Original article
Intra- and interobserver agreement of histopathological findings in pediatric patients with eosinophilic esophagitis
Mário César Vieiraa,b,
, Elizabeth Schneider Gugelminc,d, Ana Paula Percicotee,f, Melyssa Grignet Ribeirog, Renata Augusta de Mirandae, Gabriela Guimarães Vieirah, Luciana Bandeira Mendez Ribeirob, Sabine Krüger Truppelb, Nelson Augusto Rosário Filhoi
Corresponding author
a Pontifícia Universidade Católica do Paraná, Escola de Medicina, Curitiba, PR, Brazil
b Hospital Pequeno Príncipe, Centro de Gastroenterologia Pediátrica, Curitiba, PR, Brazil
c Hospital Pequeno Príncipe, Centro de Patologia, Curitiba, PR, Brazil
d Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
e Universidade Federal do Paraná, Departamento de Patologia Médica, Curitiba, PR, Brazil
f Hospital Pequeno Príncipe, Laboratório de Anatomia Patológica, Curitiba, PR, Brazil
g Laboratório Citolab, Curitiba, PR, Brazil
h Hospital Pequeno Príncipe, Programa de Residência Médica em Pediatria, Curitiba, PR, Brazil
i Universidade Federal do Paraná, Departamento de Pediatria, Curitiba, PR, Brazil
Ver másRead
3508
Timeswas read the article
1453
Total PDF
2055
Total HTML
Share statistics
array:25 [ "pii" => "S0021755721000577" "issn" => "00217557" "doi" => "10.1016/j.jped.2021.03.004" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "981" "copyright" => "Sociedade Brasileira de Pediatria" "copyrightAnyo" => "2021" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "J Pediatr (Rio J). 2022;98:26-32" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:19 [ "pii" => "S0021755721000784" "issn" => "00217557" "doi" => "10.1016/j.jped.2021.02.009" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "993" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "J Pediatr (Rio J). 2022;98:33-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Predictive factors for premature birth and respiratory exacerbation in pregnancies of women with cystic fibrosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "33" "paginaFinal" => "38" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vanessa de Souza Vieira, Taiane dos Santos Feiten, Renata Salatti Ferrari, Paulo de Tarso Roth Dalcin, Bruna Ziegler" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Vanessa de Souza" "apellidos" => "Vieira" ] 1 => array:2 [ "nombre" => "Taiane dos Santos" "apellidos" => "Feiten" ] 2 => array:2 [ "nombre" => "Renata Salatti" "apellidos" => "Ferrari" ] 3 => array:2 [ "nombre" => "Paulo de Tarso Roth" "apellidos" => "Dalcin" ] 4 => array:2 [ "nombre" => "Bruna" "apellidos" => "Ziegler" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755721000784?idApp=UINPBA000049" "url" => "/00217557/0000009800000001/v1_202201230524/S0021755721000784/v1_202201230524/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S0021755721000917" "issn" => "00217557" "doi" => "10.1016/j.jped.2021.05.008" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "1005" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "rev" "cita" => "J Pediatr (Rio J). 2022;98:15-25" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Efficacy and safety of dexmedetomidine in maintaining hemodynamic stability in pediatric cardiac surgery: a systematic review and meta-analysis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "15" "paginaFinal" => "25" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0006" "etiqueta" => "Figure 6" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr6.jpeg" "Alto" => 3313 "Ancho" => 2500 "Tamanyo" => 375665 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0006" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">Forest plot of comparison between before and after infusion of DEX and Comparison between Dexmedetomidine and Control (Placebo): A, heart rate; B, junctional ectopic tachycardia.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Qing Wang, Chuikai Chen, Li Wang" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Qing" "apellidos" => "Wang" ] 1 => array:2 [ "nombre" => "Chuikai" "apellidos" => "Chen" ] 2 => array:2 [ "nombre" => "Li" "apellidos" => "Wang" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755721000917?idApp=UINPBA000049" "url" => "/00217557/0000009800000001/v1_202201230524/S0021755721000917/v1_202201230524/en/main.assets" ] "asociados" => array:1 [ 0 => array:19 [ "pii" => "S0021755721001133" "issn" => "00217557" "doi" => "10.1016/j.jped.2021.08.001" "estado" => "S300" "fechaPublicacion" => "2022-01-01" "aid" => "1017" "copyright" => "Sociedade Brasileira de Pediatria" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "sco" "cita" => "J Pediatr (Rio J). 