Discordance Among Pathologists in the United States and Europe in Diagnosis of Low-Grade Dysplasia for Patients With Barrett's Esophagus.
There is suboptimal inter-observer agreement, even among expert gastrointestinal pathologists, in the diagnosis of low-grade dysplasia (LGD) in patients with Barrett's esophagus (BE). We analyzed histopathologic criteria required for a diagnosis of LGD using the new subcategories of LGD with inflammatory and dysplastic features. We categorized each diagnosis based on the level of confidence and assessed inter-observer agreement among gastrointestinal pathologists from 5 tertiary centers in the United States and Europe.



In the first phase of the study, 3 pathologists held a consensus conference at which they discussed the diagnostic criteria for LGD. In the second phase, 79 slides from patients with BE (23 samples of non-dysplastic BE, 22 samples of LGD, and 34 samples of high-grade dysplasia) were identified, randomly assigned to 7 pathologists (4 from the United States and 3 from Europe), and interpreted in a blinded fashion. κ Values were calculated for inter-observer agreement. We performed multinomial logistic regression analysis to assess the weighting of histologic features with the diagnosis.



The overall κ value for diagnosis was 0.43 (95% confidence interval [CI], 0.42-0.48). When categorized based on degree of dysplasia, the κ value was 0.22 (95% CI, 0.11-0.29) for non-dysplastic BE, 0.11 (95% CI, 0.004-0.15) for LGD, and 0.43 (95% CI, 0.36-0.46) for high-grade dysplasia. When all pathologists made a diagnosis with high confidence, the inter-observer agreement was substantial among the US pathologists (κ, 0.63; 95% CI, 0.61-0.66) and European pathologists (κ, 0.80; 95% CI, 0.74-0.97). The κ values for all diagnoses made by European pathologists were higher than those made by US pathologists.



In an analysis of criteria used in histopathologic diagnosis of LGD, we did not observe improvement in level of agreement among experienced pathologists, even after accounting for inflammation. The level of inter-observer agreement increased with level of pathologist confidence. There was also a difference in reading of histopathology samples of BE tissues between US and European pathologists.
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology Department, Kansas University Medical Center, Kansas City, Kansas.
Prashanth
P
Vennalaganti
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology Department, Kansas University Medical Center, Kansas City, Kansas.
Vijay
V
Kanakadandi
Pathology Department, Cleveland Clinic, Cleveland, Ohio.
John R
JR
Goldblum
Department of Pathology, Veterans Affairs Medical Center, Kansas City, Missouri.
Sharad C
SC
Mathur
Pathology Department, Cleveland Clinic, Cleveland, Ohio.
Deepa T
DT
Patil
Department of Pathology, University Medical Center, Utrecht, the Netherlands.
G Johan
GJ
Offerhaus
Department of Pathology, Academic Medical Center, Amsterdam, the Netherlands.
Sybren L
SL
Meijer
Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany.
Michael
M
Vieth
Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts.
Robert D
RD
Odze
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology Department, Kansas University Medical Center, Kansas City, Kansas.
Saligram
S
Shreyas
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology Department, Kansas University Medical Center, Kansas City, Kansas.
Sravanthi
S
Parasa
Gastroenterology, Loyola University Medical Center, Maywood, Illinois.
Neil
N
Gupta
Department of Gastroenterology, Instituto Clinico Humanitas, Milano, Italy.
Alessandro
A
Repici
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology Department, Kansas University Medical Center, Kansas City, Kansas.
Ajay
A
Bansal
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology Department, Kansas University Medical Center, Kansas City, Kansas.
Titi
T
Mohammad
Gastroenterology and Hepatology, Veterans Affairs Medical Center, Kansas City, Missouri; Gastroenterology Department, Kansas University Medical Center, Kansas City, Kansas. Electronic address: psharma@kumc.edu.
Prateek
P
Sharma
D000230:Adenocarcinoma / Q000473:pathology*; D001471:Barrett Esophagus / Q000473:pathology*; D004938:Esophageal Neoplasms / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005060:Europe; D006801:Humans; D016015:Logistic Models; D060787:Neoplasm Grading; D015588:Observer Variation; D000072142:Pathologists; D011230:Precancerous Conditions / Q000473:pathology*; D014481:United States
Barrett’s Esophagus; Interobserver Agreement; Low-Grade Dysplasia; κ Values