Inter- and Intrarater Reliability and Agreement Among Danish Head and Neck Pathologists Assessing Extranodal Extension in Lymph Node Metastases from Oropharyngeal Squamous Cell Carcinomas

Chadi Nimeh Abdel-Halim*, Max Rohde, Stine Rosenkilde Larsen, Tina Marie Green, Benedicte Parm Ulhøi, Nina Claire Woller, Oke Gerke, Poul Flemming Høilund-Carlsen, Jens Ahm Sørensen, Christian Godballe

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Background: Extranodal extension (ENE) in lymph node metastases is one of the most important prognostic factors in head and neck squamous cell carcinomas. Studies have shown inconsistency among pathologists in the assessment of ENE. The aims of this study were: (1) to determine the interrater and intrarater reliability and agreement in the assessment of ENE among Danish pathologists and (2) to test if a standardized assessment method may increase interrater agreement. Methods: Four Danish head and neck pathologists assessed ENE presence or absence in 120 histological slides from lymph nodes with oropharyngeal squamous cell carcinoma metastases (first round). Subsequently, guidelines were introduced to the pathologists and a new assessment was performed (second round). Finally, two of the pathologists assessed the slides to determine intrarater reliability and agreement (third round). Results: Interrater kappa coefficients varied between 0.57 and 0.67 in the first round and between 0.59 and 0.72 in the second round. The intrarater agreement between round 2 and 3 was 0.88 for pathologist 1 and 0.92 for pathologist 2 with resulting kappa coefficients of 0.76 (95% CI 0.64–0.88) and 0.84 (95% CI 0.74–0.94), respectively. Conclusion: We found a moderate level of reliability and agreement among pathologists for ENE in lymph node metastases from oropharyngeal squamous cell carcinomas. The intrarater reliability and agreement was generally higher than interrater measures. Interrater agreement was slightly improved by standardized assessment.

Original languageEnglish
JournalHead and Neck Pathology
Volume16
Issue number4
Pages (from-to)1082-1090
ISSN1936-0568
DOIs
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
This work was supported by the University of Southern Denmark; the Region of Southern Denmark; Odense University Hospital; and the Harboe fund. The sponsors had no involvement in study design, data collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.

Keywords

  • Extranodal extension
  • Head and neck cancer
  • Histopathology
  • Interobserver
  • Lymph node metastases
  • Oropharynx
  • Reliability
  • Squamous cell carcinoma

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