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

Joon Mee Kim, Jin Hee Sohn, Mee Yon Cho, Woo Ho Kim, Hee Kyung Chang, Eun Sun Jung, Myeong Cherl Kook, So Young Jin, Yang Seok Chae, Young Soo Park, Mi Seon Kang, Hyunki Kim, Jae Hyuk Lee, Do Youn Park, Kyoung Mee Kim, Hoguen Kim, Young Ju Suh, Sang Yong Seol, Hwoon Yong Jung, Deuck Hwa KimNa Rae Lee, Seung Hee Park, Ji Hye You

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)1568-1577
Number of pages10
JournalCancer Research and Treatment
Volume51
Issue number4
DOIs
Publication statusPublished - 2019 Oct 1

Bibliographical note

Funding Information:
This study was conducted as part of project number NA2014-001 funded by the National Evidence-based Healthcare Collaborating Agency (NECA) in Korea.

Publisher Copyright:
© 2019 Korean Cancer Association. All rights reserved.

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

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