Improved diagnostic stratification of digitised Barrett's oesophagus biopsies by p53 immunohistochemical staining
van der Wel, Myrtle J.; Duits, Lucas C.; Pouw, Roos E.; Seldenrijk, Cornelis A.; Offerhaus, G. J.A.; Visser, Mike; ten Kate, Fiebo J.; Biermann, Katharina; Brosens, Lodewijk A.A.; Doukas, Michael; Huysentruyt, Clement; Karrenbeld, Arend; Kats-Ugurlu, Gursah; van der Laan, Jaap S.; van Lijnschoten, G. Ineke; Moll, Freek C.P.; Ooms, Ariadne H.A.G.; van der Valk, Hans; Tijssen, Jan G.; Bergman, Jacques J.; Meijer, Sybren L.
(2018) Histopathology, volume 72, issue 6, pp. 1015 - 1023
(Article)
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
... read more
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.
show less
Download/Full Text
The full text of this publication is not available.
Keywords: Barrett's oesophagus, interobserver agreement, low-grade dysplasia, p53 immunohistochemistry, review panel, whole-slide imaging, Pathology and Forensic Medicine, Histology
ISSN: 0309-0167
Publisher: Wiley-Blackwell
Note: Funding Information: J J Bergman: receives research support from Olympus Endoscopy, Cook Medical, Boston Scientific, GI Solutions Covidien, Erbe, Fractyl and Ninepoint Medical, Fuji Film, Cernostics, Interpace; receives financial support for training programmes from GI Solutions Covidien; and receives honorarium/consultancy/ speakers’ fees from Cook Medical, Boston Scientific, and GI Solutions. The other authors state that they have no conflicts of interest. Publisher Copyright: © 2018 John Wiley & Sons Ltd
(Peer reviewed)