EMR for Barrett's esophagus-related superficial neoplasms offers better diagnostic reproducibility than mucosal biopsy.
BACKGROUND
EMR of Barrett's esophagus (BE)-related superficial neoplasms represents an efficacious staging modality. It also allows for better pathologic grading compared with mucosal biopsy specimens. However, the interobserver variation in the interpretation of EMR specimens has not been tested.


OBJECTIVE
To evaluate consistency in the diagnosis of BE-related neoplasia on EMR specimens.


METHODS
Nine pathologists reviewed 25 esophageal EMR specimens and corresponding biopsy specimens independently. Each pathologist classified the cases as either non-neoplastic BE, low-grade dysplasia, high-grade dysplasia, intramucosal adenocarcinoma, or invasive adenocarcinoma. Interobserver concordance for both specimens from EMRs and biopsies was measured by intraclass correlation and Kendall's coefficient of concordance. The proportion of agreement was also calculated for each specimen and compared for EMR and biopsy by using the Wilcoxon signed rank test.


METHODS
Teaching hospitals.


METHODS
Twenty-five patients who underwent EMR for BE-related neoplasia.


RESULTS
The intraclass correlation and the Kendall's coefficient for the 25 biopsy specimens was 0.938 (95% CI 0.880-0.965) and 0.677, respectively; for the 25 EMRs, these were significantly improved, at 0.977 (95% CI 0.957-0.987) and 0.831, respectively. In addition, the proportion of agreement for EMR specimens was significantly better compared with biopsy specimens (P = .015).


CONCLUSIONS
Interobserver agreement of BE-related neoplasia on EMR specimens is significantly higher compared with biopsy specimens. The results may relate to the larger tissue sampling compared with biopsy specimens and the ability to evaluate mucosal landmarks, such as double muscularis mucosae. Thus, we suggest that EMRs, in addition to being a staging and therapeutic procedure, improve diagnostic consistency.
Mino-Kenudson
Mari
M
Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA.
Hull
Mindy J
MJ
Brown
Ian
I
Muzikansky
Alona
A
Srivastava
Amitabh
A
Glickman
Jonathan
J
Park
Do-Youn
DY
Zuckerberg
Lawrence
L
Misdraji
Joseph
J
Odze
Robert D
RD
Lauwers
Gregory Y
GY
D001471:Barrett Esophagus / Q000473:pathology* / Q000601:surgery; D001706:Biopsy / Q000379:methods*; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000473:pathology; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging / Q000379:methods; D011230:Precancerous Conditions / Q000473:pathology*; D015203:Reproducibility of Results