Inter-Observer Agreement among Pathologists Using Wide-Area Transepithelial Sampling With Computer-Assisted Analysis in Patients With Barrett's Esophagus.
OBJECTIVE
The histopathological diagnosis of Barrett's esophagus (BE)-associated dysplasia has poor inter-observer agreement. The wide-area transepithelial sampling (WATS) procedure uses a minimally invasive brush biopsy technique for acquiring wide-area sampling of BE tissue followed by computer-assisted analysis. In this study, our aim was to assess inter-observer agreement among pathologists in the diagnosis of Barrett's-associated dysplasia using the WATS computer-assisted analysis technique.


METHODS
WATS slides with varying degrees of BE dysplasia were randomly selected and distributed to four pathologists. Each pathologist graded the slides as nondysplastic, low-grade dysplasia (LGD), or high-grade dysplasia/esophageal adenocarcinoma (HGD/EAC) and completed a standardized case report form (CRF) for each slide.


RESULTS
In all, 149 BE slides were evaluated in a blinded manner by 4 pathologists. The slides included the following: no dysplasia (n=109), LGD, and HGD/EAC (n=40). The overall mean kappa value for all 3 diagnoses for the 4 observers was calculated at 0.86 (95% confidence interval (CI) 0.75-0.97). The kappa values (95% CI) for HGD/EAC, IND/LGD, and no dysplasia were 0.95 (0.88-0.99), 0.74 (0.61-0.85), and 0.88 (0.81-0.94), respectively.


CONCLUSIONS
The diagnosis of BE and associated dysplasia using the WATS technique has very high inter-observer agreement. This appears to be significantly higher as compared with previously published data using standard histopathology.
Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA.
Prashanth R
PR
Vennalaganti
Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA.|Department of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Vijay
V
Naag Kanakadandi
Department of Gastroenterology, NYU Langone Medical Center, New York, New York, USA.
Seth A
SA
Gross
Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA.|Department of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Sravanthi
S
Parasa
Division of Gastroenterology and Hepatology, Barrett's Esophagus Unit, Mayo Clinic, Rochester, Minnesota, USA.
Kenneth K
KK
Wang
Department of Gastroenterology, Loyola University Medical Center, Chicago, Illinois, USA.
Neil
N
Gupta
Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA.|Department of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA.
Prateek
P
Sharma
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000473:pathology*; D003937:Diagnosis, Differential; D018450:Disease Progression; D001330:Electronic Data Processing / Q000379:methods*; D004848:Epithelium / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011230:Precancerous Conditions; D013048:Specimen Handling / Q000379:methods*; D055815:Young Adult