Concordance of the histological diagnosis of type 1 autoimmune pancreatitis and its distinction from pancreatic ductal adenocarcinoma with endoscopic ultrasound-guided fine needle biopsy specimens: an interobserver agreement study

Notohara, Kenji; Kamisawa, Terumi; Furukawa, Toru; Fukushima, Noriyoshi; Uehara, Takeshi; Kasashima, Satomi; Iwasaki, Eisuke; Kanno, Atsushi; Kawashima, Atsuhiro; Kubota, Kensuke; Kuraishi, Yasuhiro; Motoya, Masayo; Naitoh, Itaru; Nishino, Tomoya; Sato, Junichi; Shimizu, Kyoko; Tomono, Teruko; Aishima, Shinichi; Fukumura, Yuki; Hirabayashi, Kenichi; Kojima, Masaru; Mitsuhashi, Tomoko; Naito, Yoshiki; Ohike, Nobuyuki; Tajiri, Takuma; Yamaguchi, Hiroshi; Fujiwara, Haruhiko; Ibuki, Emi; Kobayashi, Shota; Miyaoka, Masashi; Nagase, Mamiko; Nakashima, Junko; Nakayama, Masamichi; Oda, Shinsuke; Taniyama, Daiki; Tsuyama, Sho; Watanabe, Syunsuke; Ikeura, Tsukasa; Kawa, Shigeyuki; Okazaki, Kazuichi

doi:10.1007/s00428-021-03236-w

Cited by 7 publications

(14 citation statements)

References 39 publications

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“…After showing the new guidance to the observers, we carried out round 2 of the agreement study. 47 The κ‐value among the specialists for storiform fibrosis increased from 0.231 to 0.262. In contrast, the κ‐value for obliterative phlebitis decreased from 0.457 to 0.327 among the specialists and from 0.537 to 0.374 among the generalists, which was probably due to the lack of familiarity with distinguishing obliterative phlebitis from fibrous venous occlusions among the observers.…”

Section: Introductionmentioning

confidence: 97%

“…The results were suboptimal; slight‐to‐moderate agreements among the observers on storiform fibrosis, obliterative phlebitis, and the ductal lesion. 47 Specifically, the agreement regarding obliterative phlebitis was the best (moderate agreement), and the agreement about the ductal lesion among the generalists was the worst (slight agreement).…”

Section: Introductionmentioning

confidence: 97%

“…The guidance delineates what ADM is and explains how to distinguish ADM from PDAC. In round 2 of the agreement study, 47 which was performed after the observers read the guidance, the κ‐values increased to 0.958 and 0.815 (both almost perfect agreement) for the specialists and generalists, respectively, suggesting that the guidance is effective for achieving an accurate distinction of PDAC and type 1 AIP.…”

Section: Introductionmentioning

confidence: 98%

“…We examined the interobserver agreement for distinguishing PDAC and non‐neoplastic lesions (definite type 1 AIP in 86% of the cases) in the guidance project. 47 Seven pathologists who were familiar with pancreatic pathology and 13 general pathologists were enrolled. The κ‐values were 0.886 (almost perfect agreement) among the specialists and 0.750 (substantial agreement) among the generalists.…”

Section: Introductionmentioning

confidence: 99%

“…We examined the interobserver agreement for distinguishing PDAC and non‐neoplastic lesions (definite type 1 AIP in 86% of the cases) in the guidance project 47 . Seven pathologists who were familiar with pancreatic pathology and 13 general pathologists were enrolled.…”

Section: Introductionmentioning

confidence: 99%

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Biopsy diagnosis of type 1 autoimmune pancreatitis: Does it bring a conclusion or confusion?