2022;98:1-3" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:9 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Eosinophilic esophagitis: when pathologists make the difference" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "1" "paginaFinal" => "3" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Silvia Salvatore" "autores" => array:1 [ 0 => array:3 [ "preGrado" => "MD, PhD" "nombre" => "Silvia" "apellidos" => "Salvatore" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755721001133?idApp=UINPBA000049" "url" => "/00217557/0000009800000001/v1_202201230524/S0021755721001133/v1_202201230524/en/main.assets" ] ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Intra- and interobserver agreement of histopathological findings in pediatric patients with eosinophilic esophagitis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "26" "paginaFinal" => "32" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mário César Vieira, Elizabeth Schneider Gugelmin, Ana Paula Percicote, Melyssa Grignet Ribeiro, Renata Augusta de Miranda, Gabriela Guimarães Vieira, Luciana Bandeira Mendez Ribeiro, Sabine Krüger Truppel, Nelson Augusto Rosário Filho" "autores" => array:9 [ 0 => array:4 [ "nombre" => "Mário César" "apellidos" => "Vieira" "email" => array:1 [ 0 => "gastroped@hpp.org.br" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0001" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0001" ] ] ] 1 => array:3 [ "nombre" => "Elizabeth Schneider" "apellidos" => "Gugelmin" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0003" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0004" ] ] ] 2 => array:3 [ "nombre" => "Ana Paula" "apellidos" => "Percicote" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">f</span>" "identificador" => "aff0006" ] ] ] 3 => array:3 [ "nombre" => "Melyssa Grignet" "apellidos" => "Ribeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">g</span>" "identificador" => "aff0007" ] ] ] 4 => array:3 [ "nombre" => "Renata Augusta" "apellidos" => "de Miranda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Gabriela Guimarães" "apellidos" => "Vieira" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">h</span>" "identificador" => "aff0008" ] ] ] 6 => array:3 [ "nombre" => "Luciana Bandeira Mendez" "apellidos" => "Ribeiro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] 7 => array:3 [ "nombre" => "Sabine Krüger" "apellidos" => "Truppel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0002" ] ] ] 8 => array:3 [ "nombre" => "Nelson Augusto Rosário" "apellidos" => "Filho" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">i</span>" "identificador" => "aff0009" ] ] ] ] "afiliaciones" => array:9 [ 0 => array:3 [ "entidad" => "Pontifícia Universidade Católica do Paraná, Escola de Medicina, Curitiba, PR, Brazil" "etiqueta" => "a" "identificador" => "aff0001" ] 1 => array:3 [ "entidad" => "Hospital Pequeno Príncipe, Centro de Gastroenterologia Pediátrica, Curitiba, PR, Brazil" "etiqueta" => "b" "identificador" => "aff0002" ] 2 => array:3 [ "entidad" => "Hospital Pequeno Príncipe, Centro de Patologia, Curitiba, PR, Brazil" "etiqueta" => "c" "identificador" => "aff0003" ] 3 => array:3 [ "entidad" => "Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil" "etiqueta" => "d" "identificador" => "aff0004" ] 4 => array:3 [ "entidad" => "Universidade Federal do Paraná, Departamento de Patologia Médica, Curitiba, PR, Brazil" "etiqueta" => "e" "identificador" => "aff0005" ] 5 => array:3 [ "entidad" => "Hospital Pequeno Príncipe, Laboratório de Anatomia Patológica, Curitiba, PR, Brazil" "etiqueta" => "f" "identificador" => "aff0006" ] 6 => array:3 [ "entidad" => "Laboratório Citolab, Curitiba, PR, Brazil" "etiqueta" => "g" "identificador" => "aff0007" ] 7 => array:3 [ "entidad" => "Hospital Pequeno Príncipe, Programa de Residência Médica em Pediatria, Curitiba, PR, Brazil" "etiqueta" => "h" "identificador" => "aff0008" ] 8 => array:3 [ "entidad" => "Universidade Federal do Paraná, Departamento de Pediatria, Curitiba, PR, Brazil" "etiqueta" => "i" "identificador" => "aff0009" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0001" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0001" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 941 "Ancho" => 1500 "Tamanyo" => 377623 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Histological features observed in EoE (Hematoxylin & Eosin, 10 ×).