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Diagnostic interobserver variability in Crohn’s disease- and ulcerative colitis-associated dysplasia: a multicenter digital survey from the IG-IBD Pathologists Group

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Abstract

Background

Crohn’s disease (CD) and ulcerative colitis, two forms of inflammatory bowel disease (IBD), are chronic and relapsing conditions of the gastrointestinal tract both characterized by long lasting chronic inflammation and increased risk of dysplasia and colorectal cancer (CRC). The aim of our study was to evaluate the interobserver agreement about IBD-associated dysplasia among pathologists belonging to the Italian Group for Inflammatory Bowel Diseases (IG-IBD P).

Methods

The present multicenter survey was performed using telepathology, supported by an open source E-learning platform. Biopsy specimens from 30 colonoscopies and from 20 patients were included. The glass slides of any case, including clinical and endoscopic data, were digitalized and uploaded on the E-learning platform. All the digital slides were grouped in 54 diagnostic “blocks”. Blinded histopathological evaluation on all the digital slides was performed by 20 gastrointestinal pathologists. Closed-ended questions about (1) the occurrence of IBD; (2) the classification of IBD (as UC or CD); (3) the presence of active versus quiescent disease; (4) the presence of dysplasia; (5) the possible association of dysplasia with the sites of disease (dysplasia-associated lesion or mass—DALM vs adenoma-like mass—ALM); (6) the grading of dysplasia according to the ECCO guidelines (negative, indefinite, low grade, high grade categories) and (7) the presence of associated serrated features, were proposed in each case. Inter-observer agreement was evaluated by mean agreement percentage and kappa statistic, when suitable.

Results

The diagnosis of IBD was confirmed in 19 of 20 patients, 17 of 19 being classified as UC, 2 as CD. The mean interobserver agreement percentages about (1) the evidence of IBD, (2) the presence of either UC or CD and (3) the activity grading resulted to be 80%, 69% and 86%, respectively. Dysplasia was detected in 8/20 patients, with moderate agreement between pathologists (mean 72%, k 0.48). Particularly, low grade dysplasia was found in 13 biopsies (combined k 0.38), whereas high grade dysplasia in 8 (combined k 0.47). When the endoscopic and histopathological data were combined, features consistent with DALM were found in 6 of 20 patients with low grade dysplasia and those consistent with ALM in 2 patients with low grade dysplasia in a single biopsy (mean agreement: 86%). An associated serrated pattern was discovered in 4 patients (7 biopsies).

Conclusions

Our study showed moderate interobserver agreement about the histopathological detection and classification of IBD-associated dysplasia. Further efforts should be undertaken to integrate the histopathological data with both the ancillary tests and molecular investigations.

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Acknowledgements

The Authors thank Bio-Optica—Milan—for technical support. L. Albarello: Institute of Pathology San Raffaele Hospital Milan, Italy; albarello.luca@hsr.it, A. Andorno: Institute of Pathology Ospedale Maggiore Novara, Italy; lisa@wolfman.it, M. R. Aprile: Institute of Pathology S.Maria delle Croci Hospital Ravenna, Italy; mariarosaria.aprile@auslromagna.it, M. C. Aquilano: Institute of Pathology ASST Niguarda Milan, Italy; mariacostanza.aquilano@ospedaleniguarda.it, L. Baron: Institute of Pathology San Leonardo Hospital ASL Napoli 3 Sud, Italy; anapat1@libero.it, S. Battista: Institute of Pathology S.Maria della Misericordia Hospital Udine, Italy; serena.battista@asuiud.sanita.fvg.it, G. Becchina: UOC Institute of Pathology Palermo Hospital, Italy; gbecchina@hotmail.com, D. Bellis: Institute of Pathology ASL Biella, Italy; donata.bellis@libero.it, E. Biletta: Institute of Pathology ASL Biella, Italy; elena.biletta@gmail.com. M. R. D’Ambrosio: UOC Anatomia Patologica Dip Biotecnologie University of Siena, Italy; maradot@libero.it, E. David: Institute of Pathology, University of Turin, Italy; ezio.david@unito.it, R. Del Sordo: Institute of Pathology S.Maria della Misericordia Hospital Perugia, Italy; rachele.delsordo@unipg.it,M. Facchetti: Institute of Pathology Spedali Civili Brescia, Italy; facchetti.m@gmail.com, M. Fortunato: Institute of Pathology S. Croce e Carle Hospital Cuneo, Italy; mirellafortunato@hotmail.com, M. C. Giustiniani: Institute of Pathology Fondazione Policlinico Gemelli Roma, Italy; giustiniani@policlinicogemelli.it, D. Piscitelli: Institute of Pathology Policlinico Bari, Italy; domenico.piscitelli@uniba.it, L. Saragoni: Institute of Pathology Ospedale Morgagni-Pierantoni Forlì, Italy; luca.saragoni@auslromagna.it, G. Tanzi: Institute of Pathology ASST Cremona, Italy; giuliapaola.gt@libero.it.

Funding

The authors study has not been supported by any source of funding.

Author information

Authors and Affiliations

  1. Pathology Unit, ASST del Garda, Desenzano del Garda (BS), Brescia, Italy

    G. Leoncini

  2. Unit of Hygiene, Epidemiology and Public Health, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    F. Donato

  3. Department of Diagnostic, Clinic and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy

    L. Reggiani-Bonetti & T. Salviato

  4. Institute of Pathology, ASST Spedali Civili, Brescia, Italy

    M. Cadei & V. Villanacci

  5. Gastroenterology Unit, Mauriziano Hospital, Turin, Italy

    M. Daperno

  6. Emergency and Organ Transplantation Department, Section of Gastroenterology, AOU Policlinico, Bari, Italy

    M. B. Principi

  7. IBD Unit, Presidio Columbus Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy

    A. Armuzzi

  8. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy

    F. Caprioli

  9. Department of Pathophysiology, University of Milan, Milan, Italy

    F. Caprioli

  10. Department of Transplantation, University of Milan, Milan, Italy

    F. Caprioli

  11. Pathology Department, Azienda Ospedaliera Città della Salute e della Scienza di Torino, Turin, Italy

    G. Canavese

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  1. G. Leoncini
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Consortia

IG-IBD Pathology Group

  • L. Albarello
  • , A. Andorno
  • , M. R. Aprile
  • , M. C. Aquilano
  • , L. Baron
  • , S. Battista
  • , G. Becchina
  • , D. Bellis
  • , E. Biletta
  • , M. R. D’Ambrosio
  • , E. David
  • , R. Del Sordo
  • , M. Facchetti
  • , M. Fortunato
  • , M. C. Giustiniani
  • , D. Piscitelli
  • , L. Saragoni
  •  & G. Tanzi

Contributions

VV contributed to the study conception. The study design was performed by GL, VV and GC. Data collection and analysis were performed by GC, GL, FD, LR-B, TS, MC, IG-IBD pathologists as collaborators (see “Acknowledgements”). The first draft was written by GL. Critical revisions were performed by FD, VV, AA, MBP, MD, FC. The final editing was performed by GL. The manuscript was finally approved by all the authors and then submitted by GL.

Corresponding author

Correspondence to G. Leoncini.

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The author survey was based on diagnostic glass slides digital scanning and examination, human participants and/or animals were not involved.

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Leoncini, G., Donato, F., Reggiani-Bonetti, L. et al. Diagnostic interobserver variability in Crohn’s disease- and ulcerative colitis-associated dysplasia: a multicenter digital survey from the IG-IBD Pathologists Group. Tech Coloproctol 25, 101–108 (2021). https://doi.org/10.1007/s10151-020-02349-9

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