Observer variation in the diagnosis of superficial oesophageal adenocarcinoma
- 1Department of Anatomic Pathology, Henry Ford Health System, Detroit, Michigan, USA
- 2Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- 3Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- 4Department of Biostatistics and Epidemiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- 5Center for Swallowing and Esophageal Diseases, and Department of Gastroenterology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Correspondence to:
Dr J E Goldblum, Cleveland Clinic Foundation, Department of Anatomic Pathology, 9500 Euclid Avenue, Cleveland Ohio 441095, USA;
- Accepted 5 March 2002
Background and aims: When to perform oesophagectomy for neoplastic progression in Barrett’s oesophagus is controversial. Some resect for high grade dysplasia whereas others defer treatment until intramucosal adenocarcinoma is diagnosed. Interobserver agreement for a diagnosis of high grade dysplasia or intramucosal adenocarcinoma remains unknown and may have therapeutic implications.
Methods: Histological slides from 75 oesophagectomy specimens with high grade dysplasia or T1 adenocarcinoma were blindly reviewed by two gastrointestinal pathologists and one general surgical pathologist, and classified as high grade dysplasia, intramucosal adenocarcinoma, or submucosal adenocarcinoma. A subsequent re-review of all 75 cases by the same observers following establishment of uniform histological criteria was undertaken. Interobserver agreement was determined by kappa statistics. Coefficients <0.21, 0.21–0.40, 0.41–0.60, 0.61–0.80, and >0.80 were considered poor, fair, moderate, good, and very good agreement, respectively.
Results: Interobserver agreement among all pathologists and between gastrointestinal pathologists when comparing high grade dysplasia with intramucosal adenocarcinoma was only fair (k=0.42; 0.56, respectively) and did not substantially improve on subsequent re-evaluation following establishment of uniform histological criteria (K=0.50; 0.61, respectively).
Conclusions: When evaluating resection specimens and after implementation of uniform histological criteria, even experienced gastrointestinal pathologists frequently disagree on a diagnosis of high grade dysplasia versus intramucosal adenocarcinoma. Treatment strategies based on the histological distinction of high grade dysplasia from intramucosal adenocarcinoma using limited biopsy specimens should be re-evaluated.