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Inter-observer Reproducibility in the Pathologic Diagnosis of Gastric Intraepithelial Neoplasia and Early Carcinoma in Endoscopic Submucosal Dissection Specimens: A Multi-center Study

Cancer Research and Treatment 2019년 51권 4호 p.1568 ~ 1577
 ( Kim Joon-Mee ) - Inha University School of Medicine Department of Pathology

 ( Sohn Jin-Hee ) - Sungkyunkwan University School of Medicine Kangbuk Samsung Hospital Department of Pathology
 ( Cho Mee-Yon ) - Yonsei University Wonju College of Medicirne Wonju Severance Christian Hospital Department of Pathology
 ( Kim Woo-Ho ) - Seoul National University College of Medicine Department of Pathology
 ( Chang Hee-Kyung ) - Kosin University College of Medicine Department of Pathology
 ( Jung Eun-Sun ) - Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Pathology
국명철 ( Kook Myeong-Cherl ) - National Cancer Center Department of Pathology
 ( Jin So-Young ) - SoonChunHyang University Seoul Hospital Department of Pathology
 ( Chae Yang-Seok ) - Korea University College of Medicine Department of Pathology
 ( Park Young-Soo ) - University of Ulsan College of Medicine Asan Medical Center Department of Pathology
강미선 ( Kang Mi-Seon ) - Inje University Busan Paik Hospital Department of Pathology
 ( Kim Hyun-Ki ) - Yonsei University College of Medicine Department of Pathology
 ( Lee Jae-Hyuk ) - Chonnam National University Hwasun Hospital Department of Pathology
 ( Park Do-Youn ) - Pusan National University College of Medicine Department of Pathology
 ( Kim Kyoung-Mee ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pathology
 ( Kim Ho-Guen ) - Yonsei University College of Medicine Department of Pathology
 ( Suh Young-Ju ) - Inha University School of Medicine Department of Biomedical Sciences
 ( Seol Sang-Yong ) - Inje University Busan Paik Hospital Department of Internal Medicine
정훈용 ( Jung Hwoon-Yong ) - University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
 ( Kim Deuck?Hwa ) - Inha University Department of Statistics
 ( Lee Na-Rae ) - National Evidence-Based Healthcare Collaborating Agency
 ( Park Seung-Hee ) - National Evidence-Based Healthcare Collaborating Agency
 ( You Ji-Hye ) - National Evidence-Based Healthcare Collaborating Agency

Abstract


Purpose: The diagnostic criteria of gastric intraepithelial neoplasia (IEN) are controversial across the world. We investigated how many discrepancies occur in the pathologic diagnosis of IEN and early gastric carcinoma in endoscopic submucosal dissection (ESD) specimens, and evaluated the reasons of the discordance.

Materials and Methods: We retrospectively reviewed 1,202 ESD specimens that were originally diagnosed as gastric IEN and early carcinoma at 12 institutions.

Results: The final consensus diagnosis of carcinoma were 756 cases, which were originally 692 carcinomas (91.5%), 43 high-grade dysplasias (5.7%), 20 low-grade dysplasias (2.6%), and 1 others (0.1%), respectively. High- and low-grade dysplasia were finally made in 63 and 342 cases, respectively. The diagnostic concordance with the consensus diagnosis was the highest for carcinoma (91.5%), followed by low-grade dysplasia (86.3%), others (63.4%) and high-grade dysplasia (50.8%). The general kappa value was 0.83, indicating excellent concordance. The kappa values of individual institutions ranged from 0.74 to 1 and correlated with the proportion of carcinoma cases. The cases revised to a final diagnosis of carcinoma exhibited both architectural abnormalities and cytologic atypia. The main differential points between low- and high-grade dysplasias were the glandular distribution and glandular shape. Additional features such as the glandular axis, surface maturation, nuclear stratification and nuclear polarity were also important.

Conclusion: The overall concordance of the diagnosis of gastric IEN and early carcinoma in ESD specimens was excellent. It correlated with the proportion of carcinoma cases, demonstrating that the diagnostic criteria for carcinoma are more reproducible than those for dysplasia.

키워드

Intraepithelial neoplasia; Stomach neoplasms; Endoscopic mucosal resection; Discrepancy; Reproducibility
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