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Interobserver reproducibility in pathologist interpretation of columnar-lined esophagus

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Abstract

Confirmation of endoscopically suspected esophageal metaplasia (ESEM) requires histology, but confusion in the histological definition of columnar-lined esophagus (CLE) is a longstanding problem. The aim of this study is to evaluate interpathologist variability in the interpretation of CLE. Thirty pathologists were invited to review three ten-case sets of CLE biopsies. In the first set, the cases were provided with descriptive endoscopy only; in the second and the third sets, ESEM extent using Prague criteria was provided. Moreover, participants were required to refer to a diagnostic chart for evaluation of the third set. Agreement was statistically assessed using Randolph’s free-marginal multirater kappa. While substantial agreement in recognizing columnar epithelium (K = 0.76) was recorded, the overall concordance in clinico-pathological diagnosis was low (K = 0.38). The overall concordance rate improved from the first (K = 0.27) to the second (K = 0.40) and third step (K = 0.46). Agreement was substantial when diagnosing Barrett’s esophagus (BE) with intestinal metaplasia or inlet patch (K = 0.65 and K = 0.89), respectively, in the third step, while major problems in interpretation of CLE were observed when only cardia/cardia-oxyntic atrophic-type epithelium was present (K = 0.05–0.29). In conclusion, precise endoscopic description and the use of a diagnostic chart increased consistency in CLE interpretation of esophageal biopsies. Agreement was substantial for some diagnostic categories (BE with intestinal metaplasia and inlet patch) with a well-defined clinical profile. Interpretation of cases with cardia/cardia-oxyntic atrophic-type epithelium, with or without ESEM, was least consistent, which reflects lack of clarity of definition and results in variable management of this entity.

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Acknowledgments

We thank Simona Pigozzi and Roberto Garavaglia for technical support.

Author information

Authors and Affiliations

  1. Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genoa, Via De Toni 14, 16132, Genoa, Italy

    Luca Mastracci, Nataniele Piol, Francesca Pitto, Roberto Fiocca & Federica Grillo

  2. IRCCS AOU S. Martino-IST, Largo Benzi 10, 16132, Genoa, Italy

    Luca Mastracci, Nataniele Piol, Francesca Pitto, Roberto Fiocca & Federica Grillo

  3. Department of Biomedical Sciences and Human Oncology, University of Turin, Via Santena 7, 10126, Turin, Italy

    Luca Molinaro

  4. Clinical Epidemiology and Biometric Unit, Foundation IRCCS Policlinico S. Matteo, Via Golgi 19, 27100, Pavia, Italy

    Carmine Tinelli & Annalisa De Silvestri

Authors
  1. Luca Mastracci
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  2. Nataniele Piol
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  3. Luca Molinaro
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  4. Francesca Pitto
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  5. Carmine Tinelli
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  6. Annalisa De Silvestri
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  7. Roberto Fiocca
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  8. Federica Grillo
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Consortia

on behalf of the ABRAM Study Group

Corresponding author

Correspondence to Luca Mastracci.

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Funding

This work was supported by University of Genoa Research grant (PRA) 2012, awarded to Luca Mastracci.

Conflict of interest

The authors have no conflicts of interest to declare.

Appendix

Appendix

Assessment of Barrett and its Reproducibility with Aim on Management (ABRAM) Study Group participants:

Alò PL (Pathology Unit, Fabrizio Spaziani Hospital, Frosinone); Al Omoush TMM (Pathology Unit, Riuniti University Hospitals, Trieste); Asioli S (Pathology Unit, G.B. Morgagni-L. Pierantoni Hospital, Forlì); Buffelli F (Pathology, Diagnostic, Bioimaging and Public Health Department, Pathology Unit, University of Bari and Policlinico Consorziale University Hospital, Bari); Conforti F (Pathology Unit, University of Magna Graecia and Mater Domini Hospital, Catanzaro); Cornaggia M (Diagnostic and Therapeutic Department, Pathology Unit, San Carlo Clinic, Paderno Dugnano, Milan, Italy); Cossu S (Pathology Unit, San Francesco Hospital, Nuoro); D’Armiento FP (Morphologic and Functional Diagnostic, Radiotherapy and Forensic Medicine Department, Pathology Unit, Federico II University Hospital, Napoli); De Marco L (Pathology Unit, S. Maria Nuova Arcispedale, Reggio Emilia), Fiocca R (Department of Surgical and Diagnostic Sciences, Pathology Unit, IRCCS S. Martino-IST University Hospital, Genoa); Foscolo AM (Pathology Unit, Castelli Hospital, Verbania); Fraternali Orcioni G (Pathology Unit, IRCCS S. Martino-IST University Hospital, Genoa), Ingravallo G (Pathology, Diagnostic, Bioimaging and Public Health Department, Pathology Unit, Policlinico Consorziale University Hospital, Bari), Locatelli F (Biomedic and Neuromotor Sciences Department, Pathology Unit, University of Bologna and M. Malpighi Bellaria Hospital, Bologna); Luinetti O (Diagnostic Medicine and Medicine of Services Department, Pathology Unit, IRCCS San Matteo, Pavia), Marchio C (Laboratory Medicine Department, Pathology Unit, Le Molinette University Hospital, Torino), Montinari E (Diagnostic and Sperimental Medicine Department, Pathology Unit, Arcispedale Sant’Anna University Hospital, Ferrara); Melchiorri L (Clinical Medicine, Public Health, Life and Environment Sciences Department University of l’Aquila and “San Salvatore” Hospital, l’Aquila); Messerini L (Pathology Unit, Careggi University Hospital, Firenze); Migliora P (Pathology Unit, S. Andrea Hospital, Vercelli); Pizzi M (Pathology Unit, University of Padova and Padova University Hospital, Padova), Rugge M (Pathology Unit, University of Padova and Padova University Hospital, Padova), Saragoni L (Pathology Unit, AUSL Forlì, Forlì,); Tamponi E (Pathologic Anatomy and Histopathology Department, University of Cagliari and San Giovanni di Dio University Hospital, Cagliari); Tomezzoli A (Pathology and Diagnostic Department, Pathology Unit, Verona University Hospital, Verona); Trisolini MP (Pathology Unit, Vito Fazzi University Hospital, Lecce); Trombatore M (Laboratory Diagnostic Department, Pathology Unit, Paolo Giaccone University Hospital, Palermo); Vanoli A (Diagnostic Medicine and Medicine of Services Department, Pathology Unit, IRCCS San Matteo, Pavia); Vellone VG (Laboratory and Services Department, Pathology Unit, Giovanni Paolo II Foundation of Research and Cure, Campobasso); and Villanacci V (Pathology Unit, Spedali Civili, Brescia).

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Mastracci, L., Piol, N., Molinaro, L. et al. Interobserver reproducibility in pathologist interpretation of columnar-lined esophagus. Virchows Arch 468, 159–167 (2016). https://doi.org/10.1007/s00428-015-1878-5

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