Variables subject to differences in opinion:
(1) process: benign, atypical or malignant
(2) class of tumor: astrocytoma, lymphoma, carcinoma
(3) cell of origin
(4) type or Grade
A difference in interpretation may or may not make a therapeutic difference.
where:
• I would divide atypical into reactive atypia and atypia suspicious for malignancy. For some organs low grade and high grade dysplasia would be additional terms.
Categories of agreement:
(1) agreement (exactly the same diagnosis made)
(2) minor discrepancy not affecting treatment
(3) minor discrepancy affecting treatment
(4) disagreement (major discrepancy) in grade of tumor
(5) disagreement (major discrepancy) with no common ground
Minor discrepancy not affecting treatment:
(1) both malignant, same class and cell type, with difference in assigned grade of 1 level
(2) both benign or malignant, same class, with difference in cell of origin
(3) both benign, same class, same cell of origin, difference in subtyping
Minor discrepancy affecting treatment:
(1) both malignant, with difference in 1 grade
(2) both benign or malignant, with difference in cell of origin
(3) one benign, other atypical
(4) one atypical suspicious for malignancy, other malignant
where:
• In the original table, one pathologist calling a meningioma benign and another calling it malignant was considered a minor discrepancy affecting treatment.
Disagreement in grade of tumor:
(1) both malignant, with difference > 1 grade, affecting treatment
Disagreement with no common ground:
(1) one benign, other malignant
(2) significant difference in class affecting treatment
Programming:
(1) if all 4 variables the same, then agree
(2) if disagree to process and/or class then disagreement with no common ground
(3) if disagreement in grade > 1 level, disagreement in grading
(4) else minor disagreement, distinguished by whether therapeutic difference or not
