Greater lnterobserver Agreement by Endoscopic Mucosal Resection Than Biopsy Samples in Barrett's Dysplasia
Greater lnterobserver Agreement by Endoscopic Mucosal Resection Than Biopsy Samples in Barrett's Dysplasia
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DOI：
10.1016/j.cgh.2010.04.028
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发表时间：
2010-09-01
影响因子：
12.6
通讯作者：
Sharma, Prateek
中科院分区：
文献类型：
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作者：
Wani, Sachin;Mathur, Sharad C.;Sharma, Prateek
背景与目的：内镜下粘膜切除术（EMR）是治疗Barrett食管（BE）相关肿瘤的重要诊断、分期和治疗工具。我们分析了EMR期间收集的标本与BE患者活检标本的组织病理学特征，并评估了病理学家对EMR和活检标本评估的观察者间差异。方法：我们评价了从2个三级转诊中心的BE患者中收集的EMR（n = 251）和活检（n = 269）标本。对每个EMR和活检标本进行详细的组织学分析，以确定异型增生的等级、标本的深度、异型增生标本的比例和样本的质量。使用kappa统计量计算活检和EMR标本的观察者间一致性（在4名经验丰富的病理学家中）。结果：组织学分析显示，与活检标本相比，大多数EMR中存在粘膜下层（88% vs 1%，P <0.0001）。几乎所有活检标本（99%）包括固有层。然而，只有58%的活检标本中观察到粘膜肌层。对于EMR和活检标本，最高级别的异型增生占标本的50%。EMR标本的观察者间对异型增生诊断的一致性显著高于活检标本（低度异型增生，0.33 vs 0.22，P <0.001;高度异型增生，0.43 vs 0.35，P = 0.018）。结论：从EMR中采集的大多数样本均可检查到粘膜下层;活检和EMR标本中肿瘤的分布是局灶性的。在对EMR样本的分析中，病理学家之间的观察者间一致性比活检标本诊断异型增生的一致性更高。
BACKGROUND & AIMS: Endoscopic mucosal resection (EMR) is an important diagnostic, staging, and therapeutic tool for patients with Barrett's esophagus (BE)-associated neoplasia. We analyzed the histopathologic characteristics of specimens collected during EMR compared with biopsy specimens from patients with BE and assessed interobserver variability in pathologists' assessment of EMR and biopsy specimens. METHODS: We evaluated EMR (n = 251) and biopsy (n = 269) specimens collected from patients with BE at 2 tertiary referral centers. A detailed histologic analysis was performed for each EMR and biopsy specimen to determine the grade of dysplasia, depth of the specimen, proportion of specimen with dysplasia, and quality of samples. Interobserver agreement for both biopsy and EMR specimens (among 4 experienced pathologists) was calculated by using kappa statistics. RESULTS: Histologic analysis showed that submucosa was present in the majority of EMRs, compared with biopsy specimens (88% vs 1%, P < .0001). Almost all biopsy specimens (99%) included lamina propria. However, the muscularis mucosa was observed in only 58% of biopsy specimens. For both EMR and biopsy specimens, the highest grade of dysplasia comprised 50% of the specimens. Interobserver agreement on the diagnosis of dysplasia was significantly greater for EMR specimens than biopsy specimens (low-grade dysplasia, 0.33 vs 0.22, P < .001; high-grade dysplasia, 0.43 vs 0.35, P = .018). CONCLUSIONS: Submucosa can be examined in most samples collected from EMR; the distribution of neoplasia is focal within biopsy and EMR specimens. There is more interobserver agreement among pathologists in the analysis of EMR samples than biopsy specimens for the diagnosis of dysplasia.