Diagnostic impact and reproducibility of p53 immunohistochemistry in Barrett's oesophagus: results of the Dutch Esophageal Pathology Panel (DEPP).
Pathologists showed substantial agreement interpreting p53 staining patterns in Barrett's oesophagus.
Diagnostic impact and reproducibility of p53 immunohistochemistry in Barrett's oesophagus: results of the Dutch Esophageal Pathology Panel (DEPP).
Evidence supporting the use of p53 immunohistochemistry (p53-IHC) in Barrett's oesophagus (BE) is largely based on selected series, limiting generalizability.
This study evaluates p53-IHC in a nationwide, real-world BE-cohort within a universal healthcare system, assessing concordance with referring hospitals, interobserver agreement (interobserver agreement) and its impact on routine diagnostic decisions.
Revision cases submitted to the Dutch Esophageal Pathology Panel (Dutch Esophageal Pathology Panel) were assessed by trained and experienced pathologists for haematoxylin and eosin (H&E)-based classification (Vienna classification), p53-IHC patterns (wild-type, overexpression, double clone, null mutation and equivocal) and combined H&E/p53-IHC review.
pathologists reading p53 patterns agreed with each other most of the time
Overall concordance of p53 assessment between referring hospitals and the expert panel was moderate-to-substantial (κ = 0.61, 95% CI 0.58-0.64), with 24.2% of p53-IHC assessments reclassified.
Ancillary p53-IHC influenced pathologists' decisions across biopsy levels.
For non-dysplastic (NDBE) biopsies, aberrant p53-IHC prompted reclassification to indefinite for dysplasia (IND, 9.2%) or low-grade dysplasia (LGD, 4.8%).
For IND biopsies, p53-IHC shifted diagnoses toward NDBE (17.0%) or LGD (37.1%).
p53-IHC interpretation is reliable, reproducible and clinically meaningful in BE diagnostics when standardized criteria are applied.
These findings support broader use of p53-IHC in routine practice and incorporation of assessment criteria into guidelines.