Interobserver variability in grading transbronchial lung biopsy specimens after lung transplantation

Sangeeta M. Bhorade, Aliya N. Husain, Chuanhong Liao, Lee Chuan Li, Vivek N. Ahya, Maher A. Baz, Vincent G. Valentine, Robert B. Love, Harish Seethamraju, Charles G. Alex, Remzi Bag, Nilto C. DeOliveira, Wickii T. Vigneswaran, Edward R. Garrity, Selim M. Arcasoy

Research output: Contribution to journalArticle

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Abstract

Background: Acute rejection remains a major source of morbidity after lung transplantation. Given the importance of this diagnosis, an international grading system was developed to standardize the diagnosis of acute lung-allograft rejection. The reliability of this grading system has not been adequately assessed by previous studies. Methods: We examined the level of agreement in grading transbronchial biopsy specimens obtained from a large multicenter study (AIRSAC [Comparison of a Tacrolimus/Sirolimus/Prednisone Regimen vs Tacrolimus/Azathioprine/Prednisone Immunosuppressive Regimen in Lung Transplantation] trial). Biopsy specimens were initially graded for acute rejection and lymphocytic bronchiolitis by the site pathologist and subsequently graded by a central pathologist. Reliability of interobserver grading was evaluated using Cohen k coefficients. Results: A total of 481 transbronchial biopsy specimens were graded by both the site and central pathologists. The overall concordance rates were 74% and 89% for grade A and grade B biopsy specimens, respectively. When samples from biopsies performed at different time points after transplantation were assessed, there was a higher level of agreement early (≤ 6 weeks) after transplant compared with later time points for acute rejection. However, there was still only moderate agreement for both grade A (k score 0.479; 95% CI, 0.29-0.67) and grade B (k score 0.465; 95% CI, 0.08-0.85) rejection. Conclusions: These results expand upon previous reports of interobserver variability in grading transbronchial biopsy specimens after lung transplantation. Given the variability in grading these specimens, we advocate further education of the histopathologic findings in lung transplant biopsy specimens, as well as revisiting the current criteria for grading transbronchial biopsy specimens to improve concordance among lung transplant pathologists.

Original languageEnglish (US)
Pages (from-to)1717-1724
Number of pages8
JournalChest
Volume143
Issue number6
DOIs
StatePublished - Jun 2013

Fingerprint

Observer Variation
Lung Transplantation
Biopsy
Lung
Tacrolimus
Prednisone
Transplants
Bronchiolitis
Azathioprine
Sirolimus
Immunosuppressive Agents
Multicenter Studies
Allografts
Transplantation
Morbidity
Education
Pathologists

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Bhorade, S. M., Husain, A. N., Liao, C., Li, L. C., Ahya, V. N., Baz, M. A., ... Arcasoy, S. M. (2013). Interobserver variability in grading transbronchial lung biopsy specimens after lung transplantation. Chest, 143(6), 1717-1724. https://doi.org/10.1378/chest.12-2107

Interobserver variability in grading transbronchial lung biopsy specimens after lung transplantation. / Bhorade, Sangeeta M.; Husain, Aliya N.; Liao, Chuanhong; Li, Lee Chuan; Ahya, Vivek N.; Baz, Maher A.; Valentine, Vincent G.; Love, Robert B.; Seethamraju, Harish; Alex, Charles G.; Bag, Remzi; DeOliveira, Nilto C.; Vigneswaran, Wickii T.; Garrity, Edward R.; Arcasoy, Selim M.

In: Chest, Vol. 143, No. 6, 06.2013, p. 1717-1724.

Research output: Contribution to journalArticle

Bhorade, SM, Husain, AN, Liao, C, Li, LC, Ahya, VN, Baz, MA, Valentine, VG, Love, RB, Seethamraju, H, Alex, CG, Bag, R, DeOliveira, NC, Vigneswaran, WT, Garrity, ER & Arcasoy, SM 2013, 'Interobserver variability in grading transbronchial lung biopsy specimens after lung transplantation', Chest, vol. 143, no. 6, pp. 1717-1724. https://doi.org/10.1378/chest.12-2107
Bhorade, Sangeeta M. ; Husain, Aliya N. ; Liao, Chuanhong ; Li, Lee Chuan ; Ahya, Vivek N. ; Baz, Maher A. ; Valentine, Vincent G. ; Love, Robert B. ; Seethamraju, Harish ; Alex, Charles G. ; Bag, Remzi ; DeOliveira, Nilto C. ; Vigneswaran, Wickii T. ; Garrity, Edward R. ; Arcasoy, Selim M. / Interobserver variability in grading transbronchial lung biopsy specimens after lung transplantation. In: Chest. 2013 ; Vol. 143, No. 6. pp. 1717-1724.
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title = "Interobserver variability in grading transbronchial lung biopsy specimens after lung transplantation",
abstract = "Background: Acute rejection remains a major source of morbidity after lung transplantation. Given the importance of this diagnosis, an international grading system was developed to standardize the diagnosis of acute lung-allograft rejection. The reliability of this grading system has not been adequately assessed by previous studies. Methods: We examined the level of agreement in grading transbronchial biopsy specimens obtained from a large multicenter study (AIRSAC [Comparison of a Tacrolimus/Sirolimus/Prednisone Regimen vs Tacrolimus/Azathioprine/Prednisone Immunosuppressive Regimen in Lung Transplantation] trial). Biopsy specimens were initially graded for acute rejection and lymphocytic bronchiolitis by the site pathologist and subsequently graded by a central pathologist. Reliability of interobserver grading was evaluated using Cohen k coefficients. Results: A total of 481 transbronchial biopsy specimens were graded by both the site and central pathologists. The overall concordance rates were 74{\%} and 89{\%} for grade A and grade B biopsy specimens, respectively. When samples from biopsies performed at different time points after transplantation were assessed, there was a higher level of agreement early (≤ 6 weeks) after transplant compared with later time points for acute rejection. However, there was still only moderate agreement for both grade A (k score 0.479; 95{\%} CI, 0.29-0.67) and grade B (k score 0.465; 95{\%} CI, 0.08-0.85) rejection. Conclusions: These results expand upon previous reports of interobserver variability in grading transbronchial biopsy specimens after lung transplantation. Given the variability in grading these specimens, we advocate further education of the histopathologic findings in lung transplant biopsy specimens, as well as revisiting the current criteria for grading transbronchial biopsy specimens to improve concordance among lung transplant pathologists.",
author = "Bhorade, {Sangeeta M.} and Husain, {Aliya N.} and Chuanhong Liao and Li, {Lee Chuan} and Ahya, {Vivek N.} and Baz, {Maher A.} and Valentine, {Vincent G.} and Love, {Robert B.} and Harish Seethamraju and Alex, {Charles G.} and Remzi Bag and DeOliveira, {Nilto C.} and Vigneswaran, {Wickii T.} and Garrity, {Edward R.} and Arcasoy, {Selim M.}",
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T1 - Interobserver variability in grading transbronchial lung biopsy specimens after lung transplantation

