Interobserver agreement among cytopathologists in the evaluation of pancreatic endoscopic ultrasound-guided fine needle aspiration cytology specimens

Rawad Mounzer; Roy Yen; Carrie Marshall; Sharon Sams; Sanjana Mehrotra; Mohamed Sherif Said; Joshua C. Obuch; Brian Brauer; Augustin Attwell; Norio Fukami; Raj Shah; Stuart Amateau; Matthew Hall; Lindsay Hosford; Robert Wilson; Amit Rastogi; Sachin Wani

doi:10.1055/s-0042-108188

Endoscopy International Open, Inhaltsverzeichnis

Endosc Int Open 2016; 04(07): E812-E819
DOI: 10.1055/s-0042-108188

Original article

Interobserver agreement among cytopathologists in the evaluation of pancreatic endoscopic ultrasound-guided fine needle aspiration cytology specimens^[*]

Rawad Mounzer

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Roy Yen

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Carrie Marshall

²Department of Pathology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Sharon Sams

²Department of Pathology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Sanjana Mehrotra

²Department of Pathology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Mohamed Sherif Said

³Department of Pathology, Denver Health Medical Center, Denver, CO, USA

,

Joshua C. Obuch

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Brian Brauer

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Augustin Attwell

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Norio Fukami

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Raj Shah

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Stuart Amateau

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Matthew Hall

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Lindsay Hosford

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Robert Wilson

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

,

Amit Rastogi

⁴Division of Gastroenterology, University of Kansas School of Medicine and Veterans Affairs Medical Center, Kansas City, MO, USA

,

Sachin Wani

¹Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Center, Aurora, CO, USA

› Institutsangaben

Abstract

Background and aims: Endoscopic ultrasound with fine needle aspiration (EUS-FNA) has become the standard of care in the evaluation of solid pancreatic lesions. Limited data exist on interobserver agreement (IOA) among cytopathologists in assessing solid pancreatic EUS-FNA specimens. This study aimed to evaluate IOA among cytopathologists in assessing EUS-FNA cytology specimens of solid pancreatic lesions using a novel standardized scoring system and to assess individual clinical and cytologic predictors of IOA.

Methods: Consecutive patients who underwent EUS-FNA of solid pancreatic lesions at a tertiary care referral center were included. EUS-FNA slides were evaluated by four blinded cytopathologists using a standardized scoring system that assessed final cytologic diagnosis and quantitative (number of nucleated/diagnostic cells) and qualitative (bloodiness, inflammation/necrosis, contamination, artifact) cytologic parameters. Final clinical diagnosis was based on final cytology, surgical pathology, or 1-year clinical follow-up. IOA was calculated using multi-rater kappa (κ) statistics. Bivariate analyses were performed comparing cases with and without uniform agreement among the cytopathologists followed by logistic regression with backward elimination to model likelihood of uniform agreement.

Results: Ninety-nine patients were included (49 % males, mean age 64 years, mean lesion size 26 mm). IOA for final diagnosis was moderate (κ = 0.45, 95 % confidence interval (CI) 0.4 – 0.49) with minimal improvement when combining suspicious and malignant diagnoses (κ = 0.54, 95 %CI 0.49 – 0.6). The weighted kappa value for overall diagnosis was 0.65 (95 %CI 0.54 – 0.76). IOA was slight to fair (κ = 0.04 – 0.32) for individual cytologic parameters. A final clinical diagnosis of malignancy was the most significant predictor of agreement [OR 3.99 (CI 1.52 – 10.49)].

Conclusions: Interobserver agreement among cytopathologists for pancreatic EUS-FNA specimens is moderate-substantial for the final cytologic diagnosis. The final clinical diagnosis of malignancy was the strongest predictor of agreement. These results have significant implications for patient management and need to be validated in future trials.

