Diagnosing Barrett's esophagus: reliability of clinical and pathologic diagnoses
Diagnosing Barrett's esophagus: reliability of clinical and pathologic diagnoses
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DOI：
10.1016/j.gie.2008.07.035
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发表时间：
2009-05-01
影响因子：
7.7
通讯作者：
Rumore, Gregory J.
中科院分区：
文献类型：
--
作者：
Corley, Douglas A.;Kubo, Ai;Rumore, Gregory J.
背景资料：Barrett食管诊断的准确性还没有得到很好的研究。目的：我们的目的是评估临床Barrett食管诊断的准确性和食管肠化生诊断的可重复性。方法：所有1994年至2005年诊断为Barrett食管的患者均使用国际疾病分类（ICD）和系统化医学命名法（SNOMED）进行识别编码亚组接受手动记录审查（内窥镜检查/病理学报告）、转诊病理学家的载玻片审查（评价者间可靠性）和同一病理学家的2次盲态审查（评价者间可靠性）。背景：综合卫生服务提供系统。主要结局指标：电子临床诊断的准确性和食管肠化生diagnosis.Results的可重复性：共2470例患者编码与巴雷特食管进行记录审查;一个亚组（616）接受手动病理切片审查。审查确认了1533例（61.9%）患者的Barrett食管诊断; 798例受试者中有437例（54.8%）仅诊断为SNOMED，671例受试者中有153例（26.8%）仅诊断为ICD，1101例受试者中有940例（85%）同时诊断为SNOMED和ICD。88.3%的受试者发生了相同的化生诊断，（内部可靠性;同一病理学家2次审查; kappa = 0.65，95%CI，0.35-0.93）。局限性：考虑到严格的标准，Barrett食管诊断的准确性可能代表最小数量。社区病理学家对食管肠化生的诊断很可能由转诊病理学家确认。Barrett食管的电子诊断高估了患病率，尽管它们通常在SNOMED和ICD诊断的Barrett食管患者中得到证实。（Gastrointest Endosc 2009;69：1004-10）
Background: The accuracy of a Barrett's esophagus diagnosis is not well studied.Objective: Our purpose was to evaluate the accuracy of a clinical Barrett's esophagus diagnosis and the reproducibility of an esophageal inestinal metaplasia diagnosis.Methods: All patients with a Barrett's esophagus diagnosis between 1994 and 2005 were identified by use of International Classification of Disease (ICD) and Systematized Nomenclature of medicine (SNOMED) coding. Subsets received manual record review (endoscopy/pathology reports), slide review by a referral pathologist (interrater reliability), and 2 blinded reviews by the same pathologist (intrarater reliabilty). Setting: An integrated health services delivery system. Main Outcome Measurements: Accuracy of electronic clinical diagnosis and reproducibility of esophageal intestinal metaplasis diagnosis.Results: A total of 2470 patients coded with Barrett's esophagus underwent record review; a subgroup (616) received manual pathology slide review. Review confirmed a Barrett's esophagus diagnosis for 1533 (61.9%) patients; 437 of 798 Subjects (54.8%) with a SNOMED diagnosis alone, 153 of 671 subjects (26.8%) with an ICD diagnosis alone, and 940 of 1101 subjects (85%) who had both a SNOMED and an ICD diagnosis. The same metaplasia diagnosis occured with 88.3% of subjects original vs referral pathologist, (intrarater reliabiltiy; 2 reviews by same pathologist; kappa = 0.65, 95% CI, 0.35-0.93).Limitations: The accuracy, of a Barrett's esophagus diagnosis likely represents the minimum number, given the strict criteriaConclusions: A community pathologist's diagnosis of esophageal intestinal metaphasia is likely to be confirmed by a referral pathologist. Electronic diagnoses of Barrett's esophagus overestimate the prevalence, although they re usually, confirmed in patients with both a SNOMED and ICD diagnosis of Barrett's esophagus. (Gastrointest Endosc 2009;69:1004-10)