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Counting mitotic figures (MF) in hematoxylin and eosin–stained histologic sections is an integral part of the diagnostic pathologist’s tumor evaluation. The mitotic count (MC) is used alone or as part of a grading scheme for assessment of prognosis and clinical decisions. Determining MCs is subjective, somewhat laborious, and has interobserver variation. Proposals for standardizing this parameter in the veterinary field are limited to terminology (use of the term MC) and area (MC is counted in an area measuring 2.37 mm2). Digital imaging techniques are now commonplace and widely used among veterinary pathologists, and field of view area can be easily calculated with digital imaging software. In addition to standardizing the methods of counting MF, the morphologic characteristics of MF and distinguishing atypical mitotic figures (AMF) versus mitotic-like figures (MLF) need to be defined. This article provides morphologic criteria for MF identification and for distinguishing normal phases of MF from AMF and MLF. Pertinent features of digital microscopy and application of computational pathology (CPATH) methods are discussed. Correct identification of MF will improve MC consistency, reproducibility, and accuracy obtained from manual (glass slide or whole-slide imaging) and CPATH approaches.

Background The concept of “advanced polyps” is well accepted and is defined as polyps ≥10 mm and/or those having a villous component and/or demonstrating areas of dysplasia. Of these parameters, computed tomography colonography (CTC) can only document size. The accepted management of CTC-detected “advanced polyps” is to recommend excision if feasible, whereas the management of “intermediate” (6–9 mm) polyps is more controversial, and interval surveillance may be acceptable. Therefore, distinction between 6-9 mm and ≥10 mm is important. Methods Datasets containing 26 polyps originally reported as between 8-12 mm in diameter were reviewed independently by 4 CTC-accredited radiologists. Observers tabulated the largest measurement for each polyp on axial, coronal, sagittal, and endoluminal views at lung-window settings. These measurements were also compared to those determined by the computer-aided detection (CAD) software. Results The interobserver reliability intra-class correlation coefficient (ICC) for sagittal projection was 0.80 (“excellent” category of Hosmer and Lemeshow [2004]), 0.71 for axial (“acceptable”), 0.69 for coronal, and 0.41 for endoluminal (“unacceptable”). The largest of sagittal/axial/coronal measurement gave the best reliability with the smallest variance (ICC = 0.80; 95% CI 0.67–0.89). For 8 of 26 polyps, at least one radiologist's measurement placed the polyp in a different category compared to a colleague. For the majority of the polyps, the CAD significantly overestimated the readings compared to the largest of the manual measurements with an average difference of 1.6 mm ( P < .0001 for sagittal/axial/coronal). This resulted in 33% of polyps falling into a different category—10% were lower and 23% were higher ( P < .034). Conclusion It is apparent that around the cutoff point of 10 mm between “advanced” and “intermediate” polyps, interobserver performance is variable.

Category: Other; Sports Introduction/Purpose: To evaluate the intra and interobserver variation on the presence of enthesophyte in patients with Achilles insertional tendinopathy and the clinical radiological correlation of x-ray (X-ray) and magnetic resonance images (MRI). Methods: We selected Lateral X-ray images of the calcaneus and videos of ankle MRI in which we showed the entire thickness of the calcaneus in the coronal, sagittal and axial views, in both T1 and T2 weightings, of 20 patients with Achilles insertional tendinopathy. 5 foot and ankle surgeons and 5 musculoskeletal radiologists, with varied experience time, analysed the images. Intra and Interobserver correlations were studied with the kappa index. Results: The average Ƙ intraobserver of the results of the MRI analyzes was 0.49, and the average Ƙ interobserver of the results of the MRI analyzes was 0.47. The mean Ƙ intraobserver values of the results of the X-ray analyzes were 0.61, while the Ƙ interobserver had a value of 0.60. We also observed that the group of less experienced surgeons and radiologists showed a worse Ƙ intraobserver than the more experienced ones. Conclusion: The values are in agreement with previous studies, confirming moderate intraobserver and interobserver reproducibility in MRI exams and good or substantial interobserver and interobserver reliability in X-ray exams.

