Diagnosing Barrett's esophagus: reliability of clinical and pathologic diagnoses.
BACKGROUND
The accuracy of a Barrett's esophagus diagnosis is not well studied.


OBJECTIVE
Our purpose was to evaluate the accuracy of a clinical Barrett's esophagus diagnosis and the reproducibility of an esophageal intestinal metaplasia diagnosis.


METHODS
All patients with a Barrett's esophagus diagnosis between 1994 and 2005 were identified by use of International Classification of Disease (ICD) and Systematized Nomenclature of Medicine (SNOMED) coding. Subsets received manual record review (endoscopy/pathology reports), slide review by a referral pathologist (interrater reliability), and 2 blinded reviews by the same pathologist (intrarater reliability).


METHODS
An integrated health services delivery system.


METHODS
Accuracy of electronic clinical diagnosis and reproducibility of esophageal intestinal metaplasia diagnosis.


RESULTS
A total of 2470 patients coded with Barrett's esophagus underwent record review; a subgroup (616) received manual pathology slide review. Review confirmed a Barrett's esophagus diagnosis for 1533 (61.9%) patients: 437 of 798 subjects (54.8%) with a SNOMED diagnosis alone, 153 of 671 subjects (26.8%) with an ICD diagnosis alone, and 940 of 1101 subjects (85%) who had both a SNOMED and an ICD diagnosis. The same metaplasia diagnosis occurred with 88.3% of subjects (original vs referral pathologist, interrater reliability; kappa = .42, 95% CI, 0.34-0.48). The referral pathologist made the same metaplasia diagnosis twice for a given patient for 88.6% of subjects (intrarater reliability, 2 reviews by same pathologist; kappa = 0.65, 95% CI, 0.35-0.93).


CONCLUSIONS
The accuracy of a Barrett's esophagus diagnosis likely represents the minimum number, given the strict criteria.


CONCLUSIONS
A community pathologist's diagnosis of esophageal intestinal metaplasia is likely to be confirmed by a referral pathologist. Electronic diagnoses of Barrett's esophagus overestimate the prevalence, although they are usually confirmed in patients with both a SNOMED and ICD diagnosis of Barrett's esophagus.
Corley
Douglas A
DA
Division of Research, Kaiser Permanente, Northern California, Oakland, California 94612, USA. Douglas.Corley@kp.org
Kubo
Ai
A
DeBoer
Jolanda
J
Rumore
Gregory J
GJ
D001471:Barrett Esophagus / Q000175:diagnosis* / Q000473:pathology*; D001706:Biopsy; D003951:Diagnostic Errors; D004938:Esophageal Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology; D006801:Humans; D038801:International Classification of Diseases; D008485:Medical Audit; D008679:Metaplasia; D015588:Observer Variation; D011230:Precancerous Conditions / Q000175:diagnosis* / Q000473:pathology*; D015203:Reproducibility of Results; D039061:Systematized Nomenclature of Medicine