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Introduction</span><p id="para0016" class="elsevierStylePara elsevierViewall">Eosinophilic esophagitis (EoE) is a chronic, inflammatory, immune- and/or antigen-mediated disease clinically characterized by symptoms of esophageal dysfunction and histologically by dense eosinophilic inflammation in mucosal biopsies.<a class="elsevierStyleCrossRefs" href="#bib0001"><span class="elsevierStyleSup">1–3</span></a> Since its initial description at the end of the 1970s and its identification as a distinct clinical entity in 1993, EoE has been increasingly recognized over the last 20 years.<a class="elsevierStyleCrossRefs" href="#bib0001"><span class="elsevierStyleSup">1–5</span></a> EoE symptoms vary according to age. Infants and younger children may present with feeding difficulties, vomiting and regurgitation, while older children, adolescents and adults may also present with dysphagia and the sensation of food lodged in the esophagus (food impaction).<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a></p><p id="para0017" class="elsevierStylePara elsevierViewall">The criteria for the diagnostic and therapeutic approach to EoE have been continuously discussed since the initial description of the disease.<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a></p><p id="para0018" class="elsevierStylePara elsevierViewall">Upper gastrointestinal endoscopy with biopsy is essential for diagnosis. Endoscopic findings include edema, furrows or vertical lines, concentric rings, and exudates or white spots. However, the macroscopic appearance may be normal.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a><span class="elsevierStyleSup">.</span><a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Upon diagnostic suspicion, biopsies should be obtained even when the endoscopic appearance is normal. As the inflammation may be focal, it is recommended that multiple biopsies of at least two esophageal segments be obtained to increase the diagnostic accuracy.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a></p><p id="para0019" class="elsevierStylePara elsevierViewall">The diagnosis of EoE involves clinical, endoscopic and histological factors, i.e., there must be clinical manifestations of esophageal dysfunction combined with mucosal changes on endoscopy and/or eosinophilic infiltrate in esophageal biopsies with a count of ≥ 15 eosinophils per high-power field (eos/HPF) in the area of greatest eosinophil density in one or more tissue samples.<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a></p><p id="para0020" class="elsevierStylePara elsevierViewall">Other causes of esophageal eosinophilia should be excluded, especially gastroesophageal reflux disease (GERD), infections, connective tissue diseases, Crohn's disease, and hypersensitivity to medications, through a detailed clinical history and physical examination and diagnostic testing according to the clinical suspicion.<a class="elsevierStyleCrossRefs" href="#bib0001"><span class="elsevierStyleSup">1–3</span></a></p><p id="para0021" class="elsevierStylePara elsevierViewall">The spectrum of histopathological changes in EoE determined the development of classifications and scores that improve diagnostic quality.<a class="elsevierStyleCrossRefs" href="#bib0009"><span class="elsevierStyleSup">9–13</span></a> A histological scoring system uses the intensity and extent of eosinophil granule protein deposition; however, the need for immunohistochemistry techniques hinders its use in clinical practice.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a></p><p id="para0022" class="elsevierStylePara elsevierViewall">In 2017, Collins et al. developed a histological scoring system (EoEHSS) to assess changes in the mucosa in addition to the peak eosinophil count. <a class="elsevierStyleCrossRef" href="#fig0001">Figure 1</a> illustrates the most common histological features observed in EoE. The EoEHSS evaluates eosinophil infiltration (EI), basal zone hyperplasia (BZH), the presence of eosinophilic abscesses (EA), eosinophil surface layering (SL), dilated intercellular spaces (DIS), surface epithelial alterations (SEA), dyskeratotic epithelial cells (DEC) and lamina propria fibrosis (LPF). The severity (grade) and extent (stage) of the changes are classified using a scale (0 - normal to 3 - maximum change). The maximum score for grade and stage for each biopsy is 24. The final score is the ratio between the sum of the scores assigned to each evaluated item divided by the maximum possible score and varies from 0 to 1. If a feature is not evaluated, the maximum score is reduced by 3 points.