Mast cell tumor (MCT) is a common canine cutaneous neoplasm with variable biological behavior. A 2-tier histologic grading system was recently proposed by Kiupel et al to reduce interobserver variation and eliminate prognostic uncertainty of the Patnaik system. This study compared the ability of these 2 grading systems to predict survival in a cohort of dogs with MCTs. However, surgical margins were unknown, and the risk of developing new/metastatic MCTs was not studied. Histologic grade was assessed according to both systems for 137 surgically resected cutaneous MCTs. The relationship between grade and survival was evaluated. According to the Patnaik system, 18 MCTs (13.1%) were classified as grade I, 83 (60.6%) as grade II, and 36 (26.3%) as grade III. Grade III was associated with a poorer prognosis ( P < .001), but no significant difference between grades I and II was detected. Grading according to the Patnaik system was based on consensus grading among 3 pathologists, and interobserver variability was not considered. All grade I MCTs were low grade in the Kiupel system, and all grade III were high grade. Among grade II, 71 (85.6%) were low grade, and 12 (14.4%) were high grade, with a 1-year survival probability of 94% and 46%, respectively ( P < .001). The 2-tier system had a high prognostic value and was able to correctly predict the negative outcomes of some grade II MCTs. Data also confirm that histologic grading cannot predict biological behavior of each MCT and should be supplemented with molecular methods for more accurate prognostication.

A departmental survey of personal methodology in the measurement of bile duct diameter was carried out by means of a representative diagram of a typical bile duct image configuration. The results revealed considerable differences in measurement practice, and factors that may explain the patterns of interobserver variation, among 20 respondents in this task, were postulated. There was considerable scope for error, by a factor of three times between the smallest and largest diameter selected noted within current practice variation. This reflects similar disparity found in the literature. Within the setting of the development of current therapeutic strategies, there may be a need for confirmation and/or re-establishment of contemporary normal ranges for biliary tree diameter. A study of reasonable magnitude would be required to clarify the many and complex common and special causes of variation in ultrasonic evaluation outlined towards enhancing the utility of this useful and hitherto important ultrasonic sign.

Significant intra- and interobserver variation has been reported for estimating the dimensions and the volume of the thyroid gland by conventional sonography in adults. This study aimed to assess the role of extended field-of-view (EFOV) sonography for evaluating the size of the thyroid gland. The mediolateral, anteroposterior, and craniocaudal diameters of both thyroid lobes as well as total thyroid volumes of 30 female patients with the clinical diagnosis of goiter were measured three times by three radiologists with the EFOV sonography technique. Based on these findings, the correlation between the measurements of different operators and different measurements of the same operator was investigated. The interobserver variations for craniocaudal diameters of the right and left thyroid lobes were 3.3% ± 1.9% (mean ± SD) and 2.8% ± 1.3% (mean ± SD), respectively ( P = .012), which were lower than the variations calculated for transverse and mediolateral diameters. The interobserver variation for the calculation of the total glandular volume was 6.3% ± 3.8% (mean ± SD). The intraobserver variations for the three radiologists assessing the total thyroid volume were 4.9% ± 3.0%, 4.2% ± 2.4%, and 4.5% ± 1.7% (all mean ± SD), respectively ( P = .521). EFOV sonography should be considered as an alternative technique for the dimension measurements of the thyroid gland, particularly in cases with goiter.

