Karamchandani Dipti M, Gonzalez Raul S, Westerhoff Maria, Westbrook Lindsey M, Panarelli Nicole C, Al-Nuaimi Mayyadah, King Tonya, Arnold Christina A
Department of Pathology, 1 Penn State Health Milton S. Hershey Medical Center/Penn State College of Medicine, Hershey, PA, USA.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
Histopathology. 2022 Jan;80(2):420-429. doi: 10.1111/his.14566. Epub 2021 Oct 28.
Emerging data support that submucosa-invasive (pT1b) esophageal adenocarcinomas are cured via endoscopic resection, provided that invasion measures ≤500 μm, they lack other histological features predictive of nodal metastasis and have negative margins. Hence, pathologists' measurement of the depth of submucosal invasion in endoscopic resections may dictate further management (i.e. endoscopic follow-up versus oesophagectomy). In this study, we assessed the interobserver agreement in measuring the depth of submucosal invasion in oesophageal endoscopic resections.
Six subspecialised gastrointestinal (GI) pathologists from five academic centres independently measured the depth of submucosal invasion in μm from the deepest muscularis mucosae on 37 oesophageal endoscopic resection slides (round 1 scoring). A consensus meeting with a systematic approach for measuring and discussion of pitfalls was undertaken and remeasuring (round 2 scoring) was conducted. Interobserver agreement was assessed by the intraclass correlation coefficient (ICC) and Cohen's kappa statistics. A lack of agreement was seen among the six reviewers with a poor ICC for both rounds: 1 [0.40, 95% confidence interval (CI) = 0.26-0.56] and 2 (0.49, 95% CI = 0.34-0.63). When measurements were categorised as < or >500 μm, the overall agreement among the six reviewers was only fair for both rounds: 1 (kappa = 0.37, 95% CI = 0.22-0.53) and 2 (kappa = 0.29, 95% CI = 0.12-0.46).
Our study shows a lack of agreement among gastrointestinal pathologists in measuring the depth of submucosal invasion in oesophageal endoscopic resections despite formulating a consensus approach for scoring. If important management decisions continue to be based upon this parameter, more reproducible and concrete guidelines are needed.
新出现的数据支持，对于黏膜下浸润性（pT1b）食管腺癌，若浸润深度≤500μm，无其他提示淋巴结转移的组织学特征且切缘阴性，则可通过内镜切除治愈。因此，病理学家对内镜切除标本中黏膜下浸润深度的测量可能决定进一步的治疗方案（即内镜随访与食管切除术）。在本研究中，我们评估了食管内镜切除标本中黏膜下浸润深度测量的观察者间一致性。
来自五个学术中心的六名专科胃肠（GI）病理学家独立测量了37张食管内镜切除标本切片中从最深黏膜肌层起的黏膜下浸润深度（以μm为单位）（第一轮评分）。随后召开了共识会议，采用系统方法进行测量并讨论陷阱，然后进行重新测量（第二轮评分）。通过组内相关系数（ICC）和科恩kappa统计量评估观察者间一致性。六位审阅者之间存在不一致，两轮的ICC均较差：第一轮为0.40（95%置信区间[CI]=0.26 - 0.56），第二轮为0.49（95%CI = 0.34 - 0.63）。当测量结果分为<或>500μm时，六位审阅者在两轮中的总体一致性均仅为一般：第一轮（kappa = 0.37，95%CI = 0.22 - 0.53），第二轮（kappa = 0.29，95%CI = 0.12 - 0.46）。
我们的研究表明，尽管制定了评分的共识方法，但胃肠病理学家在测量食管内镜切除标本中黏膜下浸润深度时仍存在不一致。如果重要的治疗决策继续基于该参数，则需要更具可重复性和具体的指南。
