Is There a Way for Pathologists to Decrease Interobserver Variability in the Diagnosis of Dysplasia?

2005 ◽  
Vol 129 (2) ◽  
pp. 174-176 ◽  
Author(s):  
Elizabeth Montgomery
Keyword(s):  
Patient Group ◽  
Interobserver Agreement ◽  
Invasive Carcinoma ◽  
Interobserver Variability ◽  
Sampling Error ◽  
Observer Variation ◽  
High Grade Dysplasia ◽  
Barrett Esophagus ◽  
High Grade

Abstract Many obstacles interfere with our efforts to screen patients with Barrett esophagus. Probably the largest is choosing the appropriate patient group for screening. Beyond this problem, sampling error on the part of endoscopists is probably more serious a problem than observer variation among pathologists reviewing patient samples. Pathologists agree well on lesions that merit close follow-up or other intervention (high-grade dysplasia and invasive carcinoma), although interobserver agreement between pathologists interpreting lesser lesions is not good. This lack of agreement is not likely to improve substantially, and many adjunct markers are being sought in an attempt to identify patients with lesions of lower grades that are most likely to progress, allowing doctors to identify patients who would benefit from upgraded surveillance.

Long-term follow-up of patients with Barrett esophagus: Progression to high-grade dysplasia and esophageal adenocarcinoma according to histology at presentation.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 20-20 ◽  
Author(s):  
Allon Kahn ◽  
Vishnu Kommineni ◽  
Jonathan Callaway ◽  
Rahul Pannala ◽  
David Fleischer ◽  
...  
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Large Cohort ◽  
High Grade Dysplasia ◽  
Continuous Treatment ◽  
Barrett Esophagus ◽  
Low Grade ◽  
High Grade ◽  
Upper Endoscopy ◽  
Early Stage Disease

20 Background: Esophageal adenocarcinoma (EAC) incidence is rising and prognosis is uniformly poor, even with early stage disease. Barrett esophagus (BE) serves as a premalignant marker for EAC, with an estimated progression of 0.5% per year. Low-grade (LGD) and high-grade dysplasia (HGD) confer a higher risk of progression, providing an opportunity for intervention and surveillance. Aims: To evaluate a large cohort of patients undergoing endoscopic evaluation of BE and thereby better understand the natural history of BE and dysplasia. Methods: A retrospective review of endoscopic databases was conducted for all patients with the diagnosis of BE undergoing upper endoscopy at a tertiary academic medical center from 1991-2010. All endoscopy and accompanying pathology reports were reviewed. Only those patients with 2 biopsies documenting specialized intestinal metaplasia were analyzed. Results: 848 patients underwent upper endoscopy for evaluation of BE. Of these, 674 patients met inclusion criteria, at a mean follow up of 66.6 months. Table 1 depicts the distribution of patients according to their histology at presentation. 22 (3.2%) patients presented with established EAC, while EAC developed in 51 (7.6%). Of patients with HGD, LGD, or no dysplasia (ND) at presentation, EAC ultimately developed in 30.6%, 6.6%, and 2.7%, respectively. EAC developed in 4 patients despite RFA treatment for ND (2) or LGD (2). HGD developed in 6 such patients after treatment for ND (3) and LGD (3). Only 1 patient in each RFA-treated cohort required esophagectomy, while the others cleared dysplasia or EAC with continuous treatment. Conclusions: In this large cohort of patients with Barrett’s esophagus, higher grade of dysplasia at first endoscopy was associated with development of EAC. Continuous surveillance during and after endoscopic treatment is necessary and often results in clearance of dysplasia and EAC. [Table: see text]

Update on the Diagnosis and Treatment of Barrett Esophagus and Related Neoplastic Precursor Lesions

2008 ◽  
Vol 132 (10) ◽  
pp. 1577-1585 ◽  
Author(s):  
Robert D. Odze
Keyword(s):  
Esophageal Adenocarcinoma ◽  
Sampling Error ◽  
High Grade Dysplasia ◽  
Barrett Esophagus ◽  
Surface Epithelium ◽  
Low Grade ◽  
High Grade ◽  
Precursor Lesions ◽  
Pathologic Features ◽  
Risk Of Cancer

