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Evaluation of two histological classifications for actinic keratoses – PRO classification scored highest inter‐rater reliability
Author(s) -
Schmitz L.,
Gupta G.,
Stücker M.,
Doerler M.,
Gambichler T.,
Welzel J.,
Szeimies R.M.,
Bierhoff E.,
Stockfleth E.,
Dirschka T.
Publication year - 2019
Publication title -
journal of the european academy of dermatology and venereology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.655
H-Index - 107
eISSN - 1468-3083
pISSN - 0926-9959
DOI - 10.1111/jdv.15580
Subject(s) - medicine , basal (medicine) , grading (engineering) , inter rater reliability , actinic keratoses , dermatology , epidermis (zoology) , basal cell carcinoma , pathology , basal cell , anatomy , biology , mathematics , statistics , ecology , rating scale , insulin
Background Actinic keratoses ( AK s) can histologically be classified by the extent of atypical keratinocytes throughout the epidermis or their pattern of basal proliferation. Currently, no data on the inter‐rater reliability of both scores is available. Objective To evaluate the inter‐rater reliability of the two classification schemes; histological grade ( AK I– III ) and basal proliferation ( PRO I– III ). Methods Histological images of 54 AK s were classified by 21 independent dermatopathologists with regard to basal proliferation ( PRO I– III ), histological grade ( AK I– III ) and assumed risk of progression into invasive carcinoma. Results Overall, of the 54 AK s 16.7% (9/54) were classified as AK I, 66.7% (36/54) as AK II , and 16.7% (9/54) as AK III . With regards to basal growth pattern, 25.9% (14/54) were classified as PRO I, 42.6% (23/54) as PRO II , and 31.5% (17/54) as PRO III . We observed a highly significant inter‐rater reliability for PRO ‐grading ( P < 0.001) which was higher than for AK ‐grading (Kendall's W coefficient: AK = 0.488 vs. PRO = 0.793). We found substantial agreement for assumed progression risk for AK s with worsening basal proliferation ( k = 0.759) compared to moderate agreement ( k = 0.563) for different AK ‐gradings. Conclusions Histological classification of basal growth pattern ( PRO ) showed higher inter‐rater reliability compared to the established classification of atypical keratinocytes throughout epidermal layers. Moreover, experienced dermatopathologists considered basal proliferation to be more important in terms of progression risk than upwards directed growth patterns. It should be considered to classify AK s according to their basal proliferation pattern ( PRO I– III ).