Rusin Spencer, Covey Shannon, Perjar Irina, Hollyfield Johnny, Speck Olga, Woodward Kimberly, Woosley John T, Dellon Evan S
Division of Laboratory Medicine and Pathology, University of North Carolina School of Medicine, Chapel Hill, NC 27599, USA.
Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, 27599 USA.
Hum Pathol. 2017 Apr;62:50-55. doi: 10.1016/j.humpath.2016.12.017. Epub 2016 Dec 30.
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.
许多嗜酸性粒细胞性食管炎（EoE）的研究采用专家病理评估，但经验较少的病理学家能否可靠地评估EoE组织学尚不清楚。我们旨在确定实习病理学家与专家病理学家相比，是否能够准确量化食管嗜酸性粒细胞计数并识别EoE相关的组织学特征。我们使用了一组来自不同程度食管嗜酸性粒细胞增多患者的40张数字化切片。6名实习病理学家每人都参加了一次培训课程，并使用我们经过验证的方案来确定嗜酸性粒细胞计数和相关的EoE表现。同样的切片之前已由专家病理学家进行评估，这些结果构成了标准对照。对嗜酸性粒细胞计数进行相关性分析，并计算每高倍视野15个嗜酸性粒细胞的诊断阈值以及相关EoE表现的一致性。实习病理学家与标准对照之间的嗜酸性粒细胞峰值计数高度相关（ρ范围为0.87至0.92；所有P值均<0.001）。实习病理学家之间的峰值计数也高度相关（0.75 - 0.91；P<0.001），平均计数结果相似。在确定计数是否超过诊断阈值方面一致性极佳（κ范围为0.83至0.89；P<0.001）。在嗜酸性粒细胞脱颗粒（κ = 0.54 - 0.83；P<0.01）和棘层松解（κ = 0.44 - 0.87；P<0.01）方面一致性很好，但在嗜酸性粒细胞微脓肿方面一致性较低（κ = 0.37 - 0.64；P<0.01）。总之，通过培训课程、数字化切片集和经过验证的方案，病理实习生与专家病理学家在确定嗜酸性粒细胞计数方面的一致性极佳。在嗜酸性粒细胞脱颗粒和棘层松解方面一致性很好，但在微脓肿方面则较差。
