title: Interobserver variation in assessment of gastric premalignant lesions: higher agreement for intestinal metaplasia than for atrophy.
abstract: BACKGROUND
  Either atrophy or intestinal metaplasia of the gastric mucosa are considered premalignant lesions. The new operative link for gastritis assessment staging system is based on the detection of atrophy, and the operative link for assessment of intestinal metaplasia staging system is based on the detection of intestinal metaplasia. Good interobserver agreement is necessary for identification of any premalignant condition.
  
  
  OBJECTIVE
  The aim of this study was to compare the agreement between findings of gastric atrophy and intestinal metaplasia by expert and general pathologists and to analyze the possible reasons behind any possible disagreement.
  
  
  METHODS
  Patients with dyspeptic symptoms, aged 55 years and above, without previous Helicobacter pylori eradication were enrolled and analyzed according to the updated Sydney Classification by two expert pathologists and an experienced general pathologist; the results were compared with the consensus driven by the two experts.
  
  
  RESULTS
  Gastric biopsy specimens from 121 patients (91 women) were included in the analysis; the mean age of the patients was 67.4 years. H. pylori infection was present in 61.2% of patients. The level of agreement between the general pathologist and the two experts (κ-value) was 0.12, 0.46, and 0.87, respectively, for detecting atrophy in the corpus; 0.77, 0.77, and 0.65, respectively, for detecting intestinal metaplasia in the corpus; 0.06, 0.51, and 0.54, respectively, for detecting atrophy in the antrum; and 0.69, 0.85, and 0.79, respectively, for detecting metaplasia in the antrum.
  
  
  CONCLUSIONS
  The agreement was substantially higher for intestinal metaplasia than for atrophy. This could result in discrepancies when the operative link for gastritis assessment and operative link for assessment of intestinal metaplasia staging systems are applied and can be caused by differences in the criteria used to define atrophy.
authors: Faculty of Medicine, University of Latvia, Riga, Latvia. cei@latnet.lv
authors: Marcis
authors: M
authors: Leja
authors: Konrads
authors: K
authors: Funka
authors: Dainius
authors: D
authors: Janciauskas
authors: Viesturs
authors: V
authors: Putnins
authors: Agnese
authors: A
authors: Ruskule
authors: Ilze
authors: I
authors: Kikuste
authors: Una
authors: U
authors: Kojalo
authors: Ivars
authors: I
authors: Tolmanis
authors: Janis
authors: J
authors: Misins
authors: Karlis
authors: K
authors: Purmalis
authors: Sergey
authors: S
authors: Pimanov
authors: Jelena
authors: J
authors: Makarenko
authors: Limas
authors: L
authors: Kupcinskas
authors: Uldis
authors: U
authors: Vikmanis
mesh_terms: D000368:Aged; D001284:Atrophy / Q000175:diagnosis; D001706:Biopsy; D002983:Clinical Competence; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D006801:Humans; D008297:Male; D008679:Metaplasia / Q000175:diagnosis; D008875:Middle Aged; D015588:Observer Variation; D011230:Precancerous Conditions / Q000175:diagnosis*; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000175:diagnosis*