricerca Finalizzata 2019, Ministero della 24 Salute, Repubblica Italiana)