Inter-observer and intra-observer variability in the diagnosis of dysplasia in patients with inflammatory bowel disease: correlation of pathological and endoscopic findings.
OBJECTIVE
Colonic epithelial dysplasia is deemed the precursor lesion of cancer arising in inflammatory bowel disease (IBD). It has been suggested that many dysplastic lesions could be endoscopically detected to obtain target biopsies, leading to better yield. However, the clinical impact of a diagnosis of dysplasia may be hampered by a significant degree of histological and endoscopic intra-observer and inter-observer variability. This study aimed to evaluate intra-observer and inter-observer variability in the microscopic diagnosis of dysplasia in IBD and correlate endoscopic and histological findings.


METHODS
In total, 158 cases of ulcerative colitis and 14 of Crohn's disease with dysplasia were selected from a pathology database. Slides were blindly reviewed twice by two expert gastrointestinal pathologists. Results of endoscopic examinations were extracted from the reports. The degree of intra-observer and inter-observer variability was determined by kappa statistics.


RESULTS
Overall, there was an excellent degree of histopathological inter-observer agreement (κ = 0.786). The lowest level of agreement in the dysplasia group was for indefinite dysplasia (κ = 0.251). Negative and high grade dysplasia diagnosis reached the highest level of agreement with κ values of 0.822 [95% confidence interval (CI) 0.673-0.971] and 1.00 (95% CI 0.850-1.149), respectively. Intra-observer agreement was good and increased during the latter period of the study (κ = 0.734, 95% CI 0.642-0.826). Endoscopic-histological correlation was poor among the negative endoscopies, as up to 43% of cases were diagnosed with at least focal high grade dysplasia. The endoscopic-histological correlation improved when evaluating suspicious endoscopic lesions.


CONCLUSIONS
Dysplasia is reliably diagnosed by expert gastrointestinal pathologists but has poor correlation with an endoscopic diagnosis of dysplasia.
Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio, USA.
D
D
Allende
M
M
Elmessiry
W
W
Hao
G
G
DaSilva
S D
SD
Wexner
P
P
Bejarano
M
M
Berho
M
M
Al-Qadasi
D000230:Adenocarcinoma / Q000473:pathology*; D001706:Biopsy; D003106:Colon / Q000473:pathology*; D003110:Colonic Neoplasms / Q000473:pathology*; D003113:Colonoscopy; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000473:pathology*; D015588:Observer Variation; D011230:Precancerous Conditions / Q000473:pathology*; D012189:Retrospective Studies; D016037:Single-Blind Method
Crohn's disease; Inflammatory bowel disease; dysplasia; ulcerative colitis