Interobserver reproducibility of a hybrid three‐tier grading system of papillary nonmuscle invasive urothelial carcinoma: an international Uropathology study
Bibliographic record
Abstract
AIMS: A hybrid-three tier system with low grade (LG), high grade- G2 (HG-G2), high grade- G3 (HG-G3) has been proposed in recognition of, and to help address, the clinical heterogeneity within high grade WHO 2004/2022. We assessed interobserver reproducibility amongst international uropathologists using this three-tier approach. METHODS AND RESULTS: Papillary Ta nonmuscle invasive bladder cancer (NMIBC) specimens (n = 30) were selected and graded by two uropathologists and assessed using WHO 2004/2022 and WHO 1973 and categorized as LG (n = 15), HG-G2 (n = 8), HG-G3 (n = 7), and photographed at 10× and 20× magnification. Images were circulated via Survey Monkey to invited uropathologists who determined: (1) that image was LG or HG, and (2) if HG, assigned to G2 or G3. Model-based kappa measure of association was used to assess interrater agreement. Eighteen uropathologists:(eight North American, eight European, two other) assessed 60 images with 1076 gradings for analysis. The kappa value amongst Europeans versus North Americans was 0.663 versus 0.647 for 10× images and 0.682 versus 0.623 for 20× images. At 10×, agreement for LG, HG-G2, and HG-G3 was 74.6%, 63.6%, and 92.0%, and at 20× was 64.3%, 63.9%, and 95.2% respectively. CONCLUSION: Three-tier grading of papillary Ta NMIBC had substantial interobserver agreement amongst international uropathologists. The recognition of the HG-G3 case reached the highest concordance. North American uropathologists had comparable kappa scores (substantial agreement) to Europeans, despite being unaccustomed to separating HG cases into G2 and G3, demonstrating three-tier grading could be "quickly" adopted by genitourinary experts if endorsed and required by the relevant bodies in their jurisdiction of practice.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".