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Interobserver agreement among expert pathologists on through-the-needle microforceps biopsy samples for evaluation of pancreatic cystic lesions.

Abstract

BACKGROUND AND AIMS

The recent development of microforceps for endoscopic ultrasound (EUS) through-the-needle biopsy (TTNB) of the wall of pancreatic cystic lesions (PCLs) allows to acquire histological specimens, which pathologists never handled and evaluated before. We aimed to estimate the interobserver agreement among pathologists in evaluating such samples.

METHODS

TTNB slides from 40 PCLs with worrisome features were retrieved and independently evaluated for specimen adequacy, presence of lining epithelium, grade of epithelial dysplasia, presence of ovarian type stroma, and specific diagnosis by 6 expert pathologists from 6 different tertiary care centers. The Gwet's AC1 was used to assess interobserver agreement.

RESULTS

An almost perfect agreement was observed for specimen's adequacy (AC1, 0.82; 95% CI, 0.79;0.98), presence of lesional epithelium (AC1, 0.90; 95% CI, 0.86-0.92), epithelial dysplasia (AC1, 0.97; 95% CI, 0.95-0.99), ovarian-like stroma (AC1, 0.90; 95% CI, 0.86-0.93). When considering all diagnoses separately, a moderate to substantial agreement was observed (AC1, 0.62; 95% CI, 0.57-0.67), similarly to mucinous cysts versus serous adenoma versus other diagnoses (AC1, 0.65; 95% CI, 0.59-0.70) and for mucinous cysts versus all other diagnoses (AC1, 0.74; 95% CI, 0.68-0.84). The agreement for diagnosis of mucinous cystic neoplasm versus intraductal mucinous papillary neoplasm was almost perfect (AC1, 0.88; 95% CI, 0.81-0.95).

CONCLUSIONS

Interobserver agreement between expert pathologists in the evaluation of TTNB samples from PCLs with worrisome feature was close to perfection for all the evaluated parameters, except the definitive diagnosis. When mucinous cystic lesions were compared versus all other diagnoses, the agreement became substantial, thus indicating that TTNB specimen can provide important information for PCLs management decisions.

Authors+Show Affiliations

Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.Department of Diagnostics and Public Health, G.B. Rossi University Hospital, Verona, Italy.Digestive Endoscopy and Gastroenterology, Azienda Unità Sanitaria Locale AUSL della Romagna, Ospedali di Forlì e Cesena, Italy.Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy.Pathology Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy.Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy.Pathology Department, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.Pathology Department, Humanitas Research Hospital, Milan, Italy.Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Research Hospital, Milan, Italy.Department of Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.Pathology Unit, Azienda USL Città di Bologna, Ospedale Maggiore, Bologna, Italy. Electronic address: adele.fornelli@ausl.bologna.it.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31323232

Citation

Larghi, Alberto, et al. "Interobserver Agreement Among Expert Pathologists On Through-the-needle Microforceps Biopsy Samples for Evaluation of Pancreatic Cystic Lesions." Gastrointestinal Endoscopy, 2019.
Larghi A, Manfrin E, Fabbri C, et al. Interobserver agreement among expert pathologists on through-the-needle microforceps biopsy samples for evaluation of pancreatic cystic lesions. Gastrointest Endosc. 2019.
Larghi, A., Manfrin, E., Fabbri, C., Crinò, S. F., Correale, L., Chiarello, G., ... Fornelli, A. (2019). Interobserver agreement among expert pathologists on through-the-needle microforceps biopsy samples for evaluation of pancreatic cystic lesions. Gastrointestinal Endoscopy, doi:10.1016/j.gie.2019.07.011.
Larghi A, et al. Interobserver Agreement Among Expert Pathologists On Through-the-needle Microforceps Biopsy Samples for Evaluation of Pancreatic Cystic Lesions. Gastrointest Endosc. 2019 Jul 16; PubMed PMID: 31323232.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Interobserver agreement among expert pathologists on through-the-needle microforceps biopsy samples for evaluation of pancreatic cystic lesions. AU - Larghi,Alberto, AU - Manfrin,Erminia, AU - Fabbri,Carlo, AU - Crinò,Stefano Francesco, AU - Correale,Loredana, AU - Chiarello,Gaia, AU - Barresi,Luca, AU - Van Velthuysen,Marie-Louise, AU - Poley,Jan Werner, AU - Rahal,Daoud, AU - Carrara,Silvia, AU - Inzani,Frediano, AU - Fornelli,Adele, Y1 - 2019/07/16/ PY - 2019/05/12/received PY - 2019/07/03/accepted PY - 2019/7/20/entrez PY - 2019/7/20/pubmed PY - 2019/7/20/medline JF - Gastrointestinal endoscopy JO - Gastrointest. Endosc. N2 - BACKGROUND AND AIMS: The recent development of microforceps for endoscopic ultrasound (EUS) through-the-needle biopsy (TTNB) of the wall of pancreatic cystic lesions (PCLs) allows to acquire histological specimens, which pathologists never handled and evaluated before. We aimed to estimate the interobserver agreement among pathologists in evaluating such samples. METHODS: TTNB slides from 40 PCLs with worrisome features were retrieved and independently evaluated for specimen adequacy, presence of lining epithelium, grade of epithelial dysplasia, presence of ovarian type stroma, and specific diagnosis by 6 expert pathologists from 6 different tertiary care centers. The Gwet's AC1 was used to assess interobserver agreement. RESULTS: An almost perfect agreement was observed for specimen's adequacy (AC1, 0.82; 95% CI, 0.79;0.98), presence of lesional epithelium (AC1, 0.90; 95% CI, 0.86-0.92), epithelial dysplasia (AC1, 0.97; 95% CI, 0.95-0.99), ovarian-like stroma (AC1, 0.90; 95% CI, 0.86-0.93). When considering all diagnoses separately, a moderate to substantial agreement was observed (AC1, 0.62; 95% CI, 0.57-0.67), similarly to mucinous cysts versus serous adenoma versus other diagnoses (AC1, 0.65; 95% CI, 0.59-0.70) and for mucinous cysts versus all other diagnoses (AC1, 0.74; 95% CI, 0.68-0.84). The agreement for diagnosis of mucinous cystic neoplasm versus intraductal mucinous papillary neoplasm was almost perfect (AC1, 0.88; 95% CI, 0.81-0.95). CONCLUSIONS: Interobserver agreement between expert pathologists in the evaluation of TTNB samples from PCLs with worrisome feature was close to perfection for all the evaluated parameters, except the definitive diagnosis. When mucinous cystic lesions were compared versus all other diagnoses, the agreement became substantial, thus indicating that TTNB specimen can provide important information for PCLs management decisions. SN - 1097-6779 UR - https://www.unboundmedicine.com/medline/citation/31323232/Interobserver_agreement_among_expert_pathologists_on_through-the-needle_microforceps_biopsy_samples_for_evaluation_of_pancreatic_cystic_lesions L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5107(19)32059-0 DB - PRIME DP - Unbound Medicine ER -