Challenges in Inter-rater Agreement on Lamina Propria Fibrosis in Esophageal Biopsies.
Pediatr Dev Pathol
; 26(2): 106-114, 2023.
Article
in En
| MEDLINE
| ID: mdl-36755427
ABSTRACT
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Eosinophilic Esophagitis
Type of study:
Diagnostic_studies
/
Prognostic_studies
Limits:
Child
/
Humans
Language:
En
Journal:
Pediatr Dev Pathol
Journal subject:
PATOLOGIA
/
PEDIATRIA
Year:
2023
Document type:
Article
Affiliation country:
United States