Interobserver agreement for Polyomavirus nephropathy grading in renal allografts using the working proposal from the 10th Banff Conference on Allograft Pathology

Summary A classification schema for grading Polyomavirus nephropathy was proposed at the 2009 Banff allograft meeting. The schema included 3 stages of Polyomavirus nephropathy: early (stage A), florid (stage B), and late sclerosing (stage C). Grading categories for histologic viral load levels were...

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Bibliographic Details
Published in:Human pathology 2011-12, Vol.42 (12), p.2018-2024
Main Authors: Sar, Aylin, MD, Worawichawong, Suchin, MD, Benediktsson, Hallgrimur, MD, Zhang, Jianguo, MSc, Yilmaz, Serdar, MD, Trpkov, Kiril, MD
Format: Article
Language:English
Subjects:
2009 Banff
Adolescent
Adult
Aged
Agreements
Biological and medical sciences
Biopsy
BK virus
Child
Classification
Female
Graft Rejection - classification
Graft Rejection - drug therapy
Graft Rejection - pathology
Graft Rejection - virology
Humans
Infectious diseases
Interobserver agreement
Investigative techniques, diagnostic techniques (general aspects)
Kidney - pathology
Kidney - virology
Kidney Diseases - classification
Kidney Diseases - drug therapy
Kidney Diseases - pathology
Kidney Diseases - virology
Kidney Transplantation - pathology
Male
Medical sciences
Middle Aged
Observer Variation
Pathology
Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques
Polyomavirus
Polyomavirus - physiology
Polyomavirus Infections - classification
Polyomavirus Infections - drug therapy
Polyomavirus Infections - pathology
Polyomavirus nephropathy
Reproducibility of Results
Retrospective Studies
Transplantation, Homologous - pathology
Tumor Virus Infections - classification
Tumor Virus Infections - drug therapy
Tumor Virus Infections - pathology
Viral diseases
Viral Load
Virus Replication
κ statistic
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Summary:Summary A classification schema for grading Polyomavirus nephropathy was proposed at the 2009 Banff allograft meeting. The schema included 3 stages of Polyomavirus nephropathy: early (stage A), florid (stage B), and late sclerosing (stage C). Grading categories for histologic viral load levels were also proposed. To examine the applicability and the interobserver agreement of the proposed Polyomavirus nephropathy grading schema, we evaluated 24 renal allograft biopsies with confirmed Polyomavirus nephropathy by histology and SV40. Four renal pathologists independently scored the Polyomavirus nephropathy stage (A, B, or C), without knowledge of the clinical history. Viral load was scored as a percent of tubules exhibiting viral replication, using either a 3-tier viral load score (1: ≤1%; 2: >1%-10%; 3: >10%) or a 4-tier score (1: ≤1%; 2: >1%-≤5%; 3: >5%-15%; 4: >15%). The κ score for the Polyomavirus nephropathy stage was 0.47 (95% confidence interval, 0.35-0.60; P < .001). There was a substantial agreement using both the 3-tier and the 4-tier scoring for the viral load (Kendall concordance coefficients, 0.72 and 0.76, respectively; P < .001 for both). A better complete agreement was found using the 3-tier viral load score. In this first attempt to evaluate the interobserver reproducibility of the proposed Polyomavirus nephropathy classifying schema, we demonstrated moderate κ agreement in assessing the Polyomavirus nephropathy stage and a substantial agreement in scoring the viral load level. The proposed grading schema can be applied in routine allograft biopsy practice for grading the Polyomavirus nephropathy stage and the viral load level.
ISSN:0046-8177
1532-8392
DOI:10.1016/j.humpath.2011.03.008