title: Pathologists are able to differentiate reliably the lamina propria associated with Barrett's musculofibrous anomaly from submucosa in oesophageal endoscopic resections.
abstract: OBJECTIVE
  Endoscopic resection (ER) is the standard therapy for early oesophageal neoplasia and is used for diagnosis and treatment. Accurate staging is especially important, as further treatment depends on this. Because Barrett's mucosa often develops fibromuscular hyperplasia with a fibrotic lamina propria and reduplicated muscularis mucosae, pathologists have expressed concern that it may not be possible to differentiate lamina propria reliably from submucosa in such resections. This study aimed to develop criteria for distinguishing submucosa from abnormal lamina propria and test reproducibility.
  
  
  RESULTS
  Virtual slides of oesophagectomy cases with early cancer were reviewed by participants, all gastrointestinal (GI) pathologists. Criteria were agreed for recognition of submucosa - the presence of any of submucosal glands, fat and large muscular vessels. A set of 20 endoscopic resections were then uploaded and 45 areas annotated and participants asked to categorize as submucosa or lamina propria. Agreement was excellent, with 35 areas showing agreement by all pathologists and a further seven areas with four of five agreeing. Paired interobserver kappa values varied between 0.69 and 0.955.
  
  
  CONCLUSIONS
  With the application of usually easily recognizable criteria, pathologists are able to differentiate submucosa from lamina propria with musculofibrous anomaly in oesophageal ER specimens with a high degree of reproducibility.
authors.affiliation: Department of Histopathology, Nottingham University Hospitals and NDDC BRU, Nottingham, UK.
authors.forename: Philip V
authors.initials: PV
authors.lastname: Kaye
authors.affiliation: Department of Pathology, Addenbrookes, Cambridge, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: O'Donovan
authors.affiliation: Department of Pathology, Lancaster Royal Infirmary, Lancaster, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Mapstone
authors.affiliation: Department of Pathology, Royal Victoria Infirmary, Newcastle, UK.
authors.forename: Babett
authors.initials: B
authors.lastname: Disep
authors.affiliation: University College London, London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Novelli
authors.affiliation: Nottingham Digestive Diseases Centre and NIHR Biomedical Research Unit, Queens Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Krish
authors.initials: K
authors.lastname: Ragunath
mesh_terms: D001471:Barrett Esophagus / Q000473:pathology*; D002983:Clinical Competence; D004938:Esophageal Neoplasms / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D009092:Mucous Membrane / Q000473:pathology*; D015203:Reproducibility of Results
keywords: Barrett's oesophagus; adenocarcinoma; oesophageal submucosa; reproducibility of results