摘要目的 探讨采取慢性胃炎病理诊断标准培训并应用直观模拟评分法能否提高病理医师间慢性胃炎病理诊断的一致性.方法 8位病理医师对70份慢性萎缩性胃炎病理切片进行两轮读片,第一轮结束后接受《中国慢性胃炎共识意见(2012,上海)》中关于慢性胃炎病理诊断标准的培训,并在第二轮读片过程中运用直观模拟评分法.8位病理医师按工作年限和所在医院进行分组,采用Kappa分析两轮读片的慢性胃炎5项组织学改变诊断的一致性,并行对比分析.结果 8位病理医师第二轮读片对慢性胃炎5项组织学改变的总体诊断Kappa值均较第一轮读片有所提高,且5项组织学改变诊断的一致性程度也均有所提高.第二轮读片,高年资组和低年资组5项组织学改变的诊断Kappa值值差在-0.018 0～0.034 1,但5项组织学改变诊断的一致性程度均相同;同一医院组和不同医院组5项组织学改变的诊断Kappa值值差在0.0122～0.0497,其中幽门螺杆菌感染的诊断一致性程度好于不同医院组,其他4项组织学改变诊断的一致性程度均与不同医院组相同.结论 对病理医师进行《中国慢性胃炎共识意见(2012,上海)》中关于慢性胃炎病理诊断标准培训,并在读片时采用直观模拟评分法,可普遍提高病理医师间慢性胃炎病理诊断的一致性.

abstractsObjective To study the improvement of interobserver consistency in pathological diagnosis of chronic gastritis by using a visual-analog scale after the training on diagnostic criteria of chronic gastritis.Methods Eight pathologists conducted two rounds of evaluation of 70 slides with confirmed diagnosis of chronic atrophic gastritis.After the first round,every pathologist was trained with the diagnosis criteria from "Chinese consensus on chronic gastritis (2012,Shanghai)",and the visual analog scale was used in the second round.Eight pathologists were grouped by working experience and hospital,respectively,and the interobserver consistency was evaluated using Kappa analysis.Results The overall Kappa values of 5 kinds of chronic gastritis features improved in the second round when compared with those from the first one.In the second round of diagnosis,the difference in Kappa value between the senior and the junior group was -0.018 0-0.034 1,while the interobserver consistency was at the same level.The difference in Kappa value between the same hospital and the different hospital groups was 0.012 2-0.049 7,but the interobserver consistency was at the same level for the various chronic gastritis features,expect for H.pylori infection,which was better for the same hospital group.Conclusion Interobserver consistency generally improves after the training of the proposed diagnostic criteria of "Chinese consensus on chronic gastritis (2012,Shanghai) " accompanied with a visual-analog scale.