B, The descriptors segmental sclerosis away from vascular and tubular pole (silver stain), tip lesion (silver stain yellow arrows), and segmental perihilar sclerosis (periodic acid–Schiff blue arrow) are grouped in the NDPSS1 and 2 subclass segmental sclerosis, the NDPSS2 subclass any sclerosis, and the NDPSS1 and 2 class segmental obliteration. Examples of descriptors in the various classes and subclasses: A, The descriptors global sclerosis with hyalinosis (periodic acid–Schiff) and obsolescence (hematoxylin-eosin) are grouped in the NDPSS1 and 2 subclass global sclerosis, the NDPSS2 subclass any sclerosis, and the NDPSS1 and 2 class global obliteration. The NDPSS1 and 2 class global obliteration includes the subclasses global sclerosis (A) and global wrinkling (C) the NDPSS1 and 2 class segmental obliteration includes the subclasses segmental sclerosis (C) and segmental wrinkling (D). The NDPSS2 subclass any sclerosis contains additional subclasses global sclerosis (A) and segmental sclerosis (C) the NDPSS2 subclass any wrinkling contains additional subclasses global wrinkling (C) and segmental wrinkling (D). The NDPSS2 class any sclerosis, wrinkling, or tip includes the subclasses any sclerosis (A and B) and any wrinkling (C and D). We suggest using the original NDPSS on whole slide images for glomerular morphology assessment and for guiding future automated technologies.Įxample of classes and subclasses of descriptors (images) and how they are organized in the modified Nephrotic Syndrome Study Network Digital Pathology Scoring System (NDPSS), NDPSS1, and NDPSS2. Use of alternative agreement statistics was strongly supported. Conclusions The NDPSS1 and NDPSS2 increased pathologists' scoring burden without improving reproducibility. Pathologist feedback indicated the NDPSS1 and NDPSS2 were time-consuming. Using the Gwet AC 1, 79% of the original NDPSS descriptors had good or excellent agreement. Mean (standard deviation) differences in agreement estimates using the NDPSS1 and NDPSS2 compared with the single-level original NDPSS were -0.09 (0.17) and -0.17 (0.17), respectively. Greater agreement was achieved using the Gwet AC 1 compared with the Cohen κ across all scoring methodologies. Results Overall, pathologists' uncertainty was low, favoring application of the Gwet AC 1. Agreement was tested using conventional (Cohen κ) and alternative (Gwet agreement coefficient 1 ) agreement statistics and compared with previously published data (original NDPSS).
Three and 5 pathologists scored 157 and 79 glomeruli using the NDPSS1 and NDPSS2, respectively. Design The original NDPSS was modified (NDPSS1 and NDPSS2) to evaluate (1) independent scoring of each individual biopsy level, (2) use of continuous measures, (3) groupings of individual descriptors into classes and subclasses prior to scoring, and (4) indication of pathologists' confidence/uncertainty for any given score. Objective To test reproducibility and feasibility of alternative scoring strategies for digital morphologic assessment of glomeruli and explore use of alternative agreement statistics.
Our previous study using the descriptor-based Nephrotic Syndrome Study Network Digital Pathology Scoring System (NDPSS) on glomerular images revealed variable reproducibility. Holzman), University of Pennsylvania, Philadelphia the Department of Pathology, Johns Hopkins University, Baltimore, Maryland (Drs Bagnasco and Rosenberg) the Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland (Dr Rosenberg) the Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland (Dr Hewitt) and the Department of Pathology, University of Miami, Miami, Florida (Dr Barisoni).Ĭontext Testing reproducibility is critical for the development of methodologies for morphologic assessment.
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