Myrtle J van der Wel1,2, Lucas C Duits2, Roos E Pouw2, Cornelis A Seldenrijk3, G J A Offerhaus4, Mike Visser5, Fiebo J Ten Kate4, Katharina Biermann6, Lodewijk A A Brosens4, Michael Doukas6, Clement Huysentruyt7, Arend Karrenbeld8, Gursah Kats-Ugurlu8, Jaap S van der Laan9, G Ineke van Lijnschoten7, Freek C P Moll10, Ariadne H A G Ooms11, Hans van der Valk11, Jan G Tijssen12, Jacques J Bergman2, Sybren L Meijer1. 1. Department of Pathology, Academic Medical Centre, Amsterdam, The Netherlands. 2. Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands. 3. Department of Pathology, Pathology-DNA, St Antonius Hospital, Nieuwegein, The Netherlands. 4. Department of Pathology, University Medical Centre, Utrecht, The Netherlands. 5. Department of Pathology, Symbiant BV, Alkmaar, The Netherlands. 6. Department of Pathology, Erasmus Medical Centre, Rotterdam, The Netherlands. 7. Department of Pathology, Stichting PAMM, Eindhoven, The Netherlands. 8. Department of Pathology, Academic Medical Centre, Groningen, The Netherlands. 9. Department of Pathology, Haga Hospital, The Hague, The Netherlands. 10. Department of Pathology, Isala Clinics, Zwolle, The Netherlands. 11. Department of Pathology, St Fransiscus Vlietland Gasthuis, Pathan BV, Rotterdam, The Netherlands. 12. Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands.
Abstract
AIMS: Interobserver agreement for dysplasia in Barrett's oesophagus (BO) is low, and guidelines advise expert review of dysplastic cases. The aim of this study was to assess the added value of p53 immunohistochemistry (IHC) for the homogeneity within a group of dedicated gastrointestinal (GI) pathologists. METHODS AND RESULTS: Sixty-single haematoxylin and eosin (HE) slide referral BO cases [20 low-grade dysplasia (LGD); 20 high-grade dysplasia (HGD); and 20 non-dysplastic BO reference cases] were digitalised and independently assessed twice in random order by 10 dedicated GI pathologists. After a 'wash-out' period, cases were reassessed with the addition of a corresponding p53 IHC slide. Outcomes were: (i) proportion of 'indefinite for dysplasia' (IND) diagnoses; (ii) interobserver agreement; and (iii) diagnostic accuracy as compared with a consensus 'gold standard' diagnosis defined at an earlier stage by five core expert BO pathologists after their assessment of this case set. Addition of p53 IHC decreased the mean proportion of IND diagnoses from 10 of 60 to eight of 60 (P = 0.071). Mean interobserver agreement increased significantly from 0.45 to 0.57 (P = 0.0021). The mean diagnostic accuracy increased significantly from 72% to 82% (P = 0.0072) after p53 IHC addition. CONCLUSION: Addition of p53 IHC significantly improves the histological assessment of BO biopsies, even within a group of dedicated GI pathologists. It decreases the proportion of IND diagnoses, and increases interobserver agreement and diagnostic accuracy. This justifies the use of accessory p53 IHC within our upcoming national digital review panel for BO biopsy cases.
AIMS: Interobserver agreement for dysplasia in Barrett's oesophagus (BO) is low, and guidelines advise expert review of dysplastic cases. The aim of this study was to assess the added value of p53 immunohistochemistry (IHC) for the homogeneity within a group of dedicated gastrointestinal (GI) pathologists. METHODS AND RESULTS: Sixty-single haematoxylin and eosin (HE) slide referral BO cases [20 low-grade dysplasia (LGD); 20 high-grade dysplasia (HGD); and 20 non-dysplastic BO reference cases] were digitalised and independently assessed twice in random order by 10 dedicated GI pathologists. After a 'wash-out' period, cases were reassessed with the addition of a corresponding p53 IHC slide. Outcomes were: (i) proportion of 'indefinite for dysplasia' (IND) diagnoses; (ii) interobserver agreement; and (iii) diagnostic accuracy as compared with a consensus 'gold standard' diagnosis defined at an earlier stage by five core expert BO pathologists after their assessment of this case set. Addition of p53 IHC decreased the mean proportion of IND diagnoses from 10 of 60 to eight of 60 (P = 0.071). Mean interobserver agreement increased significantly from 0.45 to 0.57 (P = 0.0021). The mean diagnostic accuracy increased significantly from 72% to 82% (P = 0.0072) after p53 IHC addition. CONCLUSION: Addition of p53 IHC significantly improves the histological assessment of BO biopsies, even within a group of dedicated GI pathologists. It decreases the proportion of IND diagnoses, and increases interobserver agreement and diagnostic accuracy. This justifies the use of accessory p53 IHC within our upcoming national digital review panel for BO biopsy cases.
Authors: Carlijn A M Roumans; Manon C W Spaander; Iris Lansdorp-Vogelaar; Katharina Biermann; Marco J Bruno; Ewout W Steyerberg; Dimitris Rizopoulos Journal: PLoS One Date: 2022-04-27 Impact factor: 3.752
Authors: Melissa Schmidt; Richard J Hackett; Ann-Marie Baker; Stuart A C McDonald; Michael Quante; Trevor A Graham Journal: Nat Rev Gastroenterol Hepatol Date: 2021-11-02 Impact factor: 46.802
Authors: M J van der Wel; E Klaver; L C Duits; R E Pouw; C A Seldenrijk; Gja Offerhaus; M Visser; Fjw Ten Kate; K Biermann; Laa Brosens; M Doukas; C Huysentruyt; A Karrenbeld; G Kats-Ugurlu; J S van der Laan; G van Lijnschoten; Fcp Moll; Ahag Ooms; J G Tijssen; Jjghm Bergman; S L Meijer Journal: United European Gastroenterol J Date: 2019-05-21 Impact factor: 4.623
Authors: Richard Phillips; Wladyslaw Januszewicz; Nastazja D Pilonis; Maria O'Donovan; Tarek Sawas; David A Katzka; Rebecca C Fitzgerald; Massimiliano di Pietro Journal: Gastrointest Endosc Date: 2021-02-04 Impact factor: 9.427
Authors: Georg A Busslinger; Buys de Barbanson; Rurika Oka; Bas L A Weusten; Michiel de Maat; Richard van Hillegersberg; Lodewijk A A Brosens; Ruben van Boxtel; Alexander van Oudenaarden; Hans Clevers Journal: Proc Natl Acad Sci U S A Date: 2021-11-23 Impact factor: 11.205