Background Six classification systems have been proposed for describing rotator cuff tears designed to help understand their natural history and make treatment decisions. Purpose To assess the interobserver variation for these classification systems and identify the method with the best interob-server agreement. Study Design Cohort study (diagnosis); Level of evidence, 2. Methods Six rotator cuff tear classification systems were identified in a literature search. The components of these systems included partial-thickness rotator cuff tears and classification by size, shape, configuration, number of tendons involved, and by extent, topography, and nature of the biceps. Twelve fellowship-trained orthopaedic surgeons who each perform at least 30 rotator cuff repairs per year reviewed arthroscopy videos from 30 patients with a random assortment of rotator cuff tears and classified them by the 6 classification systems. Interobserver variation was determined by a kappa analysis. Results Interobserver agreement was high when distinguishing between full-thickness and partial-thickness tears (0.95, [UNKNOWN]=0.85). The investigators agreed on the side (articular vs bursal) of involvement for partial-thickness tears (observed agreement 0.92, [UNKNOWN]= 0.85) but could not agree when classifying the depth of the partial-thickness tear (observed agreement 0.49, [UNKNOWN]= 0.19). The best agreement for full-thickness tears was seen when the tear was classified by topography (degree of retraction) in the frontal plane (observed agreement 0.70, [UNKNOWN]= 0.54). Conclusion With the exception of distinguishing partial-thickness from full-thickness rotator cuff tears and identifying the side (articular vs bursal) of involvement with partial-thickness tears, currently described rotator cuff classification systems have little interobserver agreement among experienced shoulder surgeons. Researchers should consider describing full-thickness rotator cuff tears by topography (degree of retraction) in the frontal plane.

Orthotopic human prostate tumour models in athymic nude mice are regarded as being most suitable for fundamental and pre-clinical research on prostate cancer. The anatomic localization of the tumour in the pelvis, however, provides little possibility for monitoring tumour growth or regression. To assess time-related changes in orthotopic tumour volume, we applied transrectal ultrasonography (TRUS) to the murine prostate. This technique has the advantages of allowing accurate monitoring of tumours during therapeutic manipulations and a reduction of animal use due to a reduction of sacrificing endpoints. To validate the TRUS method, the mouse prostate reconstitution model, RM-9, and the prostate-specific antigen (PSA) producing human prostate cancer xenograft PC-346 were used. Volumetric calliper measurements were performed with a 30 MHz ultrasound probe designed for intra-arterial use in humans. Tumour weight, determined at various time-points, was found to be closely related to actual tumour weight ( R = 0.99) and, in the PC-346 model, to the level of PSA in the plasma. Furthermore, the interobserver variation for TRUS was low for tumours above 50 mg. Thus, TRUS for murine prostate tumours proves to be an accurate, reproducible and sensitive method.

Laser-induced fluorescence endoscopy (LIFE) is a noninvasive method for detecting early cancers in hollow organs. A laser-induced fluorescence endoscope that was designed for lung imaging was investigated for its effectiveness in comparison to white light endoscopy (WLE) in localizing head and neck cancers. A total of 196 images from 98 sites in 56 patients were graded into 5 levels from normal to definitely abnormal. A cutoff level to differentiate normal from abnormal images was chosen from a receiver operating characteristic curve. On this basis, LIFE (sensitivity, 92.86%; specificity, 78.57%) was observed to be more effective and reliable than WLE (sensitivity, 67.86%; specificity, 70%) in locating neoplastic foci and precancerous lesions. Nevertheless, WLE was helpful in presenting anatomic details. The reliability of LIFE varied from site to site. It excelled in examination of the oropharynx (sensitivity, 100%; specificity, 96.20%), but was less effective for lesions of the nasopharynx (sensitivity, 66.70%; specificity, 75.00%). In standardizing the test, interobserver variation was assessed, and good agreement in image interpretation was confirmed by statistical analysis. In conclusion, LIFE was found to be an effective and reliable tool for detecting head and neck cancers.

