Endoscopic mucosal resection of Barrett's esophagus-related superficial neoplasms represents an efficacious staging modality.
It also allows for better pathologic grading compared with mucosal biopsy specimens.
However, the interobserver variation in the interpretation of endoscopic mucosal resection specimens has not been tested.
|The intraclass correlation was 0.9 with biopsy vs 1.0 using EMR|
Dr Mari Mino-Kenudson and colleagues from Massachusetts, USA evaluated the consistency in the diagnosis of Barrett's esophagus-related neoplasia on endoscopic mucosal resection specimens.
The team reported that 9 pathologists independently reviewed 25 esophageal endoscopic mucosal resection specimens, and corresponding biopsy specimens.
Each pathologist classified the cases as either non-neoplastic Barrett's esophagus, low-grade dysplasia, high-grade dysplasia, intramucosal adenocarcinoma, or invasive adenocarcinoma.
Interobserver concordance for both specimens from endoscopic mucosal resection and biopsies was measured by intraclass correlation and Kendall's coefficient of concordance.
The proportion of agreement was also calculated for each specimen and compared for endoscopic mucosal resection and biopsy by using the Wilcoxon signed rank test.
The researchers found that the intraclass correlation and the Kendall's coefficient for the 25 biopsy specimens was 0.9, and 0.7, respectively.
For the 25 endoscopic mucosal resection specimens, the team observed that these were significantly improved, at 1.0, and 0.8, respectively.
In addition, the proportion of agreement for endoscopic mucosal resection specimens was significantly better compared with biopsy specimens.
Dr Mino-Kenudson's team concluded, "Interobserver agreement of Barrett's esophagus-related neoplasia on endoscopic mucosal resection specimens is significantly higher compared with biopsy specimens."
"The results may relate to the larger tissue sampling compared with biopsy specimens and the ability to evaluate mucosal landmarks, such as double muscularis mucosae."
"Thus, we suggest that endoscopic mucosal resection, in addition to being a staging and therapeutic procedure, improves diagnostic consistency."