Interobserver Agreement and Diagnostic Challenges of Congo Red Staining for Amyloid Detection on Fat Pad Aspiration Biopsies

IntroductionCongo red staining of fat pad fine needle aspiration (FNA) specimens is a method utilized for evaluation of amyloid deposition. However, these specimens can pose diagnostic challenges for cytopathologists. As part of ongoing internal quality improvement measures, the objective of this study was to evaluate the intradepartmental interobserver agreement of these specimens and to identify factors that affect the variability of the interpretations.Materials and MethodsThere were 7 participants, which included 3 trainees, 3 cytopathologists, and 1 cytotechnologist. Each participant reviewed 50 Congo red stained fat pad FNA slides. The interpretations were categorized into 3 groups: negative, indeterminate/suspicious, and positive. The participants also noted any interpretation challenges they encountered for each case.ResultsThere was only slight interobserver agreement among all participants (κ=0.133). Stratified by participant group, the interobserver agreement among the trainees was slight bordering on poor (κ=0.028) and among cytopathologists was fair (κ=0.249). The highest agreement between two observers was between two cytopathologists and the level of agreement was moderate bordering on fair (κ=0.426). There were only 3 cases (6.0%) with full agreement among observers, while in 25 cases (50.0%), there were two category differences in interpretations. The primary diagnostic challenge reported by participants was when weak or focal birefringence was encountered as well as cases complicated by poor stain quality and overstaining.ConclusionsWe found only slight interobserver agreement among all study participants. A major area of challenge was cases with weak birefringence resulting in high variance of interpretation among participants.