The aim of the present study was to determine the intra- and interobserver variation during measurement of muscle hardness with a new instrument, a so-called hardness meter. In addition, we investigated the factors which may influence the recording of muscle hardness and whether the hardness differs within the same muscle. Hardness was measured at a standardized point on the trapezius muscle in 20 volunteers by 2 observers in random order and again by 1 of the observers after 30 min. Muscle hardness was then measured at 3 different locations on the trapezius muscle. In addition, the muscle hardness at the standard point was measured in 10 volunteers by both observers at 3 different speeds of the applied pressure. The intraobserver variation was 10% and the interobserver variation was 12% for recording of muscle hardness. There was no significant difference in hardness values from time to time within the same observer ( p=0.12), while there was a significant difference in hardness measurements between observers ( p=0.007). Muscle hardness differed significantly among the 3 anatomical locations ( p=0.03). For both observers, there was a significant difference among hardness recordings obtained at 3 different speeds ( p=0.01 and p=0.0001). In conclusion, we have shown that the hardness meter can measure muscle hardness reliably if the same observer is used throughout a study. The speed factor was a major source of variability. In addition, we have demonstrated that muscle hardness differs within the same muscle. We suggest that the muscle hardness meter will be an important tool in future research of the mechanisms leading to myofascial pain.

Purpose: The reproducibility of Doppler ultrasound measurements was studied in a group of radiologists with different experience of such measurements. Material and Methods: The 12 participating radiologists measured peak systolic velocity (PSV), resistance index (RI), and pulsatility index (PI) from 3 arteries and PSV alone in one artery of a healthy person under standardized circumstances. Each participant repeated the measurements 10 times. Results: Significant (pConclusion: The reproducibility of Doppler ultrasound measurements is poor. The value of the method is questionable.

An important concern in surveys of the prevalence of endemic goitre is the possibility of inaccuracy that can occur when estimating thyroid enlargement by clinical examination. We report here the results of a study from central Africa that demonstrated the importance of interobserver variation in the assessment of goitre size among experts and participants attending an international training course on iodine deficiency disorders (IDD). Agreement among raters estimated by calculation of the kappa statistic was poor on average when the five-stage goitre classification recommended by WHO was used. As expected, agreement on a single category was slightly better, especially when the category of interest was visible goitre. Our results suggest that palpation alone is not a reliable method for assessing the severity of IDD endemia. Other sources of inaccuracies are discussed and recommendations are made for better data collection on IDD in Africa and other regions.

Tri-axial accelerometery has recently been shown to produce reliable gait parameters in normal subjects. This study reports the use of this device in patients with pathological gait. Thirty-three patients with a variety of mobility-limiting disorders were studied. All patients were independently mobile with or without a walking aid. Gait was recorded by attaching the tri-axial accelerometer over the patient's sacrum with the patient walking at their usual pace along a 6m path. Gait speed was measured in all 33 patients and ranged from 0.11 m/s to 0.82m/s. Gait parameters could not be calculated in eight patients. In the remaining 25 patients, gait cycle time, cadence, stride length and mean right and left step times could be calculated. Interobserver variation was 2%. Comparison of right and left step times enabled lateralization of the gait abnormality. This portable technique allows rapid qualitative and quantitative assessment of gait within a normal ward environment.

We have developed a 10-item scoring system for estimation of initial severity of neurologic deficit and its subsequent course in stroke patients. The present study evaluated correlations between 10 clinical tests and assessed inter- and intraobserver variation when the scoring system was used by physicians without extensive neurological training. The intraobserver variation for the total score of each patient ranged from 0 to 9; mean, 1. Coefficient of variation was 6.6%. Interobserver variation varied from 0 to 4.5; mean, 2. Coefficient of variation was 8.5%. The pairwise correlations between individual items ranged from insignificant to 0.94. Based on a very high correlation between items 7 and 8 and between items 9 and 10, it was believed that items 8 and 10 could be deleted. We propose a revised scale in which all items have been designed with 4 steps. There is reason to expect that improvement may be obtained by different weighting of items. Assignment of weighing factors must, however, await a longi...

By means of the Pettersson scoring system, the degree of severity of haemophilic arthropathy in 128 knee, elbow and ankle joints was estimated by 5 radiologists. Their scores varied on average by approximately 3 points. Minimal and maximal joint involvement were scored consistently; exclusion of haemophilic arthropathy was possible with the highest degree of certainty. With regard to changes of a moderate degree agreement was seldom reached. With precisely defined characteristics, a high degree of consistency between observers was evident. Interobserver variation in the scoring was more marked in the ankle joint than in the other joints. Scoring was more consistent with the more experienced observers.