Variable pathologic interpretation of columnar lined esophagus by general pathologists in community practice

Area of Science:

• Gastroenterology
• Pathology
• Oncology

Background:

• Accurate pathologic interpretation of columnar lined esophagus is crucial for guiding patient management, including surveillance and surgical decisions.
• This study assesses the consistency of pathologic interpretations of columnar lined esophagus among general pathologists in community practice.

Purpose of the Study:

• To evaluate the interobserver variability in the pathologic interpretation of columnar lined esophagus biopsy specimens by general pathologists.
• To assess the accuracy of diagnosing dysplasia and metaplasia in columnar lined esophagus.

Main Methods:

• Twenty general pathologists reviewed five histologic slides of columnar lined esophagus.
• Cases included intestinal metaplasia with varying degrees of dysplasia (none, low-grade, high-grade) and gastric metaplasia (fundic-type, cardia-type).

Main Results:

• Significant interobserver variation was observed in classifying high-grade dysplasia (identified by 30%) and low-grade dysplasia (identified by 35%).
• Interpretations ranged from no dysplasia to invasive adenocarcinoma, highlighting diagnostic challenges.
• Gastric metaplasia was frequently misidentified as Barrett's esophagus (38% of cases).

Conclusions:

• Pathologic interpretation of columnar lined esophagus by community pathologists exhibits substantial interobserver variability.
• The frequent misapplication of the term Barrett's esophagus for columnar lined esophagus without goblet cells, which lacks clear cancer risk association, suggests reconsidering its use.
• Expert consultation for interpreting high-grade and low-grade dysplasia in esophageal pathology is supported by these findings.