An international inter-rater agreement study in the challenging diagnosis of squamous dysplasia of the oesophagus

Aims: There is a lack of published literature on the diagnostic reproducibility of oesophageal squamous dysplasia using a two-tiered grading system. Methods and results: We identified 75 oesophageal biopsies, which were reviewed by 10 international pathologists twice (1500 total observations) with a > 4-week washout period. Between rounds, a consensus meeting refining diagnostic criteria was held and an atlas was created to provide illustrations. Overall agreement was fair with kappa of 0.35 and 0.32 in round 1 and 2, respectively. Agreement was moderate to fair for negative for dysplasia (ND) (round 1 = 0.41 and round 2 = 0.34) and poor for indefinite for dysplasia (IND) and low-grade dysplasia (LGD) (kappa <0.2). Agreement for high-grade dysplasia (HGD) was good in both rounds (round 1 = 0.64; round 2 = 0.61). In round 1, majority diagnosis (MDx, ≥6 of 10 raters agreeing) was seen in 51 (68%) cases with the majority classified as ND (N = 27) or HGD (N = 18). MDx was rarely achieved for LGD (N = 6). In round 2, MDx was seen in 49 (65%) cases (20 ND, 1 IND, 11 LGD and 17 HGD). Of the 40 cases with MDx for both rounds, 39 were concordant (15 HGD, 6 LGD and 18 ND). Conclusions: Overall agreement among pathologists in diagnosing squamous lesions is fair; however, HGD had good agreement. This study fills an important gap in our knowledge of the inter-rater variability in the diagnosis of oesophageal squamous dysplasia.

Citation

Patil, A., Jiezhen, T. L., Kosiorek, H., Brown, I. S., Carneiro, F., Gill, A. J., Kumarasinghe, P. M., Kushima, R., Sheahan, K., Shepherd, N. A., Slavik, T., Srivastava, A., Lauwers, G. Y., Langner, C., & Pai, R. K. (2025). An international inter-rater agreement study in the challenging diagnosis of squamous dysplasia of the oesophagus. Histopathology, 10.1111/his.15509. Advance online publication. https://doi.org/10.1111/his.15509

DOI

10.1111/his.15509

URI

https://hdl.handle.net/20.500.14709/451