OBSERVER VARIATION IN THE DIAGNOSIS OF DYSPLASIA IN BARRETTS ESOPHAGUS
OBSERVER VARIATION IN THE DIAGNOSIS OF DYSPLASIA IN BARRETTS ESOPHAGUS
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DOI：
10.1016/s0046-8177(88)80344-7
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发表时间：
1988-02-01
期刊：
影响因子：
3.3
通讯作者：
OWEN, D
中科院分区：
文献类型：
--
作者：
REID, BJ;HAGGITT, RC;OWEN, D
由于对不典型增生的诊断标准缺乏一致意见，对Barrett‘S食道不典型增生患者进行活检监测的潜在价值被削弱。在一次初步的共识会议上，来自四个医学中心的经验丰富的胃肠道病理学家就Barrett‘’S食道异型增生的五级组织学分类标准达成一致。sbd阴性异型增生，不确定异型增生，低级别异型增生，高级别异型增生和粘膜内癌。四个中心的八名形态学者通过检查一组编码的幻灯片来测试观察者之间的一致性标准，这些编码的幻灯片被选为在所有五种组织学分类中包括一些特别困难的解释问题。当高度不典型增生和粘膜内癌的联合组与低度不典型增生的联合组比较时，观察者间的符合率分别为85%和87%，不确定为不典型增生，阴性为不典型增生。对其他组的比较得出的一致程度较低。例如，异型增生的阴性可以与所有其他诊断区分开来，观察者间的符合率为72%。我们的结论是，经验丰富的胃肠形态医生可以诊断高度不典型增生和粘膜内癌，并因此可以发现那些可能需要立即重新活检或食道切除的患者。需要进一步完善组织学标准或替代诊断方法，以实现对不确定变化和低度不典型增生的可重复性诊断。这一点很重要，因为从理论上讲，有这种变化的患者应该接受更密切的内窥镜监测。
The potential value of biopsy surveillance of patients with Barrett''s esophagus for dysplasia is diminished by a lack of agreement on the diagnostic criteria for dysplasia. In a preliminary consensus conference, experienced gastrointestinal pathologists from four medical centers agreed on criteria for a five-tiered histologic classification of dysplasia in Barrett''s esophagus.sbd.negative for dysplasia, indefinite for dysplasia, low-grade dysplasia, high-grade dysplasia, and intramucosal carcinoma. Eight morphologists in the four centers tested the criteria for interobserver agreement by examining a set of coded slides that had been chosen to include some especially difficult interpretative problems in all five histologic classifications. Interobserver agreement of 85 and 87% was achieved in successive reviews when the combined group of high-grade dysplasia and intramucosal carcinoma was compared with combined group of low-grade dysplasia, indefinite for dysplasia, and negative for dysplasia. Comparison of other groups yielded less agreement. For example, negative for dysplasia could be distinguished from all other diagnoses with an interobserver agreement of 72%. We conclude that experienced gastrointestinal morphologists can diagnose high-grade dysplasia and intramucosal carcinoma with a high degree of agreement and thus can detect those patients who may need immediate rebiopsy or esophageal resection. Either further refinement of histologic criteria or alternate diagnostic methods will be needed to achieve the reproducible diagnosis of indefinite changes and low-grade dysplasia. This is important because patients with such changes theoretically merit closer endoscopic surveillance.