Histopathologist features predictive of diagnostic concordance at expert level among a large international sample of pathologists diagnosing Barrett's dysplasia using digital pathology. Issue 5 (18th December 2019)

• Record Type: Journal Article
• Authors: van der Wel, Myrtle J; Coleman, Helen G; Bergman, Jacques J G H M; Jansen, Marnix; Meijer, Sybren L
• Other Names: author non-byline.; Aida Junko author non-byline.; Baiocco Rossana author non-byline.; Boulagnon-Rombi Camille author non-byline.; Brcic Iva author non-byline.; Brosens Lodewijk author non-byline.; Carneiro Fátima author non-byline.; Cathomas Gieri author non-byline.; Chatelain Denis author non-byline.; Cluroe Allison author non-byline.; Dabir Parag author non-byline.; Petris Giovanni De author non-byline.; Doukas Michael author non-byline.; El-Zimaity Hala author non-byline.; Fassan Matteo author non-byline.; Fiocca Roberto author non-byline.; Fléjou Jean-François author non-byline.; Varona Alejandro García author non-byline.; Obeso Elvira Gonzalez author non-byline.; Grabsch Heike author non-byline.; Grillo Federica author non-byline.; Gruber Barbara author non-byline.; Pastrian Laura Guerra author non-byline.; Hoorens Anne author non-byline.; Kamaradova Katerina author non-byline.; Kushima Ryoji author non-byline.; Langner Cord author non-byline.; Langer Rupert author non-byline.; Lasitschka Felix author non-byline.; Lörinc Ester author non-byline.; Mastracci Luca author non-byline.; McManus Damian author non-byline.; Mendez Carmen author non-byline.; Milne Anya author non-byline.; Mitchison Miriam author non-byline.; Mireskandari Masoud author non-byline.; Montgomery Elizabeth author non-byline.; Muldoon Cian author non-byline.; O'Donovan Maria author non-byline.; Odze Robert author non-byline.; Offerhaus Johan author non-byline.; Olmedilla Gabriel author non-byline.; Pauli John author non-byline.; van der Post Rachel S author non-byline.; Riddell Robert author non-byline.; Ristimaki Ari author non-byline.; Rodriguez Ana author non-byline.; Rodriguez-Justo Manual author non-byline.; Sekine Shigeki author non-byline.; Seldenrijk Cornelis author non-byline.; Souza Tulio author non-byline.; Stachler Matt author non-byline.; Vieth Michael author non-byline.; Villanacci Vincenzo author non-byline.; Yantiss Rhonda author non-byline.;
• Is Part Of: Gut. Volume 69:Issue 5(2020)
• Page Start: 811
• Page End: 822
• Publication Date: 2019-12-18
• Subjects: barrett's oesophagus -- dysplasia -- oesophageal cancer -- health service research; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2019-318985
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: Guidelines mandate expert pathology review of Barrett's oesophagus (BO) biopsies that reveal dysplasia, but there are no evidence-based standards to corroborate expert reviewer status. We investigated BO concordance rates and pathologist features predictive of diagnostic discordance. Design: Pathologists (n=51) from over 20 countries assessed 55 digitised BO biopsies from across the diagnostic spectrum, before and after viewing matched p53 labelling. Extensive demographic and clinical experience data were obtained via online questionnaire. Reference diagnoses were obtained from a review panel (n=4) of experienced Barrett's pathologists. Results: We recorded over 6000 case diagnoses with matched demographic data. Of 2805 H&E diagnoses, we found excellent concordance (>70%) for non-dysplastic BO and high-grade dysplasia, and intermediate concordance for low-grade dysplasia (42%) and indefinite for dysplasia (23%). Major diagnostic errors were found in 248 diagnoses (8.8%), which reduced to 232 (8.3%) after viewing p53 labelled slides. Demographic variables correlating with diagnostic proficiency were analysed in multivariate analysis, which revealed that at least 5 years of professional experience was protective against major diagnostic error for H&E slide review (OR 0.48, 95% CI 0.31 to 0.74). Working in a non-teaching hospital was associated with increased odds of major diagnostic error (OR 1.76, 95% CI 1.15 to 2.69); however, this was neutralised when pathologists viewed p53 labelled slides. Notably, neither case volume nor self-identifying as an expert predicted diagnostic proficiency. Extrapolating our data to real-world case prevalence suggests that 92.3% of major diagnostic errors are due to overinterpreting non-dysplastic BO. Conclusion: Our data provide evidence-based criteria for diagnostic proficiency in Barrett's histopathology.