Reproducibility of the diagnosis of dysplasia in Barrett esophagus: A reaffirmation
Reproducibility of the diagnosis of dysplasia in Barrett esophagus: A reaffirmation
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DOI：
10.1053/hupa.2001.23510
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发表时间：
2001-04-01
期刊：
影响因子：
3.3
通讯作者：
Washington, K
中科院分区：
文献类型：
--
作者：
Montgomery, E;Bronner, MP;Washington, K
尽管存在局限性，Barrett食管异型增生的形态学评估仍然是治疗的基础。我们严格测试了1988年修订的标准，评估观察者内和观察者间的重现性。参与者提交了Barrett粘膜阴性（BE）和不确定（IND）的不典型增生、低度不典型增生（LGD）和高度不典型增生（HGD）以及癌的切片。将250个载玻片分为2组。前125张切片由12名胃肠道病理学家在不了解既往诊断的情况下进行了2次审查，事先未讨论标准。通过kappa统计分析结果，该统计纠正了偶然的一致性。然后召开共识会议，通过对索引125张载玻片进行分组审查，确立本文概述的标准。第二组125张载玻片，由相同的12名病理学家每人审查两次，并计算随访kappa统计量。当使用2个广泛的诊断类别（BE、IND和LG v HG和癌）进行统计分析时，在共识会议之前和之后，观察者内一致性接近完美（平均kappa = 0.82和0.80）。观察者间的一致性是实质性的（kappa = 0.66），并在共识会议后得到改善（kappa = 0.70; P = 0.02）。当使用4种临床相关分离（BE; IND和LCD; HGD;癌）进行统计分析时，共识会议后平均观察者内kappa从0.64改善至0.68（均为实质性），平均观察者间kappa从0.43改善至0.46（均为中度一致）。当使用需要区分LGD和IND的4个诊断类别（BE; IND; LGD; HGD和癌）进行统计分析时，共识会议前平均观察者内kappa值为0.60（基本一致），会议后提高到0.65（P
Morphologic assessment of dysplasia in Barrett esophagus, despite limitations, remains the basis of treatment. We rigorously tested modified 1988 criteria, assessing intraobserver and interobserver reproducibility. Participants submitted slides of Barrett mucosa negative (BE) and indefinite (IND) for dysplasia, with low-grade dysplasia (LGD) and high-grade dysplasia (HGD), and with carcinoma. Two hundred fifty slides were divided into 2 groups. The first 125 slides were reviewed, without knowledge of the prior diagnoses, on 2 occasions by 12 gastrointestinal pathologists without prior discussion of criteria. Results were analyzed by kappa statistics, which correct for agreement by chance. A consensus meeting was then held, establishing, by group review of the index 125 slides, the criteria outlined herein. The second 125-slide set,vas then reviewed twice by each of the same 12 pathologists, and follow-up kappa statistics were calculated. When statistical analysis was performed using 2 broad diagnostic categories (BE, IND, and LG v HG and carcinoma), intraobserver agreement was near perfect both before and after the consensus meeting (mean kappa = 0.82 and 0.80). Interobserver agreement was substantial (kappa = 0.66) and improved after the consensus meeting (kappa = 0.70; P =.02). When statistical analysis was performed using 4 clinically relevant separations (BE; IND and LCD; HGD; carcinoma), mean intraobserver kappa improved from 0.64 to 0.68 (both substantial) after the consensus meeting, and mean interobserver kappa improved from 0.43 to 0.46 (both moderate agreement). When statistical analysis was performed using 4 diagnostic categories that required distinction between LGD and IND (BE; IND; LGD; HGD and carcinoma), the pre-consensus meeting mean intraobserver kappa was 0.60 (substantial agreement), improving to 0.65 after the meeting (P