Purpose: The main goal of this study was to assess the histopathological efficacy of renal mass biopsy and to check the concordance between pathological results and biopsy of the final specimen, as well as Interobserver variability in the assessment of biopsy cores. Materials and Methods: A hundred sets of core biopsies of postoperative specimens (renal masses) have been performed. Three core biopsies of the intact specimen had been performed once the kidney with the tumor, or the tumor alone were resected. The urologist aimed to obtain two cores from the peripheral sides of the tumor and one core from its center. The surgical specimen was evaluated by a single pathologist, whereas biopsy samples were referred to three independent pathologists who were blinded to the final results of the renal mass biopsy. Results: Nondiagnostic biopsy rates ranged from 13% to 22%. Sensitivity and specificity ranged 83-97% and 97-99% by excluding nondiagnostic results. The concordance between assessment of surgical specimen and biopsy in the Fuhrman grading system ranged 36. 5-77. 0%, respectively. Interobserver agreement between the three pathologists was substantial or moderate, depending on the tumor subtype. The Krippendorff's alpha coefficient, calculated by excluding the nondiagnostic results, was 0. 28 (moderate agreement) for the Fuhrman grading system. Conclusion: The agreement regarding grading of biopsies between three pathologists ranged from moderate to substantial. Therefore, a team of dedicated uropathologists should be engaged in final diagnosis of renal mass biopsy rather than single one before implementing the proper treatment.

Background: Treatment recommendations for trapeziometacarpal (TMC) arthrosis are highly variable from surgeon to surgeon. This study addressed the influence of viewing radiographs on a decision to offer surgery for TMC arthrosis. Methods: In an online survey, 92 hand surgeons viewed clinical scenarios and were asked if they would offer surgery to 30 patients with TMC arthrosis. Forty-two observers were randomly assigned to review clinical information alone and 50 to review clinical information as well as radiographs. The degree of limitation of daily activities, time since diagnosis, prior treatment, pain with grind, crepitation with grind, and metacarpal adduction with metacarpophalangeal hyperextension were randomized for each patient scenario to determine the influence of these factors on offers of surgery. A cross-classified binary logistic multilevel regression analysis identified factors associated with surgeon offer of surgery. Results: Surgeons were more likely to offer surgery when they viewed radiographs (42% vs. 32%, P = 0. 01). Other factors associated variation in offer of surgery included greater limitation of daily activities, symptoms for a year, prior splint or injection, deformity of the metacarpophalangeal joint. Factors not associated included limb dominance, prominence of the TMC joint, crepitation with the grind test, and pinch and grip strength. Conclusion: Surgeons that view radiographs are more likely to offer surgery to people with TMC arthrosis. Surgeons are also more likely to offer surgery when people do not adapt with time and nonoperative treatment. Given the notable influence of surgeon bias, and the potential for surgeon and patient impatience with the adaptation process, methods for increasing patient participation in the decision-making process merit additional attention and study.

Modified Essay Questions (MEQs) are often included in high-stakes examinations to assess higher-order cognitive skills. If the marking guides for MEQs are inadequate, this can lead to inconsistencies in marking. To ensure the reliability of MEQs as a subjective assessment tool, candidates’ responses are typically evaluated by two or more assessors. Previous studies have examined the impact of marker variance. Current study explores the possibility of assigning a single assessor to mark the students' performances in MEQ based on statistically drawn evidence in the clinical phase of the MBBS program at a private medical school in Malaysia. A robust evaluation method was employed to determine whether to continue with two raters or shift to a single-rater scheme for MEQs, using the Discrepancy-Agreement Grading (DAG) System for evaluation. A low standard deviation was observed across all 11 pairs of scores, with insignificant t-statistics (P>0.05) in 2 pairs (18.18%) and significant t-statistics (P<0.05) in 9 pairs (81.81%). The Intraclass Correlation Coefficient (ICC) results were excellent, ranging from .815 to .997, all with P<0.001. Regarding practical effect size (Cohen’s d), 1 pair (9.09%) was categorized as having a strong effect size (>0.8), 7 pairs (63.63%) as having a moderate effect size (0.5-<0.8), and 3 pairs (27.27%) as having a weak effect size (0.2-<0.5). The data analysis suggests that it is feasible to consider marking MEQ items by a single assessor without negatively impacting the reliability of the MEQ as an assessment tool.

Background: Inter-observer variability among pathologists' reports has been a significant challenge in the diagnosis of diseases, especially cancers. Designing a grading system with minimal inter-observer variability can help achieve more accurate diagnoses. Objectives: We aimed to determine whether the grading system proposed by Cheng and colleagues (Cheng’s grading system) can improve inter-observer variability among pathologists in grading urothelial cancer, compared with the World Health Organization (WHO) grading system (2004/2016). Methods: Four pathologists examined all slides of bladder biopsy samples diagnosed as urothelial carcinoma, available in the archives of Imam Reza Hospital, Mashhad, Iran, from 2019 to 2022. Each pathologist reported the tumor grade based on both grading systems, independently of previous answers or the reports of their colleagues. Results: Of 132 samples, the majority were from men (84.1%); the mean age of patients was 66.56±11.31 years. For low and high grades of the WHO system and grade II in Cheng’s grading system, κ = 0.602; agreement was lower for grade III (κ = 0.439) and higher for grade IV (κ = 0.690) compared with the WHO grading system. There was significant agreement among the pathologists in all tumor characteristics, with excellent agreement for stromal invasion (κ = 0.790) and muscular invasion (κ = 0.884), fair to good agreement for WHO 2004/2016 grading (κ = 0.602) and Cheng’s grading (κ = 0.574) overall, and poor agreement for tumor heterogeneity (κ = 0.360). Conclusions: Both grading systems demonstrated favorable agreement among pathologists, without significant differences between the two systems. These results confirm the appropriateness of both grading systems.

Background & Objective: Most colorectal cancers (CRCs) arise from adenomatous polyps, and clinical management of this type of polyp is highly dependent on the reliability and validity of the pathological diagnosis. The aim of this study was to examine the Interobserver agreement of five pathologists in assessing dysplasia in adenomatous polyps. Methods: In this study, a total of 146 adenomatous polyps of patients undergoing colonoscopy were selected from hospitals of Shahid Beheshti University of Medical Sciences, Tehran, Iran between 2017 and 2018. Five pathologists independently classified adenomatous polyps according to histologic type, nuclear pseudostratification, mitotic activity, nuclear polarity, nuclear pleomorphism, nuclear shape, nucleolus, chromatin pattern, cytology grade, architectural features, dysplasia, and final diagnosis. The overall kappa statistic (k) was used to assess agreement among pathologists. Results: The mean age of the patients was 62. 06 ± 13. 06 (mean ± SD) with a male-to-female ratio of 2. 2: 1. The most common site of resection was the sigmoid colon (28. 1%). The highest agreement was found for dysplasia grade (k=0. 415) and histologic type (k=0. 401), whereas the lowest agreement was found for mitotic activity (k=0. 185), nuclear shape (k=0. 187), and nucleolus (k=0. 196). Conclusion: Our findings indicate that agreement among pathologists in assessing dysplasia in adenomatous polyps is within fair to moderate levels of agreement. Therefore, there is a vital need to better clarify the current diagnostic criteria.