Histologic estimation of coronary artery stenoses: Reproducibility and theeffect of training

Histologic estimation of coronary artery stenoses (CAS) provides the 'gold- standard' for clinicopathologic correlations and medicolegal investigations , yet little evidence supports histology as a reproducible diagnostic measu re, and none addresses the effect of training on its use. To study these qu estions, 20 randomly selected Movat-stained coronary artery cross-sections were reviewed 3 times, at 3-month intervals, by six clinical pathologists ( CPs), six pathology residents (Res), seven anatomic pathologists (APs), and two cardiovascular pathologists (CVPs). Before the third iteration, a guid e to CAS assessment with illustrations was provided. Inter- and intraobserv er reproducibility were determined using interclass correlation coefficient s (ICC) (0.40-0.75 = fair-good; greater than or equal to0.76 = excellent ag reement beyond chance). Surprisingly, all study groups had excellent intero bserver reproducibility. Before training, at Time 1, the scores were CPs, 0 .77; Res, 0.89; APs, 0.93; and CVPs, 0.93. After training, at Time 3, the r esults were CPs, 0.81; Res, 0.91; APs, 0.86; and CVPs, 0.88. Intraobserver reproducibility for CPs overall was good (ICC, 0.74), and excellent for Res , APs, and CVPs (0.89, 0.93, and 0.97, respectively). In conclusion, statis tical analysis failed to demonstrate any significant effect of training or experience on observer reproducibility. Cardiovasc Pathol 2000;9:251-255 (C ) 2000 by Elsevier Science Inc.