Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Scottsdale, AZ.
Am J Surg Pathol. 2018 Mar;42(3):376-381. doi: 10.1097/PAS.0000000000000988.
The pathologic diagnosis of dysplasia in Barrett esophagus (BE) suffers from interobserver disagreement. Many of the studies demonstrating disagreement in the diagnosis of dysplasia have pathologists review individual biopsy slides in isolation. To more closely mimic daily practice, 3 pathologists reviewed hematoxylin and eosin slides made from 549 individual biopsy jars obtained from 129 unique patients with a diagnosis of BE. Each pathologist reviewed the entirety of a given patient's biopsy material. The grade of dysplasia present in each biopsy jar was given as well as an overall highest grade of dysplasia from the patient's entire set of biopsies. The interobserver agreement in the diagnosis of dysplasia per biopsy jar and per patient's set of biopsies was measured by Fleiss κ statistic for multiple raters. The κ values for each diagnosis was higher in the per patient analysis compared with the per biopsy jar analysis indicating that pathologists are more likely to agree on the overall grade of dysplasia compared with the grade in an individual biopsy jar. In the per patient analysis, the interobserver agreement in the diagnosis of nondysplastic BE and high-grade dysplasia were substantial (κ=0.66; 95% confidence interval [CI], 0.56-0.76 and κ=0.76; 95% CI, 0.66-0.86, respectively). The interobserver agreement in the diagnosis of low-grade dysplasia (LGD) was fair (κ=0.31; 95% CI, 0.21-0.42). When LGD and high-grade dysplasia were collapsed into 1 category of positive for dysplasia, the interobserver agreement in the per patient analysis remained substantial (κ=0.70; 95% CI, 0.60-0.80), suggesting that much of the disagreement in LGD is not due to lack of recognition of dysplastic Barrett's mucosa, but rather the degree of dysplasia. These results indicate that pathologists can reliably distinguish between nondysplastic BE and dysplastic BE when a patient's entire set of biopsies is reviewed as a group. When second opinions are obtained, all available slides from that endoscopic procedure should be sent for review.
巴雷特食管（BE）异型增生的病理诊断存在观察者间的分歧。许多研究表明，在异型增生的诊断中存在分歧，这些研究是由病理学家单独查看单个活检切片得出的。为了更接近日常实践，3 位病理学家对来自 129 名 BE 患者的 549 个单独活检瓶的苏木精和伊红切片进行了复查。每位病理学家都对给定患者的全部活检材料进行了复查。给出了每个活检瓶中存在的异型增生程度，以及患者整套活检中的最高异型增生程度。通过多位观察者 Fleiss κ 统计来衡量每个活检瓶和每位患者的活检中异型增生的诊断一致性。与每个活检瓶的分析相比，每个诊断的 κ 值在患者分析中更高，这表明病理学家更有可能就整体异型增生程度达成一致，而不是就单个活检瓶中的程度达成一致。在患者分析中，非异型增生性 BE 和高级别异型增生的观察者间诊断一致性较高（κ=0.66；95%置信区间 [CI]，0.56-0.76 和 κ=0.76；95% CI，0.66-0.86）。低级别异型增生（LGD）的观察者间诊断一致性为中度（κ=0.31；95% CI，0.21-0.42）。当 LGD 和高级别异型增生合并为异型增生阳性时，患者分析中的观察者间一致性仍然较高（κ=0.70；95% CI，0.60-0.80），这表明 LGD 中的大部分分歧不是由于缺乏对异型增生的 Barrett 黏膜的认识，而是由于异型增生的程度。这些结果表明，当作为一个整体回顾患者的整套活检时，病理学家可以可靠地区分非异型增生性 BE 和异型增生性 BE。当获得第二意见时，应将该内镜检查的所有可用切片送审。
