Good interobserver and intraobserver agreement in the evaluation of the new ILAE classification of focal cortical dysplasias |
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| Authors: | Coras Roland de Boer Onno J Armstrong Dawna Becker Albert Jacques Thomas S Miyata Hajime Thom Maria Vinters Harry V Spreafico Roberto Oz Buge Marucci Gianluca Pimentel Jose Mühlebner Angelika Zamecnik Josef Buccoliero Anna Maria Rogerio Fabio Streichenberger Nathalie Arai Nobutaka Bugiani Marianna Vogelgesang Silke Macaulay Rob Salon Carolin Hans Volkmar Polivka Marc Giangaspero Felice Fauziah Dyah Kim Jang-Hee Liu Lei Dandan Wang Gao Jing Lindeboom Benjamin Blümcke Ingmar Aronica Eleonora |
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| Affiliation: | Department of Neuropathology, University Hospital Erlangen, Erlangen, Germany Department of Pathology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Formerly Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, U.S.A Department of Neuropathology, University Hospital Bonn, Bonn, Germany UCL-Institute of Child Health and Great Ormond Street Hospital NHS Trust, London, United Kingdom Department of Neuropathology, Research Institute for Brain and Blood Vessels Akita, Akita, Japan Department of Neuropathology, Institute of Neurology, University College London, London, United Kingdom Departments of Pathology and Laboratory Medicine (Neuropathology) and Neurology, UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California, U.S.A. Department of Epilepsy Clinic and Experimental Neurophysiology, IRCCS Foundation Neurological Institute "Carlo Besta," Milan, Italy Department of Pathology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey Section of Pathology, Bellaria Hospital, University of Bologna, Bologna, Italy Laboratory of Neuropathology, Department of Neurology, CHLN, EPE- Hospital de Santa Maria, Lisbon, Portugal Institute of Neurology and Department of Pediatrics, Medical University of Vienna, Vienna, Austria Department of Pathology and Molecular Medicine, Charles University, 2nd Medical Faculty and Faculty Hospital Motol, Prague, Czech Republic Pathology Laboratory, Children's Hospital "Meyer"-University of Florence, Florence, Italy Department of Pathology, Faculty of Medical Sciences, University of Campinas, Campinas, Brazil Neuropathology Laboratory, University Lyon, Lyon, France Brain Pathology Research Center, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan Department of Pathology and Pediatrics/Child Neurology, VU University Medical Center, Amsterdam, The Netherlands Department of Neuropathology, University of Greifswald, Greifswald, Germany Department of Pathology, University of Dalhousie, Halifax, Nova Scotia, Canada Department of Pathology, University Hospital of Grenoble, Grenoble, France Institute of Neuropathology, Evangelisches Krankenhaus Bielefeld, Bielefeld, Germany Department of Pathology, Lariboisiere Hospital, Paris, France Department of Neurological Sciences, Neuromed Institute, Pozzilli, Italy Department of Pathology, Airlangga University, Surabaya, Indonesia Department of Pathology, Ajou University School of Medicine, Suwon, Korea Department of Neurology, Beijing Friendship Hospital, Capital Medical University, Beijing, China Department of Pathology, Tsinghua University, Yuquan Hospital, Beijing, China Department of Neurology, Peking Union Medical College Hospital, Beijing, China Department of (Neuro)Pathology, Academic Medical Center, University of Amsterdam, The Netherlands. |
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| Abstract: | Purpose: An International League Against Epilepsy (ILAE) consensus classification system for focal cortical dysplasias (FCDs) has been published in 2011 specifying clinicopathologic FCD variants. The aim of the present work was to microscopically assess interobserver agreement and intraobserver reproducibility for FCD categories among an international group of neuropathologists with different levels of experience and access to epilepsy surgery tissue. Methods: Surgical FCD specimens covering a broad histopathology spectrum were retrieved from 22 patients with epilepsy. Three surgical nonepilepsy specimens served as controls. A total of 188 slides with routine or immunohistochemical stainings were digitalized with a slide scanner to allow Internet‐based microscopy review. Nine experienced neuropathologists were invited to review these cases twice at a time gap of 3 months and different orders of case presentation. The 2011 ILAE FCD consensus classification served as instruction. Kappa analysis was calculated to estimate interobserver and intraobserver agreement levels. In a third evaluation round, 21 additional neuropathologists with different experience and access to epilepsy surgery reviewed the same case series. Key Findings: Interobserver agreement was good (κ = 0.6360), with 84% consensus of diagnoses during the first evaluation (21 of 25 cases). Kappa values increased to 0.6532 after reevaluation, and consensus was obtained in 24 (96%) of 25 cases. Overall intraobserver reproducibility was also good (κ = 0.7824, ranging from 0.4991 to 1.000). Fewest changes in the classification were made in the FCD type II group (2.2% of 225 original diagnoses), whereas the majority of changes occurred in FCD type III (13.7% of 225 original diagnoses). In the third evaluation round, interobserver agreement was reflected by the level of experience of each neuropathologist, with κ values ranging from moderate (0.5056; high level of experience >40 cases/year) to low (0.3265; low level of experience <10 cases/year). Significance: Our study achieved a good and reliable interobserver agreement among the group of expert neuropathologists originally involved in the ILAE FCD consensus classification system. Intraobserver reproducibility in this group was even more robust. These results showed considerable improvement compared to a previous study evaluating the 2004 Palmini FCD classification. Agreement levels were lower in our second group of neuropathologists and were related to their level of access and experience with epilepsy surgery specimens. These results suggested that the more precise ILAE definition of FCD histopathology patterns improves operational procedures in the diagnosis of FCDs. On the other hand, microscopic assessment of FCD is a challenge and requires sustained experience and teaching. The virtual slide review system allowed testing of this hypothesis and reached a widespread group of participating colleagues from different centers all over the world. We propose to further use this tool as a teaching device and also to address other epilepsy‐associated entities still difficult to classify such as hippocampal sclerosis, long‐term epilepsy‐associated tumors, or mild malformations of cortical development (mMCDs), which were not yet covered by current ILAE classification systems. |
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| Keywords: | Brain Epilepsy Neuropathology Classification Agreement Reproducibility |
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