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Challenges in Inter-rater Agreement on Lamina Propria Fibrosis in Esophageal Biopsies
Ameet I Thaker1, Jacob Smith2, Mona Pathak3
1Division of Pediatric Pathology, UT Southwestern/Children's Health, Dallas, TX, USA.
Background:
Mucosal biopsies in eosinophilic esophagitis (EoE) can exhibit lamina propria (LP) fibrosis, which may portend stenotic complications; however, the histologic diagnosis of LP fibrosis is subjective. We sought to assess and improve the consistency of LP fibrosis diagnosis among our pathologist group.
Methods:
At a large pediatric hospital, 25 esophageal biopsy slides from 19 patients (16 with EoE) exhibiting a wide spectrum of LP area, artifacts, and fibrosis severity were scanned into whole-slide images. Staff pediatric pathologists (n = 8) separate from the authors classified each biopsy by LP adequacy and fibrosis severity 1 month before and after completion of an educational tutorial. Consensus was defined as >70% agreement.
Results:
At baseline, 16/25 (64%) cases reached consensus for no fibrosis (n = 3), fibrosis (n = 7), or inadequate LP (n = 6); agreement was fair (α = 0.34). Post-tutorial, 13/25 (52%) cases reached consensus for no fibrosis (n = 2), fibrosis (n = 7), or inadequate LP (n = 4); agreement was again fair (α = 0.33). There was moderate agreement in grading of fibrosis severity (α = 0.54).
Conclusion:
We document only fair-to-moderate agreement in the diagnosis of esophageal LP fibrosis and adequacy in a large pediatric pathologist group despite targeted education, highlighting a challenge in incorporating this feature into EoE research and clinical decision-making.
Insights
Diagnosing lamina propria fibrosis in eosinophilic esophagitis (EoE) biopsies remains challenging. Targeted education did not significantly improve pathologist agreement on fibrosis and adequacy, impacting EoE research and care.
Area of Science:
- Gastroenterology
- Pathology
- Pediatric Medicine
Background:
- Eosinophilic esophagitis (EoE) biopsies can show lamina propria (LP) fibrosis, a potential indicator of stricture formation.
- Histologic diagnosis of LP fibrosis is subjective, posing challenges for consistent clinical and research applications.
Purpose of the Study:
- To assess and enhance the diagnostic consistency of lamina propria fibrosis in esophageal biopsies among a group of pathologists.
- To evaluate the impact of targeted educational intervention on the inter-observer agreement for LP fibrosis and adequacy in EoE.
Main Methods:
- Whole-slide imaging of 25 esophageal biopsy slides from 19 patients (16 with EoE) with varying LP fibrosis severity.
- Eight pediatric pathologists assessed biopsy adequacy and fibrosis severity before and after an educational tutorial.
- Consensus was defined as agreement among >70% of pathologists.
Main Results:
- Baseline inter-observer agreement for LP adequacy and fibrosis was fair (κ = 0.34), with consensus reached in 64% of cases.
- Post-tutorial, consensus decreased to 52% of cases, with agreement remaining fair (κ = 0.33).
- Moderate agreement was observed for grading fibrosis severity (κ = 0.54).
Conclusions:
- Fair-to-moderate inter-observer agreement persists in diagnosing esophageal LP fibrosis and adequacy among pathologists, even after targeted education.
- The subjectivity in diagnosing LP fibrosis presents a significant challenge for its integration into EoE research and clinical decision-making.