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References
1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin 2015; 65: 5-29
2 Smith BD, Smith GL, Hurria A et al. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 2009; 27: 2758-2765
3 Tempero MA, Malafa MP, Behrman SW et al. Pancreatic adenocarcinoma, version 2.2014: featured updates to the NCCN guidelines. J Natl Compr Canc Netw 2014; 12: 1083-1093
4 Sun H, Ma H, Hong G et al. Survival improvement in patients with pancreatic cancer by decade: a period analysis of the SEER database, 1981–2010. Sci Rep 2014; 4: 6747
5 Rosch T, Lorenz R, Braig C et al. Endoscopic ultrasound in pancreatic tumor diagnosis. Gastrointest Endosc 1991; 37: 347-352
6 Owens DJ, Savides TJ. Endoscopic ultrasound staging and novel therapeutics for pancreatic cancer. Surg Oncol Clin N Am 2010; 19: 255-266
7 Eloubeidi MA, Jhala D, Chhieng DC et al. Yield of endoscopic ultrasound-guided fine-needle aspiration biopsy in patients with suspected pancreatic carcinoma. Cancer 2003; 99: 285-292
8 Eloubeidi MA, Tamhane A. Prospective assessment of diagnostic utility and complications of endoscopic ultrasound-guided fine needle aspiration. Results from a newly developed academic endoscopic ultrasound program. Dig Dis 2008; 26: 356-363
9 Adler DG, Jacobson BC, Davila RE et al. ASGE guideline: complications of EUS. Gastrointest Endosc 2005; 61: 8-12
10 Ngamruengphong S, Swanson KM, Shah ND et al. Preoperative endoscopic ultrasound-guided fine needle aspiration does not impair survival of patients with resected pancreatic cancer. Gut 2015; 64: 1105-1110
11 Hewitt MJ, McPhail MJ, Possamai L et al. EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 2012; 75: 319-331
12 Fisher L, Segarajasingam DS, Stewart C et al. Endoscopic ultrasound guided fine needle aspiration of solid pancreatic lesions: Performance and outcomes. J Gastroenterol Hepatol 2009; 24: 90-96
13 Shin HJ, Lahoti S, Sneige N. Endoscopic ultrasound-guided fine-needle aspiration in 179 cases: the M.D. Anderson Cancer Center experience. Cancer 2002; 96: 174-180
14 Weynand B, Borbath I, Bernard V et al. Pancreatic neuroendocrine tumour grading on endoscopic ultrasound-guided fine needle aspiration: high reproducibility and inter-observer agreement of the Ki-67 labelling index. Cytopathology 2014; 25: 389-395
15 Larghi A, Correale L, Ricci R et al. Interobserver agreement and accuracy of preoperative endoscopic ultrasound-guided biopsy for histological grading of pancreatic cancer. Endoscopy 2015; 47: 308-314
16 Pitman MB, Centeno BA, Ali SZ et al. Standardized terminology and nomenclature for pancreatobiliary cytology: the Papanicolaou Society of Cytopathology guidelines. Diagn Cytopathol 2014; 42: 338-350
17 Rastogi A, Wani S, Gupta N et al. A prospective, single-blind, randomized, controlled trial of EUS-guided FNA with and without a stylet. Gastrointest Endosc 2011; 74: 58-64
18 Wani S, Gupta N, Gaddam S et al. A comparative study of endoscopic ultrasound guided fine needle aspiration with and without a stylet. Dig Dis Sci 2011; 56: 2409-2414
19 Wani S, Early D, Kunkel J et al. Diagnostic yield of malignancy during EUS-guided FNA of solid lesions with and without a stylet: a prospective, single blind, randomized, controlled trial. Gastrointest Endosc 2012; 76: 328-335
20 Downs-Kelly E, Mendelin JE, Bennett AE et al. Poor interobserver agreement in the distinction of high-grade dysplasia and adenocarcinoma in pretreatment Barrett’s esophagus biopsies. Am J Gastroenterol 2008; 103: 2333-2340; quiz 2341
21 Skacel M, Petras RE, Gramlich TL et al. The diagnosis of low-grade dysplasia in Barrett’s esophagus and its implications for disease progression. Am J Gastroenterol 2000; 95: 3383-3387
