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Interobserver variation in assessment of gastric premalignant lesions

higher agreement for intestinal metaplasia than for atrophy

Leja, Marcisa,b,c; Funka, Konradsd; Janciauskas, Dainiuse,f; Putnins, Viestursg; Ruskule, Agnesea,b,c; Kikuste, Ilzed; Kojalo, Unad; Tolmanis, Ivarsh; Misins, Janisd; Purmalis, Karlisi; Pimanov, Sergeyj; Makarenko, Jelenaj; Kupcinskas, Limask; Vikmanis, Uldisd

European Journal of Gastroenterology & Hepatology: June 2013 - Volume 25 - Issue 6 - p 694–699
doi: 10.1097/MEG.0b013e32835e3397
Original Articles: Atrophic Gastritis
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Background Either atrophy or intestinal metaplasia of the gastric mucosa are considered premalignant lesions. The new operative link for gastritis assessment staging system is based on the detection of atrophy, and the operative link for assessment of intestinal metaplasia staging system is based on the detection of intestinal metaplasia. Good interobserver agreement is necessary for identification of any premalignant condition.

Aims The aim of this study was to compare the agreement between findings of gastric atrophy and intestinal metaplasia by expert and general pathologists and to analyze the possible reasons behind any possible disagreement.

Methods Patients with dyspeptic symptoms, aged 55 years and above, without previous Helicobacter pylori eradication were enrolled and analyzed according to the updated Sydney Classification by two expert pathologists and an experienced general pathologist; the results were compared with the consensus driven by the two experts.

Results Gastric biopsy specimens from 121 patients (91 women) were included in the analysis; the mean age of the patients was 67.4 years. H. pylori infection was present in 61.2% of patients. The level of agreement between the general pathologist and the two experts (κ-value) was 0.12, 0.46, and 0.87, respectively, for detecting atrophy in the corpus; 0.77, 0.77, and 0.65, respectively, for detecting intestinal metaplasia in the corpus; 0.06, 0.51, and 0.54, respectively, for detecting atrophy in the antrum; and 0.69, 0.85, and 0.79, respectively, for detecting metaplasia in the antrum.

Conclusion The agreement was substantially higher for intestinal metaplasia than for atrophy. This could result in discrepancies when the operative link for gastritis assessment and operative link for assessment of intestinal metaplasia staging systems are applied and can be caused by differences in the criteria used to define atrophy.

aFaculty of Medicine, University of Latvia, Riga, Latvia

bDigestive Diseases Centre GASTRO, Riga, Latvia

cDepartment of Research, Riga East University hospital, Riga, Latvia

dFaculty of Medicine, University of Latvia, Riga, Latvia

eDepartment of Pathology, Lithuanian University of Health Sciences, Kaunas, Lithuania

fFaculty of Medicine, University of Latvia, Riga, Latvia

gAcademic Histology laboratory, SIA, Riga, Latvia

hDepartment of Endoscopy and Gastroenterology, Digestive Diseases Centre GASTRO, Riga, Latvia

iFaculty of Economics and Management, University of Latvia, Riga, Latvia

jDepartment of Internal Medicine, Vitebsk State Medical University, Vitebsk, Belarus

kGastroenterology Research Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania

Correspondence to Marcis Leja, PhD, MD, Digestive Diseases Centre GASTRO, Riga East University Hospital, 6 Linezera iela, LV1006 Riga, Latvia Tel: +37 12 949 750 0; fax: +37 16 704 035 8; e-mail: cei@latnet.lv

Received September 18, 2012

Accepted December 19, 2012

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins