Abstract
Introduction
The subjective evaluation of nuclear features in follicular-patterned lesions of the thyroid is a reason for diagnosis discordance. The assessment of nuclear features also varies whether the observation is performed optically or digitally. Our objective was to study the concordance among pathologists regarding the nuclear score (NS) evaluation in a series of follicular-patterned lesions, using optical versus three digital scanning protocols.
Methods
Three pathologists evaluated the NS in a 3mm2 area randomly selected from 20 hematoxylin-eosin slides representative of the respective 20 follicular-patterned thyroid lesions. The NS evaluation was performed using optical and three different scanning protocols in two scanners: P1000_20x, P1000_40x and DP200_20x. Kappa statistic (κ) and intraclass correlation coefficient (ICC) were obtained for intra- and interpathologist concordance.
Results
We recorded a good agreement among pathologists in the optical evaluation of the NS (ICC of 0.73). The concordance between optical versus digital observation had an almost perfect agreement for P1000_20x [κ = 0.85 (0.67–1.02); p < 0.0001] and a substantial agreement for both P1000_40x [κ = 0.69 (0.43–0.95) p = 0.002] and DP200_20x [κ = 0.77 (0.57–0.97); p = 0.001]. The P1000_20x protocol had the best intrapathologist concordance with the optical method, classified as almost perfect agreement for pathologists A (80%) and B (85%), and substantial agreement for pathologist C (70%).
Conclusion
Digital observation of the WSI is valid for the NS evaluation in follicular-patterned thyroid lesions, with good agreement among pathologists and between optical and scanning protocols. Performance studies and validation procedures cannot be avoided in this setting to prevent diagnostic discordance due to the scanning process.
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Abbreviations
- DP:
-
digital pathology;
- Nuclear score:
-
NS;
- PTC:
-
Papillary thyroid carcinoma;
- SD:
-
Standard deviation;
- World Health Organization:
-
WHO;
- Whole slide image:
-
WSI.
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This manuscript has been submitted solely to this journal and has not been published in press or submitted elsewhere. The attributions that the authors had in the production of the manuscript were: literature review and article writing (H.E.R. and C.E.), text review, and interpretation of work data (F.H., S.L., F.E. L.B., P.R. F.R., and C.E.), figure creation (F.H. and G.R.), data collection (J.P., A.M., J.V., and C.E.), text review (C.E. and H.E.R.), and research coordinator and text review (C.E.). The authors approved the version to be published and agree to be responsible for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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Ramos, H.E., Vale, J., Lopes, S. et al. Nuclear score evaluation in follicular-patterned thyroid lesions using optical and digital environments. Endocrine 77, 486–492 (2022). https://doi.org/10.1007/s12020-022-03104-w
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DOI: https://doi.org/10.1007/s12020-022-03104-w