Reid B J, Haggitt R C, Rubin C E, Roth G, Surawicz C M, Van Belle G, Lewin K, Weinstein W M, Antonioli D A, Goldman H
University of Washington, Seattle 98195.
Hum Pathol. 1988 Feb;19(2):166-78. doi: 10.1016/s0046-8177(88)80344-7.
The potential value of biopsy surveillance of patients with Barrett's esophagus for dysplasia is diminished by a lack of agreement on the diagnostic criteria for dysplasia. In a preliminary consensus conference, experienced gastrointestinal pathologists from four medical centers agreed on criteria for a five-tiered histologic classification of dysplasia in Barrett's esophagus--negative for dysplasia, indefinite for dysplasia, low-grade dysplasia, high-grade dysplasia, and intramucosal carcinoma. Eight morphologists in the four centers tested the criteria for interobserver agreement by examining a set of coded slides that had been chosen to include some especially difficult interpretative problems in all five histologic classifications. Interobserver agreement of 85 and 87% was achieved in successive reviews when the combined group of high-grade dysplasia and intramucosal carcinoma was compared with the combined group of low-grade dysplasia, indefinite for dysplasia, and negative for dysplasia. Comparison of other groups yielded less agreement. For example, negative for dysplasia could be distinguished from all other diagnoses with an interobserver agreement of 72%. We conclude that experienced gastrointestinal morphologists can diagnose high-grade dysplasia and intramucosal carcinoma with a high degree of agreement and thus can detect those patients who may need immediate rebiopsy or esophageal resection. Either further refinement of histologic criteria or alternate diagnostic methods will be needed to achieve the reproducible diagnosis of indefinite changes and low-grade dysplasia. This is important because patients with such changes theoretically merit closer endoscopic surveillance.
巴雷特食管发育异常患者活检监测的潜在价值因发育异常诊断标准缺乏一致性而降低。在一次初步共识会议上，来自四个医疗中心的经验丰富的胃肠病理学家就巴雷特食管发育异常的五级组织学分类标准达成了一致，即发育异常阴性、发育异常不明确、低级别发育异常、高级别发育异常和黏膜内癌。四个中心的八位形态学家通过检查一组编码玻片来测试观察者间一致性的标准，这些玻片被选择用于涵盖所有五种组织学分类中一些特别难以解释的问题。当将高级别发育异常和黏膜内癌的组合组与低级别发育异常、发育异常不明确和发育异常阴性的组合组进行比较时，在连续审查中观察者间一致性分别达到了85%和87%。其他组的比较一致性较低。例如，发育异常阴性与所有其他诊断的区分观察者间一致性为72%。我们得出结论，经验丰富的胃肠形态学家能够高度一致地诊断高级别发育异常和黏膜内癌，从而能够检测出那些可能需要立即再次活检或食管切除的患者。要实现对不明确变化和低级别发育异常的可重复诊断，需要进一步完善组织学标准或采用替代诊断方法。这很重要，因为理论上有这些变化的患者需要更密切的内镜监测。
