Abstract：
Endoscopic resection (ER) is an important diagnostic step in management of patients with early Barrett\'s esophagus (BE) neoplasia. Based on ER specimens, an accurate histological diagnosis can be made, which guides further treatment. Based on depth of tumor invasion, differentiation grade, lymphovascular invasion, and margin status, the risk of lymph node metastases and local recurrence is judged to be low enough to justify endoscopic management, or high enough to warrant invasive surgical esophagectomy. Adequate assessment of these histological risk factors is therefore of the utmost importance. Aim of this study was to assess pathologist concordance on these histological features on ER specimens and evaluate causes of discrepancy. Of 62 challenging ER cases, one representative H&E slide and matching desmin and endothelial marker were digitalized and independently assessed by 13 dedicated GI pathologists from 8 Dutch BE expert centers, using an online assessment module. For each histological feature, concordance and discordance were calculated. Clinically relevant discordances were observed for all criteria. Grouping depth of invasion categories according to expanded endoscopic treatment criteria (T1a and T1sm1 vs. T1sm2/3), ≥1 pathologist was discrepant in 21% of cases, increasing to 45% when grouping diagnoses according to the traditional T1a versus T1b classification. For differentiation grade, lymphovascular invasion, and margin status, discordances were substantial with 27%, 42%, and 32% of cases having ≥1 discrepant pathologist, respectively. In conclusion, histological assessment of ER specimens of early BE cancer by dedicated GI pathologists shows significant discordances for all relevant histological features. We present propositions to improve definitions of diagnostic criteria.
摘要：
内镜切除术（ER）是治疗早期Barrett食管（BE）瘤形成的重要诊断步骤。根据急诊室标本，可以做出准确的组织学诊断，指导进一步的治疗。根据肿瘤的浸润深度,分化等级，淋巴管浸润,和保证金状态，淋巴结转移和局部复发的风险被认为是足够低的内镜治疗，或者高到足以进行侵入性手术食管癌切除术.因此，对这些组织学危险因素的充分评估至关重要。这项研究的目的是评估病理学家对ER标本这些组织学特征的一致性，并评估差异的原因。在62个有挑战性的急诊室病例中，一个代表性的H&E载玻片和匹配的结蛋白和内皮标记物被数字化，并由来自8个荷兰BE专家中心的13名专门的胃肠道病理学家独立评估。使用在线评估模块。对于每个组织学特征，计算了一致性和不一致性。所有标准均观察到临床相关的不一致。根据扩大的内镜治疗标准对浸润深度类别进行分组(T1a和T1sm1vs.T1sm2/3),≥1名病理学家在21%的病例中存在差异，当根据传统的T1a和T1b分类进行分组诊断时，增加到45%。对于差异化等级，淋巴管浸润,和保证金状态，分歧很大，占27%，42%,32%的病例有≥1名病理学家，分别。总之,由专门的GI病理学家对早期BE癌的ER标本进行的组织学评估显示,所有相关组织学特征均存在显著差异.我们提出了改进诊断标准定义的建议。