Abstract Context.—At present, Barrett esophagus is the most common cause of esophageal adenocarcinoma. In the past 20 years, the incidence of esophageal adenocarcinoma in white males has exceeded that of tumors of the colorectum, lung, prostate, and skin. Objectives.—To (1) provide an evidence-based review of the diagnosis, classification, and histologic differentiation of Barrett esophagus from gastric carditis, (2) provide a summary of the key pathologic features of precursor lesions, such as dysplasia, and (3) evaluate adjunctive markers of dysplasia and predictive markers for the development of cancer. The natural history and risk of cancer in patients with Barrett esophagus is also reviewed. Data Sources.—For this review, selected published peer reviewed articles were chosen from a search through PubMed between the years 1970 and 2007. Conclusions.—The current definition of Barrett esophagus is partially flawed because not all cases are endoscopically recognizable, nongoblet epithelium is biologically intestinalized, and determination of the presence or absence of goblet cells is susceptible to sampling error. Differentiation of ultrashort segment Barrett esophagus from chronic gastric carditis can be accomplished, in a minority of cases, by evaluating for the presence or absence of histologic features that are known to be associated with Barrett esophagus. Dysplasia in Barrett esophagus begins in the crypt bases and then extends more superficially to include the upper portions of the crypts and surface epithelium. Low- and high-grade dysplasia are distinguished by the presence of marked cytologic and/or architectural abnormalities in the latter compared with the former. There are few, if any, reliable adjunctive diagnostic techniques that can help differentiate nondysplastic from dysplastic epithelium. However, α-methylacyl coenzyme A racemase staining has been shown to be useful in 2 separate studies. Both low- and high-grade dysplasia are progressive lesions, and in general, the extent of dysplasia, particularly low grade, is a strong risk factor for progression to carcinoma. Of all the biologic and genetic biomarkers studied to date, evaluation of DNA content is the most reliable and specific. The management of patients with dysplasia is variable among institutions and ranges from aggressive surveillance, endoscopic mucosal resection, mucosal ablation, or total esophagectomy.

Invasive carcinoma versus pseudoinvasion: interobserver variability in the assessment of left-sided colorectal polypectomies

2021 ◽  
pp. jclinpath-2021-207406
Author(s):  
Michael Lee ◽  
Satoru Kudose ◽  
Armando Del Portillo ◽  
Huaibin Mabel Ko ◽  
Hwajeong Lee ◽  
...  
Keyword(s):  
Lamina Propria ◽  
Invasive Carcinoma ◽  
Interobserver Variability ◽  
High Grade Dysplasia ◽  
Colon Polyps ◽  
High Grade ◽  
Histological Findings ◽  
Invasive Adenocarcinoma ◽  
Perfect Agreement ◽  
Intramucosal Adenocarcinoma

ObjectivesMisplaced epithelium in adenomas can occasionally be difficult to distinguish from invasive adenocarcinoma. We evaluated interobserver variability in the assessment of left-sided colon polypectomies for pseudoinvasion versus invasive adenocarcinoma and further investigated relevant histological findings.Methods28 consecutive left-sided colon polyps with the keywords “pseudoinvasion”, “epithelial misplacement”, “herniation”, “prolapse” or “invasive adenocarcinoma” were collected from 28 patients and reviewed by eight gastrointestinal pathologists. Participants assessed stromal hemosiderin, lamina propria/eosinophils surrounding glands, desmoplasia, high grade dysplasia/intramucosal adenocarcinoma and margin status and rendered a diagnosis of pseudoinvasion, invasive adenocarcinoma, or both.ResultsAgreement among pathologists was substantial for desmoplasia (κ=0.70), high grade dysplasia/intramucosal adenocarcinoma (κ=0.66), invasive adenocarcinoma (κ=0.63) and adenocarcinoma at the margin (κ=0.65). There was moderate agreement for hemosiderin in stroma (κ=0.53) and prolapse/pseudoinvasion (κ=0.50). Agreement was low for lamina propria/eosinophils around glands (κ=0.12). For invasive adenocarcinoma, seven or more pathologists agreed in 24 of 28 cases (86%), and there was perfect agreement in 19/28 cases (68%). For pseudoinvasion, seven or more pathologists agreed in 19 of 28 cases (68%), and there was perfect agreement in 16/28 cases (57%).ConclusionModerate to substantial, though imperfect, agreement was achieved in the distinction of pseudoinvasion from invasive carcinoma.

Controversies in the Diagnosis of Barrett Esophagus and Barrett-Related Dysplasia: One Pathologist's Perspective

2010 ◽  
Vol 134 (10) ◽  
pp. 1479-1484 ◽  
Author(s):  
John R. Goldblum
Keyword(s):  
English Literature ◽  
Goblet Cells ◽  
High Grade Dysplasia ◽  
Barrett Esophagus ◽  
Low Grade ◽  
High Grade ◽  
Biopsy Specimens ◽  
Columnar Lined Esophagus ◽  
Intramucosal Adenocarcinoma ◽  
Rule Out

Abstract Context.—Pathologists frequently assess esophageal biopsy specimens to “rule out Barrett esophagus,” as well as to assess for the presence or absence of dysplasia. Objective.—To review some of the recent controversies in the diagnosis of Barrett esophagus and Barrett-related dysplasia. Data Sources.—Sources were the author's experience and review of the English literature from 1978 to 2009. Conclusions.—Although goblet cells are required by the American College of Gastroenterology to confirm a diagnosis of Barrett esophagus, this definition might expand to include columnar-lined esophagus without goblet cells. The recognition of dysplasia in Barrett esophagus remains a difficult task for the surgical pathologist, with difficulties in distinguishing reactive epithelium from dysplasia, low-grade dysplasia from high-grade dysplasia, and even high-grade dysplasia from intramucosal adenocarcinoma.

Optimizing the Technique for Circumferential Ablation of Barrett Esophagus Containing High-Grade Dysplasia Using the HALO360 System

2007 ◽  
Vol 65 (5) ◽  
pp. AB151 ◽  
Author(s):  
Joep J. Gondrie ◽  
Roos E. Pouw ◽  
Carine Sondermeijer ◽  
Wilda D. Rosmolen ◽  
Femke Peters ◽  
...  
Keyword(s):  
High Grade Dysplasia ◽  
Barrett Esophagus ◽  
High Grade

Endoscopic Surveillance Practice for Barrett's Oesophagus in Scotland and Early Experience in Implementing Local Guidelines

2003 ◽  
Vol 48 (2) ◽  
pp. 43-45 ◽  
Author(s):  
E F Shen ◽  
S Gladstone ◽  
G Milne ◽  
S Paterson-Brown ◽  
I D Penman
Keyword(s):  
Early Experience ◽  
High Grade Dysplasia ◽  
Low Grade ◽  
High Grade ◽  
Wide Variability ◽  
Low Grade Dysplasia ◽  
Surveillance Practice ◽  
Four Quadrant ◽  
The Impact

Management of columnar lined oesophagus (CLO; Barrett s oesophagus) is controversial. We prospectively audited surveillance practices in Scotland and prospectively assessed the impact of introducing local guidelines for Barrett s surveillance in Edinburgh. Most respondents were gastroenterologists. The majority take random, not four quadrant, biopsies from the CLO. In Edinburgh during 2000, 80 patients underwent surveillance. The guideline protocol was not followed in 30 (37.5%) patients. Follow up of patients without dysplasia generally conformed to the guidelines. Follow up of patients with low grade dysplasia was highly variable while management of those with high grade dysplasia followed the guidelines. Overall we found a wide variability in the management and surveillance of CLO. Early experience suggests that implementation of guidelines is helpful but there is still variation in practice.

Invasive Carcinoma after Endoscopic Ablative Therapy for High-Grade Dysplasia in Barrett’s Oesophagus

2003 ◽  
Vol 20 (5) ◽  
pp. 440-444 ◽  
Author(s):  
Richard van Hillegersberg ◽  
Jelle Haringsma ◽  
Fibo J.W. ten Kate ◽  
Guido N.J. Tytgat ◽  
Jan J.B. van Lanschot
Keyword(s):  
Invasive Carcinoma ◽  
High Grade Dysplasia ◽  
Barrett’S Oesophagus ◽  
High Grade ◽  
Barrett's Oesophagus ◽  
Ablative Therapy

scholarly journals High Grade Dysplasia And Invasive Carcinoma Among Sendai Negative Intraductal Papillary Mucinous Neoplasms

HPB ◽  
2020 ◽  
Vol 22 ◽  
pp. S15-S16
Author(s):  
C.L. Wolfgang ◽  
N. Amini ◽  
N. Rezaee ◽  
G.A. Margonis ◽  
J.L. Cameron ◽  
...  
Keyword(s):  
Invasive Carcinoma ◽  
High Grade Dysplasia ◽  
High Grade ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Mucinous Neoplasms
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