Value of an Additional Review for Eosinophil Quantification in Esophageal Biopsies

Abstract

Eosinophilic esophagitis (EoE) requires a peak count of 15 eosinophils per high-power field (hpf). Herein, the peak eosinophil count specified by a pathologist was compared with the second review of a research assistant. Of 477 biopsies, 106 had a peak count between 1 and 14 eosinophils/hpf cited in the pathology report, and 23/106 (22%) had ≥15 eosinophils/hpf on second review. The pathology report detected potential EoE with 99% specificity, but 80% sensitivity. As such, an additional review of esophageal biopsies yields higher eosinophil counts in ∼5% of cases. We propose that biopsies with a count between 1 and 14 eosinophils/hpf require further investigation because ∼22% may yield a potential EoE diagnosis.

Figure 1. Correlation of pathology report eosinophil counts and second review eosinophil counts

(a) The entire dataset (n = 477) is included. Line y = x represents where the values would be located if the pathology report count and second review count were equivalent. (b) Correlation of pathology report counts vs. second review counts for pathology reports that had counts <15 eosinophils/hpf that were not 0 eosinophils/hpf for both reviews (n = 168). Dotted line y = 15 represents the diagnostic threshold, for which 24 points were at or above after the second review. Line y = x represents where the values would be located if the pathology report count and second review count were equivalent. hpf, high-power field.

Figure 2. Potential testing algorithm for stratifying need of second review for eosinophilic esophagitis

The percentage of cases found to be eosinophilic esophagitis (EoE) on second review are reported under the corresponding pathology report count ranges as shown.