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AVALIAÇÃO DA CONFIABILIDADE ENTRE DOIS OBSERVADORES EM EXAMES CITOPATOLÓGICO E IMUNOCITOQUÍMICO DE ASPIRADO DE MEDULA ÓSSEA NO DIAGNÓSTICO DA LEISHMANIOSE VISCERAL CANINA
Alternative title
Reliability evaluation between two evaluators in the cytopathologic and immunocytochemical exams from bone marrow aspirate in the canine visceral leishmaniasis diagnosisAuthor
Affilliation
Universidade Federal Fluminense, Niterói, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia. Rio de Janeiro, RJ, Brasil.
Abstract
Visceral leishmaniasis is a zoonosis in which the dog appears as the main source of infection in urban
areas. Its diagnosis is complex and the cytopathological exam is a fast and cheap alternative to parasite
direct visualization and its sensitivity can be increased by immunocytochemistry, though with a higher
cost. The accuracy of such methods is dependent on the microscopist's experience and therefore, this
study evaluated the reliability of such techniques between two observers, from bone marrow aspirates of
50 dogs from an endemic area for the disease. The parasitological culture in Novy-MacNeal-Nicolle
medium was used as the reference standard. Among the main findings, the sensitivities obtained by
observers I and II were respectively 62.5% and 37.5%, while specificities were 81.1% and 100%. On immunocytochemistry evaluation, the sensitivity was 0% for both evaluators and the specificity 97.3%
and 100%. The agreement between evaluators was weak (κ = 0.167) for the cytopathological test and it
could not be evaluated for immunocytochemistry, for which there was no detection by the evaluator II.
The agreements among the diagnostic methods and the standard reference for the observer I were
reasonable (κ = 0.364) for cytopathological examination and bad (κ = -0.041) for immunocytochemistry.
For observer II, such agreement could be assessed only for the cytopathological test, being moderate (κ
= 0.497). The results point to the possible expertise difference between evaluators, with the evaluator II
demonstrating greater experience when interpreting the citopathological test. Although there was the expected sensitivity increase with immunocytochemistry, the technique used in this study was not effective for the diagnosis of infection, regardless of the evaluator.
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