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Improved diagnostic stratification of digitised Barrett's oesophagus biopsies by p53 immunohistochemical staining
Author(s) -
Wel Myrtle J,
Duits Lucas C,
Pouw Roos E,
Seldenrijk Cornelis A,
Offerhaus G J A,
Visser Mike,
Kate Fiebo J,
Biermann Katharina,
Brosens Lodewijk A A,
Doukas Michael,
Huysentruyt Clement,
Karrenbeld Arend,
KatsUgurlu Gursah,
Laan Jaap S,
Lijnschoten G Ineke,
Moll Freek C P,
Ooms Ariadne H A G,
Valk Hans,
Tijssen Jan G,
Bergman Jacques J,
Meijer Sybren L
Publication year - 2018
Publication title -
histopathology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.626
H-Index - 124
eISSN - 1365-2559
pISSN - 0309-0167
DOI - 10.1111/his.13462
Subject(s) - medicine , dysplasia , medical diagnosis , gold standard (test) , biopsy , immunohistochemistry , radiology , pathology , gastroenterology
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 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.