Observer error in bone disease description : a cautionary note

The aim of this paper is to examine the accuracy of pathological description on human bones. Ten participants (five forensic pathologists and five anthropologists) were asked to describe 30 bone lesions through observation of the real specimens and photographic images, including character of the lesion, the aspect of the margins and the presence of periosteal new bone, according to recognized and accepted pathological terminology on dry bone. Results were analysed using statistical analysis and interobserver and intraobserver agreements were tested. The anthropologists showed slightly more consistent and accurate results compared with the forensic pathologists, and overall results were better when assessed on the real specimens. Lesion descriptions showed important contradictions and inaccuracies, particularly in the evaluation of the character of the lesion and periosteal new bone, with dramatic potential consequences for the diagnosis of bone disease. This study shows the considerable pitfalls in the assessment of basic pathological bone manifestations and demonstrates the importance of continuing efforts in the standardization of pathological terminology on dry bone.