Interobserver reproducibility in pathologist interpretation of columnar-lined esophagus

Area of Science:

• Gastroenterology and Pathology
• Esophageal disease diagnosis
• Histopathology interpretation

Background:

• Histological confirmation of endoscopically suspected esophageal metaplasia (ESEM) is crucial.
• The histological definition of columnar-lined esophagus (CLE) presents diagnostic challenges.
• Interpathologist variability in CLE interpretation is a significant clinical issue.

Purpose of the Study:

• To evaluate interpathologist variability in the histological interpretation of CLE.
• To assess the impact of endoscopic information and diagnostic aids on CLE interpretation consistency.

Main Methods:

• Thirty pathologists reviewed three sets of 10 CLE biopsy cases.
• Case sets varied in provided information: endoscopy descriptions, Prague criteria for ESEM extent, and a diagnostic chart.
• Statistical analysis of agreement used Randolph's free-marginal multirater kappa.

Main Results:

• Substantial agreement was found in recognizing columnar epithelium (kappa=0.76).
• Overall concordance in clinico-pathological diagnosis was low (kappa=0.38), improving with additional information (kappa=0.46 in the third set).
• High agreement was observed for Barrett's esophagus with intestinal metaplasia (kappa=0.65) and inlet patch (kappa=0.89).
• Low agreement was noted for cardia/cardia-oxyntic atrophic-type epithelium (kappa=0.05-0.29).

Conclusions:

• Precise endoscopic descriptions and diagnostic charts enhance consistency in CLE interpretation.
• Diagnostic consistency is substantial for specific entities like Barrett's esophagus with intestinal metaplasia and inlet patch.
• Lack of clarity in defining cardia/cardia-oxyntic atrophic-type epithelium leads to interpretation variability and inconsistent patient management.