An inter-rater agreement study of diagnosis of squamous dysplasia of esophagus
Literature on the diagnostic reproducibility of esophageal squamous dysplasia using a two-tiered grading system is lacking. The authors undertook a study to address these knowledge gaps by assessing inter-rater agreement in the diagnosis and grading of squamous precursor lesions among a group of 10 international pathologists. For the study, they identified 75 esophageal biopsies, which were reviewed by 10 international pathologists two times (1,500 total observations), with a washout period of more than four weeks. 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 rounds one and two, respectively. Agreement was moderate to fair for negative for dysplasia (ND) (round one, 0.41; round two, 0.34) and poor for indefinite for dysplasia (IND) and low-grade dysplasia (kappa of less than 0.2). Agreement for high-grade dysplasia was good in both rounds (round one, 0.64; round two, 0.61). In round one, majority diagnosis (six or more of 10 raters agreeing) was seen in 51 (68 percent) cases, with the majority classified as ND (n=27) or high-grade dysplasia (n=18). Majority diagnosis was rarely achieved for low-grade dysplasia (n=6). In round two, majority diagnosis was seen in 49 (65 percent) cases (20 ND, one IND, 11 low-grade dysplasia, and 17 high-grade dysplasia). Of 40 cases with majority diagnosis for both rounds, 39 were concordant (15 high-grade dysplasia, six low-grade dysplasia, and 18 ND). The authors concluded that overall agreement among pathologists diagnosing squamous lesions was fair. However, high-grade dysplasia had a good level of agreement among pathologists. They also concluded that this study fills a gap in pathologists’ knowledge of inter-rater variability in the diagnosis of esophageal squamous dysplasia.
Patil A, Jiezhen TL, Kosiorek H, et al. An international inter-rater agreement study in the challenging diagnosis of squamous dysplasia of the oesophagus. Histopathology. 2025. doi.org/10.1111/his.15509
Correspondence: Dr. Rish K. Pai at [email protected]
Predictors of neoplastic progression in gastroesophageal lesions indefinite for dysplasia
A need exists to identify patients with indefinite dysplasia in Barrett’s esophagus and stomach who are at higher risk of progression to provide them with the best care. The authors conducted a study to identify the predictive histological and clinicopathologic hallmarks of progression for lesions that are indefinite for dysplasia. The study included patients with confirmed Barrett’s esophagus indefinite for dysplasia (BE-IND) or gastric indefinite for dysplasia (G-IND), no previous evidence of dysplasia or cancer, and follow-up of six or more months. The rate of neoplastic progression was calculated, and the multivariate Cox regression model adjusted for demographic and histological features was used to identify risk factors for progression. A total of 324 of 719 patients diagnosed with IND (77 BE-IND and 247 G-IND) were identified after applying exclusion criteria. Progression rates were 4.4 per 100 person-years for BE-IND and 1.6 per 100 person-years for G-IND. Progression was observed only in IND of hyperproliferative intestinal metaplasia type. Operative link for gastritis assessment (OLGA) stage (III–IV versus 0–II) was the only significant predictor of G-IND progression (hazard ratio [HR], 47.82; 95 percent confidence interval [CI], 6.24–366.37; P<.001). In BE-IND patients, lack of interval endoscopy significantly increased the risk for neoplasia at multivariate Cox regression (HR, 13.45; 95 percent CI, 1.24–145.75; P=.032). The authors concluded that IND is a challenging diagnosis for pathologists and implies an increased risk for neoplasia, especially in Barrett’s esophagus patients, without providing definitive information for patient management. This study highlights that neoplastic progression of IND lesions is primarily associated with hyperproliferative intestinal metaplasia type. Interval endoscopy significantly reduces risk of progression for BE-IND, while OLGA staging (III–IV) is a strong predictor of progression in G-IND. These findings emphasize the importance of identifying hyperproliferative intestinal metaplasia and using OLGA staging in G-IND to enhance risk stratification and follow-up strategies.
Angerilli V, Galuppini F, Brignola S, et al. Predictors of neoplastic progression in gastroesophageal lesions indefinite for dysplasia. Histopathology. 2025. doi.org/10.1111/his.15449
Correspondence: Dr. Matteo Fassan at [email protected]