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Inter- and Intraobserver Reliability and Validation of a New Method for Determination of Eosinophil Counts in Patients with Esophageal Eosinophilia

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Abstract

Background

Diagnosis of eosinophilic esophagitis (EoE) requires quantification of esophageal eosinophilia.

Aims

The aims of this study were to assess inter- and intraobserver reliability for measuring esophageal eosinophil counts and to validate a novel method of determining tissue eosinophil density using digitized histopathology slides.

Methods

Patients were selected from the University of North Carolina EoE clinicopathologic database. Glass slides were de-identified and scanned to create digitized slides. Using a set protocol, 40 slides were read by each of three pathologists for interobserver measures, and were also reread by one pathologist as traditional glass slides. Different sets of 20 unique slides were read twice by each pathologist for intraobserver measures. Correlation and agreement were calculated with Pearson’s rho and the κ statistic.

Results

There was excellent correction between digitized images and glass slides (r = 0.91–0.95, P < 0.001). For maximum eosinophil densities, interobserver correlations were 0.91, 0.76, and 0.79. For mean densities, interobserver correlations were 0.90, 0.89, and 0.85. Intraobserver correlations for maximum densities were 0.99, 0.94, and 0.96, and for mean densities were 0.97, 0.87, and 0.89 (P < 0.001 for all correlations). Agreement was in the “substantial” to “near-perfect” range for pathologists using several diagnostic cut-points for EoE.

Conclusions

Both inter- and intraobserver correlations were excellent for determining eosinophil densities and counts. A method of using digitized slides was valid when compared with traditional glass slides. This protocol could be adopted for research and clinical purposes to further standardize the diagnostic process for EoE.

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Abbreviations

eos/hpf:

Eosinophils per high-power field

hpf:

High-power field

mm2 :

Square millimeters

μm2 :

Square microns

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Acknowledgments

This work is funded, in part, by support from the National Institutes of Health training grant T32 DK007634, and award number KL2RR025746 from the National Center for Research Resources.

Conflict of Interest

No conflicts of interest pertaining to this study exist for any of the authors.

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Authors and Affiliations

  1. Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, UNC-CH, CB#7080, Bioinformatics Building, 130 Mason Farm Rd., Chapel Hill, NC, 27599-7080, USA

    Evan S. Dellon & Nicholas J. Shaheen

  2. Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Karen J. Fritchie, Tara C. Rubinas & John T. Woosley

Authors
  1. Evan S. Dellon
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  2. Karen J. Fritchie
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  3. Tara C. Rubinas
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  4. John T. Woosley
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  5. Nicholas J. Shaheen
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Corresponding author

Correspondence to Evan S. Dellon.

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Dellon, E.S., Fritchie, K.J., Rubinas, T.C. et al. Inter- and Intraobserver Reliability and Validation of a New Method for Determination of Eosinophil Counts in Patients with Esophageal Eosinophilia. Dig Dis Sci 55, 1940–1949 (2010). https://doi.org/10.1007/s10620-009-1005-z

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  • DOI: https://doi.org/10.1007/s10620-009-1005-z

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