{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:51:40Z","timestamp":1787014300735,"version":"build-2736575974"},"reference-count":24,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T00:00:00Z","timestamp":1630627200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>\n                      Most vulvar squamous cell carcinomas are\u2009human papillomavirus (HPV)\u2010associated or\n                      <jats:italic>TP53<\/jats:italic>\n                      \u2010mutant. A third category of HPV\u2010independent\n                      <jats:italic>TP53<\/jats:italic>\n                      \u2010wild\u2010type lesions is uncommon and not fully understood. Differentiated exophytic vulvar intraepithelial lesion (DEVIL) has been characterised as a precursor of this latter category. The reproducibility of the diagnosis of DEVIL and its distinction from lesions with overlapping morphology has not been studied. Our aim was to establish the interobserver agreement in the diagnosis of DEVIL and its distinction from neoplastic and reactive conditions of the vulva on haematoxylin and eosin evaluation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>\n                      A set of 35 slides was evaluated by eight reviewers (two trainees and six practising gynaecological pathologists). The set included DEVIL, condyloma, established vulvar precursors [high\u2010grade squamous intraepithelial lesion (HSIL) and differentiated vulvar intraepithelial neoplasia (dVIN)] with superimposed acanthosis or verruciform growth, lichen simplex chronicus (LSC), and psoriasis. Kappa (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      ) values were calculated. Overall, interobserver agreement was moderate (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.56), improving to substantial (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.7) when evaluation was performed by practising pathologists. Agreement was strong for the diagnosis of HSIL (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.88), and substantial for the diagnosis of DEVIL (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.61), condyloma (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.79), and LSC (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.72). Agreement was moderate for the diagnosis of dVIN (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.59) and psoriasis (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.53). Perfect agreement (6\/6) among practising pathologists was observed in 43% of cases, and majority agreement (5\/6 or 4\/6) was observed in 48% of cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Reproducibility in the diagnosis of verruciform vulvar lesions, including the novel DEVIL, is acceptable overall. Reproducibility is higher for well\u2010known lesions such as HSIL and condyloma than for more challenging diagnoses such as DEVIL, dVIN, and psoriasis. Agreement is higher among practising gynaecological pathologists, suggesting that training and experience improve reproducibility. Our findings support the inclusion of DEVIL as a diagnostic entity in the classification of vulvar squamous lesions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/his.14442","type":"journal-article","created":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T13:55:05Z","timestamp":1625234105000},"page":"957-965","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Interobserver reproducibility of the diagnosis of differentiated exophytic vulvar intraepithelial lesion (DEVIL) and the distinction from its mimics"],"prefix":"10.1111","volume":"79","author":[{"given":"Grace","family":"Neville","sequence":"first","affiliation":[{"name":"Division of Women\u2019s and Perinatal Pathology Department of Pathology Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9733-5442","authenticated-orcid":false,"given":"David B","family":"Chapel","sequence":"additional","affiliation":[{"name":"Division of Women\u2019s and Perinatal Pathology Department of Pathology Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P","family":"Crum","sequence":"additional","affiliation":[{"name":"Division of Women\u2019s and Perinatal Pathology Department of Pathology Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon J","family":"Song","sequence":"additional","affiliation":[{"name":"Division of Women\u2019s and Perinatal Pathology Department of Pathology Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ju\u2010Yoon","family":"Yoon","sequence":"additional","affiliation":[{"name":"Division of Women\u2019s and Perinatal Pathology Department of Pathology Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth R","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Women\u2019s and Perinatal Pathology Department of Pathology Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L","family":"Kolin","sequence":"additional","affiliation":[{"name":"Division of Women\u2019s and Perinatal Pathology Department of Pathology Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle S","family":"Hirsch","sequence":"additional","affiliation":[{"name":"Division of Women\u2019s and Perinatal Pathology Department of Pathology Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marisa R","family":"Nucci","sequence":"additional","affiliation":[{"name":"Division of Women\u2019s and Perinatal Pathology Department of Pathology Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1420-7291","authenticated-orcid":false,"given":"Carlos","family":"Parra\u2010Herran","sequence":"additional","affiliation":[{"name":"Division of Women\u2019s and Perinatal Pathology Department of Pathology Brigham and Women\u2019s Hospital Harvard Medical School Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,9,3]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"World Health Organization classification of tumours of the female reproductive organs","author":"WHO Classification of Tumours Editoral Board 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interobserver agreement: the kappa statistic","volume":"37","author":"Viera AJ","year":"2005","journal-title":"Fam. Med."},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.13989"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2020.09.024"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijms21218091"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/his.14238"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/PGP.0000000000000509"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/PGP.0000000000000620"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/PGP.0000000000000263"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2012.235"},{"key":"e_1_2_7_23_1","first-page":"740","article-title":"Non\u2010invasive verruciform lesions of the vulva: a comparison of clinical, histological and recurrence parameters","volume":"34","author":"Roy S","year":"2021","journal-title":"Mod. Pathol."},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.path.2019.01.001"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41379-020-00651-3"}],"container-title":["Histopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.14442","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/his.14442","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/his.14442","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,23]],"date-time":"2023-08-23T16:47:16Z","timestamp":1692809236000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/his.14442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,3]]},"references-count":24,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1111\/his.14442"],"URL":"https:\/\/doi.org\/10.1111\/his.14442","archive":["Portico"],"relation":{},"ISSN":["0309-0167","1365-2559"],"issn-type":[{"value":"0309-0167","type":"print"},{"value":"1365-2559","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,3]]},"assertion":[{"value":"2021-05-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-07-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-09-03","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}