title: Interobserver reproducibility in pathologist interpretation of columnar-lined esophagus.
abstract: Confirmation of endoscopically suspected esophageal metaplasia (ESEM) requires histology, but confusion in the histological definition of columnar-lined esophagus (CLE) is a longstanding problem. The aim of this study is to evaluate interpathologist variability in the interpretation of CLE. Thirty pathologists were invited to review three ten-case sets of CLE biopsies. In the first set, the cases were provided with descriptive endoscopy only; in the second and the third sets, ESEM extent using Prague criteria was provided. Moreover, participants were required to refer to a diagnostic chart for evaluation of the third set. Agreement was statistically assessed using Randolph's free-marginal multirater kappa. While substantial agreement in recognizing columnar epithelium (K = 0.76) was recorded, the overall concordance in clinico-pathological diagnosis was low (K = 0.38). The overall concordance rate improved from the first (K = 0.27) to the second (K = 0.40) and third step (K = 0.46). Agreement was substantial when diagnosing Barrett's esophagus (BE) with intestinal metaplasia or inlet patch (K = 0.65 and K = 0.89), respectively, in the third step, while major problems in interpretation of CLE were observed when only cardia/cardia-oxyntic atrophic-type epithelium was present (K = 0.05-0.29). In conclusion, precise endoscopic description and the use of a diagnostic chart increased consistency in CLE interpretation of esophageal biopsies. Agreement was substantial for some diagnostic categories (BE with intestinal metaplasia and inlet patch) with a well-defined clinical profile. Interpretation of cases with cardia/cardia-oxyntic atrophic-type epithelium, with or without ESEM, was least consistent, which reflects lack of clarity of definition and results in variable management of this entity.
authors.affiliation: Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genoa, Via De Toni 14, 16132, Genoa, Italy. mastracc@hotmail.com.|IRCCS AOU S. Martino-IST, Largo Benzi 10, 16132, Genoa, Italy. mastracc@hotmail.com.
authors.forename: Luca
authors.initials: L
authors.lastname: Mastracci
authors.affiliation: Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genoa, Via De Toni 14, 16132, Genoa, Italy.|IRCCS AOU S. Martino-IST, Largo Benzi 10, 16132, Genoa, Italy.
authors.forename: Nataniele
authors.initials: N
authors.lastname: Piol
authors.affiliation: Department of Biomedical Sciences and Human Oncology, University of Turin, Via Santena 7, 10126, Turin, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Molinaro
authors.affiliation: Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genoa, Via De Toni 14, 16132, Genoa, Italy.|IRCCS AOU S. Martino-IST, Largo Benzi 10, 16132, Genoa, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pitto
authors.affiliation: Clinical Epidemiology and Biometric Unit, Foundation IRCCS Policlinico S. Matteo, Via Golgi 19, 27100, Pavia, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Tinelli
authors.affiliation: Clinical Epidemiology and Biometric Unit, Foundation IRCCS Policlinico S. Matteo, Via Golgi 19, 27100, Pavia, Italy.
authors.forename: Annalisa
authors.initials: A
authors.lastname: De Silvestri
authors.affiliation: Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genoa, Via De Toni 14, 16132, Genoa, Italy.|IRCCS AOU S. Martino-IST, Largo Benzi 10, 16132, Genoa, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Fiocca
authors.affiliation: Department of Surgical and Diagnostic Sciences (DISC), Pathology Unit, University of Genoa, Via De Toni 14, 16132, Genoa, Italy.|IRCCS AOU S. Martino-IST, Largo Benzi 10, 16132, Genoa, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Grillo
mesh_terms: D000328:Adult; D000368:Aged; D001471:Barrett Esophagus / Q000175:diagnosis / Q000473:pathology*; D001706:Biopsy; D004848:Epithelium / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D008679:Metaplasia; D008875:Middle Aged; D015203:Reproducibility of Results
keywords: Barrett’s esophagus; Columnar-lined esophagus; Histological diagnosis; Interobserver variation