Notohara

2021

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A biopsy‐based diagnosis of type 1 autoimmune pancreatitis (AIP) is now feasible via an endoscopic ultrasound‐guided fine‐needle biopsy, but there are potential issues to address. The benefits of acquiring large tissue samples include more successful immunostaining for Immunoglobulin G4 and more identifications of storiform fibrosis, obliterative phlebitis, and the ductal lesions of type 1 AIP. However, storiform fibrosis may not be present in all the type 1 AIP lesions. An interobserver agreement study revealed only slight‐to‐moderate agreement among pathologists diagnosing the histological findings of type 1 AIP. Potential reasons for disagreement are the different time phases of the inflammation (which result in heterogeneous histological pictures), a focal appearance of the typical histological findings, and the different definitions used by pathologists. We have thus devised guidance for diagnosing type 1 AIP based on biopsy tissues. In this guidance, we define each histological finding of type 1 AIP, for example, storiform fibrosis as a swirling arrangement of inflammatory cells, spindle‐shaped cells, and delicate collagens as a unit. The necessity of elastic stains for identifying obliterative phlebitis is explained, with examples of mimickers. Another important purpose of a biopsy in type 1 AIP cases is differentiation from pancreatic ductal adenocarcinoma (PDAC). In this situation, acinar‐ductal metaplasia observed in type 1 AIP is a mimicker of PDAC and should not be confused. For the resolution of potential disagreements among pathologists, a multi‐disciplinary approach with the collaboration of clinicians, radiologists, and pathologists is necessary to avoid confusion.

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Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Biopsy diagnosis of type 1 autoimmune pancreatitis: Does it bring a conclusion or confusion?

Notohara

2021

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Histopathologische Diagnostik von soliden und zystischen Pankreasläsionen mit Hauptaugenmerk auf dem duktalen Adenokarzinom

Esposito,

Yavas,

Häberle

2024

Pathologie

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Diagnostic Categories and Key Features for Pathological Diagnosis of Endoscopic Ultrasound-Guided Fine Needle Aspiration Biopsy Samples of Pancreatic Lesions

et al. 2022

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ObjectivesThis study aimed to establish a reliable and reproducible categorized diagnostic classification system with identification of key features to achieve accurate pathological diagnosis of endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) samples of pancreatic lesions.MethodsTwelve pathologists examined virtual whole-slide images of EUS-FNAB samples obtained from 80 patients according to proposed diagnostic categories and key features for diagnosis. Fleiss κ was used to assess the concordance.ResultsA hierarchical diagnostic system consisting of the following 6 diagnostic categories was proposed: inadequate, nonneoplasm, indeterminate, ductal carcinoma, nonductal neoplasm, and unclassified neoplasm. Adopting these categories, the average κ value of participants was 0.677 (substantial agreement). Among these categories, ductal carcinoma and nonductal neoplasm showed high κ values of 0.866 and 0.837, respectively, which indicated the almost perfect agreement. Key features identified for diagnosing ductal carcinoma were necrosis in low-power appearance; structural atypia/abnormalities recognized by irregular glandular contours, including cribriform and nonuniform shapes; cellular atypia, including enlarged nuclei, irregular nuclear contours, and foamy gland changes; and haphazard glandular arrangement and stromal desmoplasia.ConclusionsThe proposed hierarchical diagnostic classification system was proved to be useful for achieving reliable and reproducible diagnosis of EUS-FNAB specimens of pancreatic lesions based on evaluated histological features.

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Concordance of the histological diagnosis of type 1 autoimmune pancreatitis and its distinction from pancreatic ductal adenocarcinoma with endoscopic ultrasound-guided fine needle biopsy specimens: an interobserver agreement study

Cited by 7 publications

References 39 publications

Biopsy diagnosis of type 1 autoimmune pancreatitis: Does it bring a conclusion or confusion?

Biopsy diagnosis of type 1 autoimmune pancreatitis: Does it bring a conclusion or confusion?

Histopathologische Diagnostik von soliden und zystischen Pankreasläsionen mit Hauptaugenmerk auf dem duktalen Adenokarzinom

Diagnostic Categories and Key Features for Pathological Diagnosis of Endoscopic Ultrasound-Guided Fine Needle Aspiration Biopsy Samples of Pancreatic Lesions

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