title: Determination of esophageal eosinophil counts and other histologic features of eosinophilic esophagitis by pathology trainees is highly accurate.
abstract: Many studies of eosinophilic esophagitis (EoE) use expert pathology review, but it is unknown whether less experienced pathologists can reliably assess EoE histology. We aimed to determine whether trainee pathologists can accurately quantify esophageal eosinophil counts and identify associated histologic features of EoE, as compared with expert pathologists. We used a set of 40 digitized slides from patients with varying degrees of esophageal eosinophilia. Each of 6 trainee pathologists underwent a teaching session and used our validated protocol to determine eosinophil counts and associated EoE findings. The same slides had previously been evaluated by expert pathologists, and these results comprised the criterion standard. Eosinophil counts were correlated, and agreement was calculated for the diagnostic threshold of 15 eosinophils per high-power field as well as for associated EoE findings. Peak eosinophil counts were highly correlated between the trainees and the criterion standard (ρ ranged from 0.87 to 0.92; P<.001 for all). Peak counts were also highly correlated between trainees (0.75-0.91; P<.001), and results were similar for mean counts. Agreement was excellent for determining if a count exceeded the diagnostic threshold (κ ranged from 0.83 to 0.89; P<.001). Agreement was very good for eosinophil degranulation (κ = 0.54-0.83; P<.01) and spongiosis (κ = 0.44-0.87; P<.01) but was lower for eosinophil microabscesses (κ = 0.37-0.64; P<.01). In conclusion, using a teaching session, digitized slide set, and validated protocol, the agreement between pathology trainees and expert pathologists for determining eosinophil counts was excellent. Agreement was very good for eosinophil degranulation and spongiosis but less so for microabscesses.
authors.affiliation: Division of Laboratory Medicine and Pathology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
authors.forename: Spencer
authors.initials: S
authors.lastname: Rusin
authors.affiliation: Division of Laboratory Medicine and Pathology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Covey
authors.affiliation: Division of Laboratory Medicine and Pathology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
authors.forename: Irina
authors.initials: I
authors.lastname: Perjar
authors.affiliation: Division of Laboratory Medicine and Pathology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
authors.forename: Johnny
authors.initials: J
authors.lastname: Hollyfield
authors.affiliation: Division of Laboratory Medicine and Pathology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
authors.forename: Olga
authors.initials: O
authors.lastname: Speck
authors.affiliation: Division of Laboratory Medicine and Pathology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Woodward
authors.affiliation: Division of Laboratory Medicine and Pathology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
authors.forename: John T
authors.initials: JT
authors.lastname: Woosley
authors.affiliation: Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599 USA. Electronic address: edellon@med.unc.edu.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
mesh_terms: D000038:Abscess / Q000473:pathology; D001706:Biopsy; D015550:Cell Degranulation; D002983:Clinical Competence; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D057765:Eosinophilic Esophagitis / Q000175:diagnosis* / Q000473:pathology; D004804:Eosinophils / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D006801:Humans; D007396:Internship and Residency; D007958:Leukocyte Count; D015588:Observer Variation; D010336:Pathology / Q000193:education*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results
keywords: Agreement; Diagnosis; Eosinophilic esophagitis; Histology; Training