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Interobserver reproducibility in pathologist interpretation of columnar-lined esophagus

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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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We thank Simona Pigozzi and Roberto Garavaglia for technical support.

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Correspondence to Luca Mastracci.

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

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The authors have no conflicts of interest to declare.



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).

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