<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> The EoEHSS allows evaluation of the severity and extent of multiple histological features of EoE and can be applied in the routine histopathological analysis. The intraobserver and interobserver agreement of these findings was recently evaluated among pathologists specialized in gastrointestinal diseases with experience in the diagnosis of EoE after specific training in the analysis of items included in the EoEHSS.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a></p><elsevierMultimedia ident="fig0001"></elsevierMultimedia><p id="para0023" class="elsevierStylePara elsevierViewall">However, the repeatability and reproducibility of this system have not yet been evaluated in clinical practice among non-expert pathologists.</p><p id="para0024" class="elsevierStylePara elsevierViewall">The objective of this study was to evaluate the intraobserver and interobserver agreement of the EoEHSS in pediatric patients with EoE.</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Materials and methods</span><p id="para0025" class="elsevierStylePara elsevierViewall">This study was conducted at a tertiary pediatric referral center in the south of Brazil where approximately 2,000 endoscopic procedures are performed annually in children aged 0-18 years. A simple random sampling without replacement was performed by assigning a unique number to each pediatric patient diagnosed with EoE (≥ 15 eos/HPF) registered at the Endoscopy Unit database (n = 462) from 2005 to 2018. In the next step, these numbers were written on separate cards that were placed in a box, thoroughly mixed and taken out randomly. Slides of esophageal biopsies stained with hematoxylin & eosin from 50 patients were used in the study. In order to assess the quality of the material, all slides were reviewed by the most experienced pathologist participating in the study, two months prior to the beginning of the research.</p><p id="para0026" class="elsevierStylePara elsevierViewall">The study protocol was approved by the Research Ethics Committee of Hospital Pequeno Príncipe - Curitiba, Brazil.</p><p id="para0027" class="elsevierStylePara elsevierViewall">Four pathologists with different levels of experience in the diagnosis of EoE in clinical practice volunteered to participate in the study. Prior to the study, the pathologist considered to be the most experienced (more than 30 years in practice) had evaluated more biopsies of patients with EoE (> 1,200) than the pathologist considered moderately experienced (13 years in practice, approximately 150 biopsies) and the pathologists considered less experienced (less than 2 years in practice, < 15 biopsies). All pathologists were aware of the protocol to determine EI and other histological findings of EoE before evaluating the slides; however, no training on interpreting each feature in order to create histological standards was performed.<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a></p><p id="para0028" class="elsevierStylePara elsevierViewall">The slide identification records were modified so that they could not be correlated with the patients or identified in two consecutive evaluations as belonging to the same patient.</p><p id="para0029" class="elsevierStylePara elsevierViewall">The medical pathologists analyzed the histopathological findings (EoEHSS) under optical microscopy at two different times with an interval of at least two weeks between the evaluations using their own working binocular optical microscopes (CH30, BX23, CX31 - Olympus, Tokyo, Japan, and Zeiss Axiostar - Zeiss Inc., Göttingen, Germany). The area of greatest eosinophil density was selected, and the total number of eos/HPF (400x magnification; area of 0.238 mm2) was recorded. All individual EoEHSS components were analyzed, as well as the grade (severity) and stage (extent) scores, which were recorded in a standardized data collection form (Appendix 1).</p><p id="para0030" class="elsevierStylePara elsevierViewall">At the end of each analysis, the information obtained from the database was entered in Microsoft Excel® spreadsheets (Microsoft Corporation, Redmond, USA) and imported into Stata/SE v.14.1 (StataCorp LP, USA) for processing.