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Performance of gastrointestinal pathologists within a national digital review panel for Barrett’s oesophagus in the Netherlands: results of 80 prospective biopsy reviews
  1. Esther Klaver1,
  2. Myrtle van der Wel1,2,
  3. Lucas Duits1,
  4. Roos Pouw1,
  5. Kees Seldenrijk3,
  6. Johan Offerhaus4,
  7. Mike Visser5,
  8. Fiebo ten Kate4,
  9. Katharina Biermann6,
  10. Lodewijk Brosens4,
  11. Michael Doukas6,
  12. Clément Huysentruyt7,
  13. Arend Karrenbeld8,
  14. Gursah Kats-Ugurlu8,
  15. Jaap van der Laan9,
  16. Ineke van Lijnschoten7,
  17. Freek Moll10,
  18. Ariadne Ooms11,
  19. Jan Tijssen12,
  20. Sybren Meijer2,
  21. Jacques Bergman1
  1. 1 Department of Gastroenterology and Hepatology, Amsterdam UMC – Locatie AMC, Amsterdam, The Netherlands
  2. 2 Department of Pathology, Amsterdam UMC – Locatie AMC, Amsterdam, The Netherlands
  3. 3 Department of Pathology, Pathologie-DNA BV, Sint Antonius Hospital, Nieuwegein, The Netherlands
  4. 4 Department of Pathology, UMC Utrecht, Utrecht, The Netherlands
  5. 5 Department of Pathology, Symbiant BV, Alkmaar, The Netherlands
  6. 6 Department of Pathology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
  7. 7 Department of Pathology, Stichting PAMM, Eindhoven, The Netherlands
  8. 8 Department of Pathology, UMCG, Groningen, The Netherlands
  9. 9 Department of Pathology, Haga Hospital, Den Haag, The Netherlands
  10. 10 Department of Pathology, Isala Klinieken, Zwolle, The Netherlands
  11. 11 Department of Pathology, Pathan BV, Sint Franciscus Vlietland Groep, Rotterdam, The Netherlands
  12. 12 Department of Cardiology, Amsterdam UMC – Locatie AMC, Amsterdam, The Netherlands
  1. Correspondence to Esther Klaver, Gastroenterology and Hepatology, Amsterdam UMC - Locatie AMC, Amsterdam 1105 AZ, Netherlands; e.klaver{at}


Aims The histopathological diagnosis of low-grade dysplasia (LGD) in Barrett’s oesophagus (BO) is associated with poor interobserver agreement and guidelines dictate expert review. To facilitate nationwide expert review in the Netherlands, a web-based digital review panel has been set up, which currently consists of eight ‘core’ pathologists. The aim of this study was to evaluate if other pathologists from the Dutch BO expert centres qualify for the expert panel by assessing their performance in 80 consecutive LGD reviews submitted to the panel.

Methods Pathologists independently assessed digital slides in two phases. Both phases consisted of 40 cases, with a group discussion after phase I. For all cases, a previous consensus diagnosis made by five core pathologists was available, which was used as reference. The following criteria were used: (1) percentage of ‘indefinite for dysplasia’ diagnoses, (2) percentage agreement with consensus diagnosis and (3) proportion of cases with a consensus diagnosis of dysplasia underdiagnosed as non-dysplastic. Benchmarks were based on scores of the core pathologists.

Results After phase I, 1/7 pathologists met the benchmark score for all quality criteria, yet three pathologists only marginally failed the agreement with consensus diagnosis (score 68.3%, benchmark 69%). After a group discussion and phase II, 5/6 remaining aspirant panel members qualified with all scores within the benchmark range.

Conclusions The Dutch BO review panel now consists of 14 pathologists, who—after structured assessments and group discussions—can be considered homogeneous in their review of biopsies with LGD.

  • Barrett's oesophagus
  • digital pathology
  • quality assurance

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  • Handling editor Dhirendra Govender.

  • EK and MvdW contributed equally.

  • Contributors The following author contributions were made: study concept and design: EK, MW, SM and JB. Acquisition of data: EK, MW, CS, GO, MV, FtK, KB, LB, MD, CH, AK, GKU, JL, GvL, FM, AO and SM. Analysis and interpretation of data: EK, MW, JT, JB and SM. Drafting of the manuscript: EK, MW, LD, RP, JT, JB and SM. Critical revision for important intellectual content and final approval of the manuscript: all authors. Study supervision: SM and JB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The need for approval by the Medical Ethical Commitee was waived.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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