Background and Aims

The diagnosis of low-grade dysplasia (LGD) in Barrett’s esophagus (BE) is subject to substantial interobserver variation. Our central aim in this study is to compare independent pathology practices using objective measures of BE risk stratification proficiency, including frequency of diagnosis and rate of progression, with high-grade dysplasia (HGD) or adenocarcinoma (EAC) after the first diagnosis of LGD.

Methods

We retrospectively evaluated over 29,000 endoscopic biopsy cases to identify 4734 patients under endoscopic biopsy surveillance for BE in a healthcare system with multiple independent pathology practices: a subspecialized GI pathology group (SSGI; 162 BE cases per pathologist annually), 3 high BE volume general surgical pathology practices (GSPs; >50 BE cases per pathologist annually), and multiple low BE volume GSPs (10.6 BE cases per pathologist annually). We measured LGD diagnosis frequencies and rates of diagnostic progression to HGD or EAC in patients diagnosed with LGD.

Results

The proportion of all BE cases diagnosed as LGD (LGD/BE diagnosis ratio) ranged from 1.1% to 6.8% in the different hospital settings (P < .001). The cumulative proportion of patients with HGD or EAC within 2 years of the first diagnosis of LGD was 35.3% in the SSGI and ranged from 1.4% to 14.3% in the GSPs (P < .001). LGD diagnosed by the GSP with the lowest LGD/BE diagnosis ratio had an adjusted risk of progression similar to LGD diagnosed by subspecialists (hazard ratio, .42; 95% CI, .06-3.03). However, when LGD was diagnosed by other generalists, the adjusted risk of progression was 79% to 91% lower than subspecialists (P < .001). When LGD was diagnosed in a low-volume GSP practice, the risk of progression was not significantly increased relative to patients with nondysplastic BE (hazard ratio, 1.3; 95% CI, .4-3.9).

Conclusions

General surgical pathologists and subspecialists show highly significant differences with respect to LGD/BE ratio, risk of progression relative to nondysplastic BE, crude annual progression rates, and the cumulative 2-year progression rate after LGD. These metrics can be used to assess proficiency in BE risk stratification in historical cases. Some general practitioners were able to achieve results similar to subspecialists. General surgical pathologists with little annual experience evaluating BE biopsy specimens did not successfully risk stratify patients with BE.

中文翻译：

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低度异型增生的诊断率和进展指标可确定独立病理实践中可变的Barrett食道风险分层熟练程度

背景和目标

巴雷特食管（BE）的低度发育异常（LGD）的诊断受观察者间差异的影响。这项研究的主要目的是比较使用BE风险分层能力的客观指标（包括诊断频率和进展率）与LGD初次诊断后的高度异型增生（HGD）或腺癌（EAC）进行客观病理学比较的独立病理学方法。

方法

我们回顾性评估了29,000例内镜活检病例，以鉴定在医疗系统中进行内窥镜活检监测的4734例BE，该系统具有多种独立的病理学实践：亚专业GI病理学组（SSGI；每位病理学家每年162 BE例），3例高BE量的普通外科手术病理实践（GSP；每位病理学家每年> 50个BE病例）和多个低BE量GSP（每位病理学家每年10.6个BE病例）。我们测量了诊断为LGD的患者的LGD诊断频率和诊断进展为HGD或EAC的速度。

结果

在不同的医院环境中，所有诊断为LGD的BE病例的比例（LGD / BE诊断比率）在1.1％至6.8％之间（P  <.001）。首次诊断为LGD的2年内，患有HGD或EAC的患者在SSGI中的累积比例为35.3％，在GSP中为1.4％至14.3％（P  <.001）。由GSP诊断的LGD / BE诊断率最低的LGD与亚专科医生诊断的LGD相似，具有调整后的进展风险（危险比，.42； 95％CI，.06-3.03）。但是，当LGD被其他通才诊断出时，调整后的进展风险要比专科医师低79％至91％（P <.001）。当采用小剂量GSP实践诊断出LGD时，相对于非增生性BE患者，进展风险并未显着增加（危险比，1.3； 95％CI，.4-3.9）。

结论

普通外科病理学家和专科医生在LGD / BE比率，相对于非发育异常BE的进展风险，粗略的年进展率以及LGD术后2年累积进展率方面显示出非常显着的差异。这些指标可用于评估历史案例中BE风险分层的熟练程度。一些全科医生能够获得与专科医师相似的结果。仅有很少的年度经验评估BE活检标本的普通外科病理学家没有成功地将BE患者分层。