AU - Bhorade, Sangeeta M.

AU - Husain, Aliya N.

AU - Liao, Chuanhong

AU - Li, Lee Chuan

AU - Ahya, Vivek N.

AU - Baz, Maher A.

AU - Valentine, Vincent G.

AU - Love, Robert B.

AU - Seethamraju, Harish

AU - Alex, Charles G.

AU - Bag, Remzi

AU - DeOliveira, Nilto C.

AU - Vigneswaran, Wickii T.

AU - Garrity, Edward R.

AU - Arcasoy, Selim M.

PY - 2013/6

Y1 - 2013/6

N2 - Background: Acute rejection remains a major source of morbidity after lung transplantation. Given the importance of this diagnosis, an international grading system was developed to standardize the diagnosis of acute lung-allograft rejection. The reliability of this grading system has not been adequately assessed by previous studies. Methods: We examined the level of agreement in grading transbronchial biopsy specimens obtained from a large multicenter study (AIRSAC [Comparison of a Tacrolimus/Sirolimus/Prednisone Regimen vs Tacrolimus/Azathioprine/Prednisone Immunosuppressive Regimen in Lung Transplantation] trial). Biopsy specimens were initially graded for acute rejection and lymphocytic bronchiolitis by the site pathologist and subsequently graded by a central pathologist. Reliability of interobserver grading was evaluated using Cohen k coefficients. Results: A total of 481 transbronchial biopsy specimens were graded by both the site and central pathologists. The overall concordance rates were 74% and 89% for grade A and grade B biopsy specimens, respectively. When samples from biopsies performed at different time points after transplantation were assessed, there was a higher level of agreement early (≤ 6 weeks) after transplant compared with later time points for acute rejection. However, there was still only moderate agreement for both grade A (k score 0.479; 95% CI, 0.29-0.67) and grade B (k score 0.465; 95% CI, 0.08-0.85) rejection. Conclusions: These results expand upon previous reports of interobserver variability in grading transbronchial biopsy specimens after lung transplantation. Given the variability in grading these specimens, we advocate further education of the histopathologic findings in lung transplant biopsy specimens, as well as revisiting the current criteria for grading transbronchial biopsy specimens to improve concordance among lung transplant pathologists.

AB - Background: Acute rejection remains a major source of morbidity after lung transplantation. Given the importance of this diagnosis, an international grading system was developed to standardize the diagnosis of acute lung-allograft rejection. The reliability of this grading system has not been adequately assessed by previous studies. Methods: We examined the level of agreement in grading transbronchial biopsy specimens obtained from a large multicenter study (AIRSAC [Comparison of a Tacrolimus/Sirolimus/Prednisone Regimen vs Tacrolimus/Azathioprine/Prednisone Immunosuppressive Regimen in Lung Transplantation] trial). Biopsy specimens were initially graded for acute rejection and lymphocytic bronchiolitis by the site pathologist and subsequently graded by a central pathologist. Reliability of interobserver grading was evaluated using Cohen k coefficients. Results: A total of 481 transbronchial biopsy specimens were graded by both the site and central pathologists. The overall concordance rates were 74% and 89% for grade A and grade B biopsy specimens, respectively. When samples from biopsies performed at different time points after transplantation were assessed, there was a higher level of agreement early (≤ 6 weeks) after transplant compared with later time points for acute rejection. However, there was still only moderate agreement for both grade A (k score 0.479; 95% CI, 0.29-0.67) and grade B (k score 0.465; 95% CI, 0.08-0.85) rejection. Conclusions: These results expand upon previous reports of interobserver variability in grading transbronchial biopsy specimens after lung transplantation. Given the variability in grading these specimens, we advocate further education of the histopathologic findings in lung transplant biopsy specimens, as well as revisiting the current criteria for grading transbronchial biopsy specimens to improve concordance among lung transplant pathologists.

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