title: The need for specialist review of pathology in paediatric cancer.
abstract: A retrospective histopathological review of 2104 cases of solid tumour was carried out to assess the variability in diagnosis of childhood cancer. Cases were subject to three independent, concurrent opinions from a national panel of specialist pathologists. The conformity between them was analysed using the percentage of agreement and the kappa statistic (kappa), a measure of the level of agreement beyond that which could occur by chance alone, and weighted kappa (w kappa), which demonstrates the degree of variation between opinions. The major groupings of the Birch-Marsden classification were used within which tumours were assigned for kappa analysis according to the clinical significance of the differential diagnoses. The mean agreement for all tumours together was 90%; kappa = 0.82, w kappa = 0.82. Retinoblastoma achieved the highest kappa value (1.0) and lymphoma the lowest (0.66). Of the cases, 16.5% had their original diagnoses amended and the panel confirmed the original diagnosis of paediatric pathologists in 89% of cases compared with 78% for general pathologists. The varying levels of agreement between experts confirm the difficulty of diagnosis in some tumour types, suggesting justification for specialist review in most diagnoses. Specialist training in paediatric pathology is also recommended.
authors.affiliation: West Midlands Regional Children's Tumour Research Group, Birmingham Children's Hospital, UK.
authors.forename: S E
authors.initials: SE
authors.lastname: Parkes
authors.forename: K R
authors.initials: KR
authors.lastname: Muir
authors.forename: A H
authors.initials: AH
authors.lastname: Cameron
authors.forename: F
authors.initials: F
authors.lastname: Raafat
authors.forename: M C
authors.initials: MC
authors.lastname: Stevens
authors.forename: B J
authors.initials: BJ
authors.lastname: Morland
authors.forename: P C
authors.initials: PC
authors.lastname: Barber
authors.forename: M P
authors.initials: MP
authors.lastname: Carey
authors.forename: H
authors.initials: H
authors.lastname: Fox
authors.forename: E L
authors.initials: EL
authors.lastname: Jones
authors.forename: H B
authors.initials: HB
authors.lastname: Marsden
authors.forename: J R
authors.initials: JR
authors.lastname: Pincott
authors.forename: J A
authors.initials: JA
authors.lastname: Pringle
authors.forename: H
authors.initials: H
authors.lastname: Reid
authors.forename: D I
authors.initials: DI
authors.lastname: Rushton
authors.forename: C M
authors.initials: CM
authors.lastname: Starkie
authors.forename: H L
authors.initials: HL
authors.lastname: Whitwell
authors.forename: D H
authors.initials: DH
authors.lastname: Wright
authors.forename: J R
authors.initials: JR
authors.lastname: Mann
mesh_terms: D002648:Child; D006801:Humans; D008511:Medicine; D009369:Neoplasms / Q000175:diagnosis*; D010340:Pathology, Surgical; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013038:Specialization