The utility of P53 immunohistochemistry in the diagnosis of Barrett's esophagus with indefinite for dysplasia.
Pilonis, Nastazja D
Katzka, David A
Fitzgerald, Rebecca C
MetadataShow full item record
Januszewicz, W., Pilonis, N. D., Sawas, T., Phillips, R., O'Donovan, M., Miremadi, A., Malhotra, S., et al. (2022). The utility of P53 immunohistochemistry in the diagnosis of Barrett's esophagus with indefinite for dysplasia.. Histopathology https://doi.org/10.1111/his.14642
BACKGROUND: Barrett's esophagus with indefinite for dysplasia (BE-IND) is a subjective diagnosis with a low interobserver agreement (IOA) among pathologists and uncertain clinical implications. This study aimed to assess the utility of p53 immunohistochemistry (p53-IHC) in assessing BE-IND specimens. METHODS: Archive endoscopic biopsies with a BE-IND diagnosis from two academic centers were analyzed. Firstly, hematoxylin and eosin-stained slides (H&E) were reviewed by four expert GI pathologists allocated into two groups (A and B). After a wash-out period of at least eight weeks, H&E slides were re-assessed side-to-side with p53-IHC available. We compared the rate of changed diagnosis and the IOA for all BE grades before and after p53-IHC. FINDINGS: We included 216 BE-IND specimens from 185 patients, of which 44.0% and 32.9% were confirmed after H&E slide revision by Groups A and B, respectively. Over half of the cases were reclassified to a non-dysplastic BE (NDBE), while 5.6% of cases in Group A and 7.4% in Group B were reclassified to definite dysplasia. The IOA for NDBE, BE-IND, low-grade dysplasia (LGD), and high-grade dysplasia (HGD)/intramucosal cancer (IMC) was 0.31, 0.21, -0.03, and -0.02, respectively. Use of p53-IHC led to a >40% reduction in BE-IND diagnoses (P<.001), and increased IOA for all BE grades (κ=0.46 [NDBE], 0.26 [BE-IND], 0.49 [LGD], 0.35 [HGD/IMC]). An aberrant p53-IHC pattern significantly increased the likelihood of reclassifying BE-IND to definite dysplasia (odds ratio 44.3, 95%CI:18.8-113.0). INTERPRETATION: P53-IHC reduces the rate of BE-IND diagnoses and improves the IOA among pathologists when reporting BE with equivocal epithelial changes.
This study received infrastructure support from the NIHR Cambridge Biomedical Research Centre
Embargo Lift Date
External DOI: https://doi.org/10.1111/his.14642
This record's URL: https://www.repository.cam.ac.uk/handle/1810/334825
All Rights Reserved
Licence URL: http://www.rioxx.net/licenses/all-rights-reserved