Determination of esophageal eosinophil counts and other histologic features of eosinophilic esophagitis by pathology trainees is highly accurate

Abstract

Summary Many studies of eosinophilic esophagitis (EoE) utilize expert pathology review, but it is unknown whether less experienced pathologists can reliably assess EoE histology. We aimed to determine whether trainee pathologists can accurately quantify esophageal eosinophil counts and identify associated histologic features of EoE, as compared to expert pathologists. We used a set of 40 digitized slides from patients with varying degrees of esophageal eosinophilia. Each of six trainee pathologists underwent a teaching session and used our validated protocol to determine eosinophil counts and associated EoE findings. The same slides had previously been evaluated by expert pathologists, and these results comprised the gold standard. Eosinophil counts were correlated, and agreement was calculated for the diagnostic threshold of 15 eosinophils per high-power field (eos/hpf) as well as for associated EoE findings. Peak eosinophil counts were highly correlated between the trainees and the gold standard (Rho ranged from 0.87–0.92; p<0.001 for all). Peak counts were also highly correlated between trainees (0.75–0.91; p<0.001), and results were similar for mean counts. Agreement was excellent for determining if a count exceeded the diagnostic threshold (kappa ranged from 0.83 to 0.89; p<0.001). Agreement was very good for eosinophil degranulation (kappa 0.54 to 0.83; p<0.01) and spongiosis (kappa 0.44–0.87; p<0.01), but was lower for eosinophil microabscesses (kappa 0.37–0.64; p<0.01). In conclusion, using a teaching session, digitized slide set, and validated protocol, the agreement between pathology trainees and expert pathologists for determining eosinophil counts was excellent. Agreement was very good for eosinophil degranulation and spongiosis, but less so for microabscesses.

Efficacy of Budesonide vs Fluticasone for Initial Treatment of Eosinophilic Esophagitis in a Randomized Controlled Trial

“…Eosinophil counts were determined by the study pathologist (JTW) both for the screening (baseline) and post-treatment examinations using a previously validated protocol. 21,22 In brief, 4 esophageal biopsies were obtained from both the distal (3 cm above the gastroesophageal junction) and proximal (15 cm above the…”

Clinical and Molecular Factors Associated With Histologic Response to Topical Steroid Treatment in Patients With Eosinophilic Esophagitis

“…From each biopsy, the maximum eosinophil count (eos/hpf) was quantified using a microscopic field size of 0.24 mm 2 and per our previously described method. 22,23…”

Systematic review of histological remission criteria in eosinophilic esophagitis

“…Additional monitoring of improvement in other histological parameters suggestive of eosinophilic inflammation, such as eosinophilic microabscesses, surface layering of eosinophils, extracellular eosinophil granules, and basal cell hyperplasia, would help to adequately discriminate treatment success and nonsuccess. The presence of these histological features could indicate strong evidence of clinically unresolved EoE, even with low esophageal eosinophil counts after treatment . Even though results from a recently published systematic review of disease activity indices in EoE, Warners and colleagues (2017), suggest that there is dissociation between symptomatic and histological improvement of EoE after treatment, Martin et al ., using the EoE clinical symptomology instrument (Pediatric Eosinophilic Esophagitis Symptom Scores [PEESS v2.0]), had demonstrated that esophageal activity measured by eosinophil peroxidase (EPX) immunohistochemical staining is significantly correlated with dysphagia symptoms in pediatric patients with EoE…”