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Laohawetwanit T, Wanpiyarat N, Lerttanatum N, Apornvirat S, Kantasiripitak C, Atiroj N, Pisutpunya A, Phairintr P, Suttichan K, Poungmeechai N, Tassanawarawat T, Chumponpanich N, Khueankaeo C, Chaijitrawan P, Sooksaen P, Stithsuksanoh C, Thinpanja W, Kaewnopparat W. Histopathologic evaluation of gastric intestinal metaplasia in non-neoplastic biopsy specimens: Accuracy and interobserver reliability among general pathologists and pathology residents. Ann Diagn Pathol 2024; 70:152284. [PMID: 38422806 DOI: 10.1016/j.anndiagpath.2024.152284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVES This study aimed to evaluate the accuracy and interobserver reliability of diagnosing and subtyping gastric intestinal metaplasia (IM) among general pathologists and pathology residents at a university hospital in Thailand, focusing on the challenges in the histopathologic evaluation of gastric IM for less experienced practitioners. METHODS The study analyzed 44 non-neoplastic gastric biopsies, using a consensus diagnosis of gastrointestinal pathologists as the reference standard. Participants included 6 general pathologists and 9 pathology residents who assessed gastric IM and categorized its subtype (complete, incomplete, or mixed) on digital slides. After initial evaluations and receiving feedback, participants reviewed specific images of gastric IM, as agreed by experts. Following a one-month washout period, a reevaluation of the slides was conducted. RESULTS Diagnostic accuracy, interobserver reliability, and time taken for diagnosis improved following training, with general pathologists showing higher accuracies than residents (median accuracy of gastric IM detection: 100 % vs. 97.7 %). Increased years of experience were associated with more IM detection accuracy (p-value<0.05). However, the overall median accuracy for diagnosing incomplete IM remained lower than for complete IM (86.4 % vs. 97.7 %). After training, diagnostic errors occurred in 6 out of 44 specimens (13.6 %), reported by over 40 % of participants. Errors involved omitting 5 slides with incomplete IM and 1 with complete IM, all showing a subtle presence of IM. CONCLUSIONS The study highlights the diagnostic challenges in identifying incomplete gastric IM, showing notable discrepancies in accuracy and interobserver agreement. It underscores the need for better diagnostic protocols and training to enhance detection and management outcomes.
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Affiliation(s)
- Thiyaphat Laohawetwanit
- Division of Pathology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand; Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand.
| | - Natcha Wanpiyarat
- Department of Pathology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | | | - Sompon Apornvirat
- Division of Pathology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand; Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand.
| | - Charinee Kantasiripitak
- Division of Pathology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand; Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand.
| | - Nawaluk Atiroj
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand; Department of Pathology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
| | - Adiluck Pisutpunya
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand; Department of Pathology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Putch Phairintr
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand; Department of Pathology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Komkrit Suttichan
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand; Department of Pathology, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Natcha Poungmeechai
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand
| | | | | | | | | | - Pornchai Sooksaen
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand
| | | | - Warut Thinpanja
- Division of Pathology, Thammasat University Hospital, Pathum Thani, Thailand
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