Poor Interobserver Agreement in the Distinction of High-Grade Dysplasia and Adenocarcinoma in Pretreatment Barrett's Esophagus Biopsies
Poor Interobserver Agreement in the Distinction of High-Grade Dysplasia and Adenocarcinoma in Pretreatment Barrett's Esophagus Biopsies
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DOI：
10.1111/j.1572-0241.2008.02020.x
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发表时间：
2008-09-01
影响因子：
9.8
通讯作者：
Goldblum, John R.
中科院分区：
文献类型：
--
作者：
Downs-Kelly, Erinn;Mendelin, Joel E.;Goldblum, John R.
目的：Barrett‘s异型增生分级位于化生-异型增生谱的低端(阴性、不确定和低级别异型增生)，观察者间的一致性很差，甚至在胃肠道病理学家之间也是如此。评估Barrett粘膜活检与异常增殖谱(高度不典型增生、粘膜内腺癌和粘膜下腺癌)上端变化的观察者间一致性的数据尚未公布。治疗前活检的准确分类推动了治疗决策，但如果巴雷特活检中癌症和高度不典型增生之间的诊断区分不一致，那么使用这些诊断来做出管理决策是值得怀疑的。为此，我们的目的是评估一组胃肠道病理学家在解释剖检活检时的重复性。方法：所有研究的病理学家都同意区分四种诊断类别的组织学标准，包括高度异型增生；高度异型增生伴明显的腺体结构扭曲，不能排除粘膜内腺癌、粘膜内腺癌和粘膜下侵袭性腺癌。组织学标准被用来独立审查连续163例Barrett‘s食道患者的切除前活检，这些患者至少有高度不典型增生，最终接受了食道切除术。评价者记录用于对每个病例进行分类的特定组织学标准，并计算Kappa统计量来评估观察者间的一致性。结果：使用Kappa统计量，总体一致性仅为一般(K=0.30)。对于高度异型增生的一致性为中等(K=0.47)，对于高度异型增生伴明显结构扭曲的一致性仅为一般(K=0.21和0.30)，对于粘膜下腺癌的一致性较差(K=0.14)。结论：胃肠道病理学家看到大量Barrett病例的胃肠道病理学家之间的总体较差的重复性使治疗方案受到质疑，因为假设活检标本中可以可靠地区分高度异型增生、粘膜内腺癌和粘膜下腺癌。
OBJECTIVE: Grading Barrett's dysplasia at the lower end of the metaplasia-dysplasia spectrum (negative, indefinite, and low-grade dysplasia) suffers from poor interobserver agreement, even among gastrointestinal pathologists. Data evaluating interobserver agreement in Barrett's mucosal biopsies with changes at the upper end of the dysplasia spectrum (high-grade dysplasia, intramucosal, and submucosal adenocarcinoma) have not been published. The accurate categorization of pretreatment biopsies drives therapeutic decision making, but if the diagnostic distinction between cancer and high-grade dysplasia in Barrett's biopsies is inconsistent, then the use of these diagnoses to make management decisions is suspect. To this end, our aim was to assess interobserver reproducibility among a group of gastrointestinal pathologists in the interpretation of preresection biopsies.METHODS: All study pathologists agreed upon the histologic criteria distinguishing four diagnostic categories, including high-grade dysplasia; high-grade dysplasia with marked distortion of glandular architecture, cannot exclude intramucosal adenocarcinoma; intramucosal adenocarcinoma; and submucosally invasive adenocarcinoma. The histologic criteria were used to independently review preresection biopsies from 163 consecutive Barrett's esophagus patients with at least high-grade dysplasia who ultimately underwent esophagectomy. Reviewers recorded the specific histologic criteria used to categorize each case and Kappa statistics were calculated to assess interobserver agreement.RESULTS: Using kappa statistics, the overall agreement was only fair (K = 0.30). Agreement for high-grade dysplasia was moderate (K = 0.47), while agreement for high-grade dysplasia with marked architectural distortion, cannot exclude intramucosal adenocarcinoma and intramucosal adenocarcinoma were only fair (K = 0.21 and 0.30, respectively) and agreement for submucosal adenocarcinoma was poor (K = 0.14).CONCLUSIONS: The overall poor interobserver reproducibility among gastrointestinal pathologists who see a high volume of Barrett's cases calls into question treatment regimens based on the assumption that high-grade dysplasia, intramucosal adenocarcinoma, and submucosal adenocarcinoma can reliably be distinguished in biopsy specimens.