Do pathologists agree with each other on the histological assessment of pT1b oesophageal adenocarcinoma?

Annieke W Gotink, Fiebo Jc Ten Kate, Michael Doukas, Bas Pl Wijnhoven, Marco J Bruno, Leendert Hj Looijenga, Arjun D Koch, Katharina Biermann

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)


Background: In early (T1) oesophageal adenocarcinoma (OAC), the histological profile of an endoscopic resection specimen plays a pivotal role in the prediction of lymph node metastasis and the potential need for oesophagectomy with lymphadenectomy.

Objective: To evaluate the inter-observer agreement of the histological assessment of submucosal (pT1b) OAC.

Methods: Surgical and endoscopic resection specimens with pT1b OAC were independently reviewed by three gastrointestinal pathologists. Agreement was determined by intraclass correlation coefficient for continuous variables, and Fleiss' kappa (κ) for categorical variables. Bland-Altman plots of the submucosal invasion depth were made.

Results: Eighty-five resection specimens with pT1b OAC were evaluated. The agreement was good for differentiation grade (κ=0.77, 95% confidence interval (CI) 0.68-0.87), excellent for lymphovascular invasion (κ=0.88, 95% CI 0.76-1.00) and moderate for submucosal invasion depth using the Paris and Pragmatic classifications (κ=0.60, 95% CI 0.49-0.72 and κ=0.42, 95% CI 0.33-0.51, respectively). Systematic mean differences between pathologists were detected for the measurement of submucosal invasion depth, ranging from 297 µm to 602 µm.

Conclusions: A substantial discordance was found between pathologists for the measurement of submucosal invasion depth in pT1b OAC. Differences may lead to an over- or underestimation of the lymph node metastasis risk, with grave implications for the treatment strategy. Review by a second gastrointestinal pathologist is recommended to improve differentiating between a favourable and an unfavourable histological profile.

Original languageEnglish
Pages (from-to)261-269
Number of pages9
JournalUnited European gastroenterology journal
Issue number2
Publication statusPublished - Mar 2019
Externally publishedYes


  • Adenocarcinoma/diagnosis
  • Adult
  • Aged
  • Aged, 80 and over
  • Esophageal Neoplasms/diagnosis
  • Esophagoscopy
  • Female
  • Follow-Up Studies
  • Histocytochemistry/methods
  • Humans
  • Lymphatic Metastasis
  • Male
  • Middle Aged
  • Neoplasm Grading
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Observer Variation
  • Pathologists


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