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.

中文翻译：

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组织病理学家在使用数字病理学诊断巴雷特发育不良的大量国际病理学家样本中预测专家水平的诊断一致性


客观指南要求对发现发育异常的巴雷特食管 (BO) 活检进行专家病理学审查，但没有循证标准来证实专家审查者的身份。我们调查了 BO 一致性率和预测诊断不一致的病理学家特征。来自 20 多个国家的设计病理学家 (n=51) 在查看匹配的 p53 标签之前和之后评估了整个诊断范围的 55 个数字化 BO 活检。通过在线调查问卷获得了广泛的人口统计和临床经验数据。参考诊断是从经验丰富的巴雷特病理学家组成的审查小组（n=4）获得的。结果 我们记录了 6000 多个病例诊断以及匹配的人口统计数据。在 2805 例 H&E 诊断中，我们发现非不典型增生 BO 和高度不典型增生具有极好的一致性 (>70%)，而低度不典型增生 (42%) 和不确定不典型增生 (23%) 具有中等一致性。在 248 例诊断中发现了主要诊断错误 (8.8%)，在查看 p53 标记的幻灯片后，该错误减少到 232 例 (8.3%)。在多变量分析中对与诊断熟练程度相关的人口统计学变量进行了分析，结果表明至少 5 年的专业经验可以防止 H&E 幻灯片审查出现重大诊断错误（OR 0.48，95% CI 0.31 至 0.74）。在非教学医院工作与重大诊断错误的几率增加相关（OR 1.76，95% CI 1.15 至 2.69）；然而，当病理学家查看 p53 标记的载玻片时，这种情况就被抵消了。值得注意的是，病例数量和专家自我认同都无法预测诊断能力。将我们的数据外推到现实世界的病例流行率表明，92.3% 的主要诊断错误是由于过度解释非发育不良 BO 造成的。 结论 我们的数据为 Barrett 组织病理学诊断能力提供了循证标准。