Adherence to pre-set benchmark quality criteria to qualify as expert assessor of dysplasia in Barrett's esophagus biopsies - towards digital review of Barrett's esophagus

M J van der Wel, E Klaver, L C Duits, R E Pouw, C A Seldenrijk, Gja Offerhaus, M Visser, Fjw Ten Kate, K Biermann, Laa Brosens, M Doukas, C Huysentruyt, A Karrenbeld, G Kats-Ugurlu, J S van der Laan, G van Lijnschoten, Fcp Moll, Ahag Ooms, J G Tijssen, Jjghm BergmanS L Meijer

Research output: Contribution to journalArticleAcademicpeer-review

11 Citations (Scopus)


Background: Dysplasia assessment of Barrett's esophagus biopsies is associated with low observer agreement; guidelines advise expert review. We have developed a web-based review panel for dysplastic Barrett's esophagus biopsies.

Objective: The purpose of this study was to test if 10 gastrointestinal pathologists working at Dutch Barrett's esophagus expert centres met pre-set benchmark scores for quality criteria.

Methods: Ten gastrointestinal pathologists twice assessed 60 digitalized Barrett's esophagus cases, enriched for dysplasia; then randomised (7520 assessments). We tested predefined benchmark quality criteria: (a) percentage of 'indefinite for dysplasia' diagnoses, benchmark score ≤14% for all cases, ≤16% for dysplastic subset, (b) intra-observer agreement; benchmark score ≥0.66/≥0.39, (c) percentage agreement with 'gold standard diagnosis'; benchmark score ≥82%/≥73%, (d) proportion of cases with high-grade dysplasia underdiagnosed as non-dysplastic Barrett's esophagus; benchmark score ≤1/78 (≤1.28%) assessments for dysplastic subset.

Results: Gastrointestinal pathologists had seven years' Barrett's esophagus-experience, handling seven Barrett's esophagus-cases weekly. Three met stringent benchmark scores; all cases and dysplastic subset, three met extended benchmark scores. Four pathologists lacked one quality criterion to meet benchmark scores.

Conclusion: Predefined benchmark scores for expert assessment of Barrett's esophagus dysplasia biopsies are stringent and met by some gastrointestinal pathologists. The majority of assessors however, only showed limited deviation from benchmark scores. We expect further training with group discussions will lead to adherence of all participating gastrointestinal pathologists to quality criteria, and therefore eligible to join the review panel.

Original languageEnglish
Pages (from-to)889-896
Number of pages8
JournalUnited European gastroenterology journal
Issue number7
Publication statusPublished - Aug 2019


  • Barrett Esophagus/diagnosis
  • Benchmarking
  • Biopsy
  • Cell Transformation, Neoplastic
  • Esophagus/pathology
  • Guideline Adherence
  • Humans
  • Internet
  • Microscopy/methods
  • Netherlands
  • Observer Variation
  • Pathologists/standards
  • Risk Factors

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