Background and Aims
The recent development of microforceps for EUS through-the-needle biopsy (TTNB) sampling
of the wall of pancreatic cystic lesions (PCLs) allows the collection of histologic
specimens never handled and evaluated before by pathologists. We aimed to estimate
the interobserver agreement among pathologists in evaluating such samples.
Methods
TTNB specimen slides from 40 PCLs with worrisome features were retrieved and independently
evaluated for specimen adequacy, presence of lining epithelium, grade of epithelial
dysplasia, presence of ovarian type stroma, and specific diagnosis by 6 expert pathologists
from 6 different tertiary care centers. The Gwet’s AC1 was used to assess interobserver
agreement.
Results
An almost perfect agreement was observed for specimen adequacy (AC1, .82; 95% confidence
interval [CI], .79-.98), presence of lesional epithelium (AC1, .90; 95% CI, .86-.92),
epithelial dysplasia (AC1, .97; 95% CI, .95-.99), and ovarian-like stroma (AC1, .90;
95% CI, .86-.93). When considering all diagnoses separately, a moderate to substantial
agreement was observed (AC1, .62; 95% CI, .57-.67), similarly to mucinous cysts versus
serous adenoma versus other diagnoses (AC1, .65; 95% CI, .59-.70) and for mucinous
cysts versus all other diagnoses (AC1,.74; 95% CI, .68-.84). The agreement for diagnosis
of mucinous cystic neoplasm versus intraductal mucinous papillary neoplasm was almost
perfect (AC1, .88; 95% CI, .81-.95).
Conclusions
Interobserver agreement between expert pathologists in the evaluation of TTNB samples
from PCLs with worrisome features was close to perfection for all evaluated parameters,
except definitive diagnosis. When mucinous cystic lesions were compared versus all
other diagnoses, the agreement became substantial, thus indicating that TTNB specimens
can provide important information for PCL management decisions.
Graphical abstract
Graphical Abstract
Abbreviations:
IPMN (intraductal papillary mucinous neoplasm), MCN (mucinous cystic neoplasm), PCL (pancreatic cystic lesion), SCA (serous cyst adenoma), TTNB (through-the-needle biopsy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 16, 2019
Accepted:
July 3,
2019
Received:
May 12,
2019
Footnotes
DISCLOSURE: Dr Poley was a consultant for and received speakers fees from Boston Scientific, Cook Endoscopy, and Pentax Medical. All other authors disclosed no financial relationships relevant to this publication.
Identification
Copyright
© 2019 by the American Society for Gastrointestinal Endoscopy
