The three-tier (A vs. B vs. C) pattern-based (Silva) classification system is a strong and fairly reproducible predictor of the risk of lymph node involvement and recurrence of human papillomavirus (HPV)-associated endocervical adenocarcinoma (EA). Recently, a binary pattern-based classification system has been proposed which incorporates the Silva pattern and lymphovascular invasion (LVI) to assign tumors as "low risk" or "high risk" and this may have superior prognostic significance compared with the three-tier system as well as current International Federation of Gynecology and Obstetrics (FIGO) staging of cervix-confined disease. The interobserver reproducibility of this binary system, however, is unknown. Representative slides from 59 HPV-associated EAs (1-3 slides/case) were independently reviewed by 5 gynecologic pathologists who participated in an online training module before the study. In the first review, a pattern was assigned using the three-tier system. On the second review, a "low risk" or "high risk" designation was assigned and the presence or absence of LVI was specifically documented. Interobserver agreement was assessed using Fleiss' kappa. The binary system showed improved interobserver agreement (kappa=0.634) compared with the three-tier system (kappa=0.564), with a higher proportion of cases having agreement between at least 4/5 reviewers (86% vs. 73%). Nineteen and 8 cases showed improved and worse interobserver agreement using the binary system, respectively; the remainder showed no change. 3/5 reviewers showed no intraobserver discrepancy while the remaining 2 did in a small subset of cases (n=2 and 4, respectively). In this study, a binary pattern-based classification system showed improved interobserver agreement compared with the traditional three-tier system.

中文翻译：

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评估妇科病理学家针对 HPV 相关宫颈内膜腺癌的三层分类系统与基于二元模式的分类系统之间的观察者间一致性。


基于模式的三层（A vs. B vs. C）（Silva）分类系统是人乳头瘤病毒（HPV）相关宫颈腺癌（EA）淋巴结受累和复发风险的强有力且具有相当可重复性的预测因子。最近，提出了一种基于二元模式的分类系统，该系统结合了席尔瓦模式和淋巴管侵犯（LVI），将肿瘤分配为“低风险”或“高风险”，与三层系统相比，这可能具有更好的预后意义以及当前国际妇产科联合会 (FIGO) 对宫颈局限性疾病的分期。然而，该二元系统的观察者间再现性尚不清楚。来自 59 个 HPV 相关 EA 的代表性幻灯片（1-3 张幻灯片/病例）由 5 名妇科病理学家独立审查，他们在研究前参加了在线培训模块。在第一次审查中，使用三层系统分配了一个模式。在第二次审查中，指定了“低风险”或“高风险”，并专门记录了是否存在 LVI。使用 Fleiss' kappa 评估观察者间的一致性。与三层系统 (kappa=0.564) 相比，二元系统显示出改进的观察者间一致性 (kappa=0.634)，其中至少 4/5 审阅者之间达成一致的案例比例更高（86% 对 73%）。使用二元系统分别有 19 例和 8 例显示观察者间一致性有所改善和较差；其余部分没有变化。 3/5 的评审者没有表现出观察者内部差异，而其余 2 名评审者则在一小部分病例中表现出差异（分别为 n=2 和 4）。 在本研究中，与传统的三层系统相比，基于二元模式的分类系统显示出改进的观察者间一致性。