22 Wang KK, Sampliner RE. Practice Parameters Committee of the American College of Gastroenterology. Updated guidelines 2008 for the diagnosis, surveillance and therapy of Barrett’s esophagus. Am J Gastroenterol 2008; 103: 788-797
23 Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159-174
24 Gonzalo-Marin J, Vila JJ, Perez-Miranda M. Role of endoscopic ultrasound in the diagnosis of pancreatic cancer. World J Gastrointest Oncol 2014; 6: 360-368
25 Chang KJ, Nguyen P, Erickson RA et al. The clinical utility of endoscopic ultrasound-guided fine-needle aspiration in the diagnosis and staging of pancreatic carcinoma. Gastrointest Endosc 1997; 45: 387-393
26 Wani S, Mathur SC, Curvers WL et al. Greater interobserver agreement by endoscopic mucosal resection than biopsy samples in Barrett’s dysplasia. Clin Gastroenterol Hepatol 2010; 8: 783-788
27 Kaye PV, Haider SA, Ilyas M et al. Barrett’s dysplasia and the Vienna classification: reproducibility, prediction of progression and impact of consensus reporting and p53 immunohistochemistry. Histopathology 2009; 54: 699-712
28 Montgomery E, Bronner MP, Goldblum JR et al. Reproducibility of the diagnosis of dysplasia in Barrett esophagus: a reaffirmation. Hum Pathol 2001; 32: 368-378
29 Kerkhof M, van Dekken H, Steyerberg EW et al. Grading of dysplasia in Barrett’s oesophagus: substantial interobserver variation between general and gastrointestinal pathologists. Histopathology 2007; 50: 920-927
30 Tanaka M, Masuda T, Yao T et al. Observer variation of diagnoses based on simple biopsy criteria differentiating among Crohn’s disease, ulcerative colitis, and other forms of colitis. J Gastroenterol Hepatol 2001; 16: 1368-1372
31 Geboes K, Riddell R, Ost A et al. A reproducible grading scale for histological assessment of inflammation in ulcerative colitis. Gut 2000; 47: 404-409
32 Osmond A, Li-Chang H, Kirsch R et al. Interobserver variability in assessing dysplasia and architecture in colorectal adenomas: a multicentre Canadian study. J Clin Pathol 2014; 67: 781-786
33 Karadsheh Z, Al-Haddad M. Endoscopic ultrasound-guided fine-needle aspiration needles: which one and in what situation?. Gastrointest Endosc Clin N Am 2014; 24: 57-69
34 Chen J, Yang R, Lu Y et al. Diagnostic accuracy of endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesion: a systematic review. J Cancer Res Clin Oncol 2012; 138: 1433-1441
35 Lee LS, Nieto J, Watson RR et al. Randomized noninferiority trial comparing diagnostic yield of cytopathologist-guided versus 7 passes for EUS-FNA of pancreatic masses. Dig Endosc 2015; [Epub ahead of print]
36 Savides TJ, Donohue M, Hunt G et al. EUS-guided FNA diagnostic yield of malignancy in solid pancreatic masses: a benchmark for quality performance measurement. Gastrointest Endosc 2007; 66: 277-282
37 Bergeron JP, Perry KD, Houser PM et al. Endoscopic ultrasound-guided pancreatic fine-needle aspiration: potential pitfalls in one institution's experience of 1212 procedures. Cancer Cytopathol 2015; 123: 98-107
38 Madhoun MF, Wani SB, Rastogi A et al. The diagnostic accuracy of 22-gauge and 25-gauge needles in endoscopic ultrasound-guided fine needle aspiration of solid pancreatic lesions: a meta-analysis. Endoscopy 2013; 45: 86-92
39 Wani S, Muthusamy VR, Komanduri S. EUS-guided tissue acquisition: an evidence-based approach (with videos). Gastrointest Endosc 2014; 80: 939-959 e7
40 Larghi A, Capurso G, Carnuccio A et al. Ki-67 grading of nonfunctioning pancreatic neuroendocrine tumors on histologic samples obtained by EUS-guided fine-needle tissue acquisition: a prospective study. Gastrointest Endosc 2012; 76: 570-577

Interobserver agreement among cytopathologists in the evaluation of pancreatic endoscopic ultrasound-guided fine needle aspiration cytology specimens[*]

Interobserver agreement among cytopathologists in the evaluation of pancreatic endoscopic ultrasound-guided fine needle aspiration cytology specimens^[*]