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Inter-Observer Agreement among Pathologists Using Wide-Area Transepithelial Sampling With Computer-Assisted Analysis in Patients With Barrett’s Esophagus

Vennalaganti, Prashanth R MD1; Kanakadandi, Vijay Naag MD1,2; Gross, Seth A MD3; Parasa, Sravanthi MD, MPH1,2; Wang, Kenneth K MD4; Gupta, Neil MD, MPH5; Sharma, Prateek MD1,2

American Journal of Gastroenterology: September 2015 - Volume 110 - Issue 9 - p 1257–1260
doi: 10.1038/ajg.2015.116
THE RED SECTION
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OBJECTIVES: The histopathological diagnosis of Barrett’s esophagus (BE)-associated dysplasia has poor inter-observer agreement. The wide-area transepithelial sampling (WATS) procedure uses a minimally invasive brush biopsy technique for acquiring wide-area sampling of BE tissue followed by computer-assisted analysis. In this study, our aim was to assess inter-observer agreement among pathologists in the diagnosis of Barrett’s-associated dysplasia using the WATS computer-assisted analysis technique.

METHODS: WATS slides with varying degrees of BE dysplasia were randomly selected and distributed to four pathologists. Each pathologist graded the slides as nondysplastic, low-grade dysplasia (LGD), or high-grade dysplasia/esophageal adenocarcinoma (HGD/EAC) and completed a standardized case report form (CRF) for each slide.

RESULTS: In all, 149 BE slides were evaluated in a blinded manner by 4 pathologists. The slides included the following: no dysplasia (n=109), LGD, and HGD/EAC (n=40). The overall mean kappa value for all 3 diagnoses for the 4 observers was calculated at 0.86 (95% confidence interval (CI) 0.75–0.97). The kappa values (95% CI) for HGD/EAC, IND/LGD, and no dysplasia were 0.95 (0.88–0.99), 0.74 (0.61–0.85), and 0.88 (0.81–0.94), respectively.

CONCLUSIONS: The diagnosis of BE and associated dysplasia using the WATS technique has very high inter-observer agreement. This appears to be significantly higher as compared with previously published data using standard histopathology.

1Department of Gastroenterology, Kansas City Veterans Affairs Medical Center, Kansas City, Missouri, USA

2Department of Gastroenterology, University of Kansas Medical Center, Kansas City, Kansas, USA

3Department of Gastroenterology, NYU Langone Medical Center, New York, New York, USA

4Division of Gastroenterology and Hepatology, Barrett’s Esophagus Unit, Mayo Clinic, Rochester, Minnesota, USA

5Department of Gastroenterology, Loyola University Medical Center, Chicago, Illinois, USA

Correspondence: Prashanth R. Vennalaganti, MD or Prateek Sharma, MD, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, 66160, USA. E-mail: pvennalaganti@gmail.com or psharma@kumc.edu

Guarantor of the article: Prateek Sharma, MD.

Specific author contributions: Study conception and design; analysis and interpretation of the data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content: Prashanth Vennalaganti; study concept and design; statistical analysis; interpretation of data; and drafting of the manuscript: Vijay Kanakadandi; critical revision of the manuscript for intellectual content: Seth A. Gross, Kenneth K. Wang and Sravanthi Parasa; analysis and interpretation of the data; drafting of the manuscript; and critical revision of the manuscript for important intellectual content: Neil Gupta; study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; and statistical analysis: Prateek Sharma.

Financial support: None.

Potential competing interests: Dr Gross is a consultant for CDx Diagnostics.

© The American College of Gastroenterology 2015. All Rights Reserved.
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