</p><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Statistical analysis</span><p id="para0031" class="elsevierStylePara elsevierViewall">Kappa (κ) is a measure of intraobserver and interobserver agreement that indicates the degree of agreement beyond what would be expected by chance alone and typically ranges from +1 to -1, where a greater value indicates better reliability. Values close to or less than zero suggest that the agreement is attributable to chance. A κ <0.0 indicates no agreement, from 0 to 0.20 indicates poor agreement, from 0.21 to 0.40 indicates fair agreement, from 0.41 to 0.60 indicates moderate agreement, from 0.61 to 0.80 indicates substantial agreement and from 0.81 to 1.00 indicates excellent agreement.<a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a></p><p id="para0032" class="elsevierStylePara elsevierViewall">To calculate the sample size, a scale with four classifications with uniformly distributed marginals was considered for the comparison of two evaluations. For this calculation, a κ value of 0.8 and a 95 percent confidence interval were considered acceptable. A sample of 50 slides was considered adequate to estimate the κ coefficient of agreement between two evaluations, considering a relative margin of error of 20%.</p><p id="para0033" class="elsevierStylePara elsevierViewall">Descriptive statistics were used to characterize the patients under study. Frequencies and percentages were used for categorical variables.</p><p id="para0034" class="elsevierStylePara elsevierViewall">The intraobserver and interobserver agreement for all EoEHSS components were calculated. The interobserver agreement was based on the results of each pathologist's first reading.</p><p id="para0035" class="elsevierStylePara elsevierViewall">Fleiss’ κ coefficient was estimated to assess agreement for ordinal variables, and the intraclass correlation coefficient (ICC) was estimated to evaluate the measurements in the composite score variable.<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> The student's t-test was used to evaluate the existence of a systematic difference between the two measurements performed by the same pathologist regarding the composite score. Repeated measures analysis of variance (ANOVA) was used to test the homogeneity of the four pathologists’ evaluations for the score. For the κ coefficients, 95% confidence intervals were constructed. P-values less than 0.05 indicated statistical significance.</p></span></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Results</span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Demographics</span><p id="para0036" class="elsevierStylePara elsevierViewall">The mean age was 9.6 years (SD ± 4), range 1-15 years and the majority were male (72%). Of the 50 patients, 40% (n = 20) had a diagnosis of asthma, 32% (n = 16) of allergic rhinitis, 24% (n = 12) of atopic dermatitis and 30% (n = 15) of food allergy. The most frequent symptoms that led to the indication for endoscopy were vomiting in 58% (n = 29), feeding difficulties in 40% (n = 20), dysphagia in 26% (n = 13) and low weight gain in 26% (n = 13) of patients. The endoscopic findings observed included edema in 96% (n = 48), vertical lines in 86% (n = 43), white exudates in 62% (n = 31) and concentric rings in 4% (n = 2) of patients. Only one patient presented with esophageal stricture, and only one patient had a normal endoscopic examination.</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Assessment of eosinophilic infiltration (≥15 eos/HPF)</span><p id="para0037" class="elsevierStylePara elsevierViewall">The EI was graded in categories as per the EoEHSS (0: eosinophils not present; 1: <15 eos/HPF; 2: 15-59 eos/HPF; 3: >60 eos /HPF). Intra- and interobserver agreement for the identification of eosinophil counts ≥15 /high power field (grades 2 and 3), essential for the diagnosis of EoE, was excellent for all pathologists.</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0013">Assessment of intraobserver agreement (EoEHSS individual items and composite scores)</span><p id="para0038" class="elsevierStylePara elsevierViewall">Intraobserver agreement in the evaluation of the individual components of the EoEHSS varied among the pathologists. The highest κ values were observed in the evaluation of EA (grade and stage), followed by SL (grade and stage), EI (grade), and BZH (grade).</p><p id="para0039" class="elsevierStylePara elsevierViewall">The most experienced medical pathologist showed excellent (κ > 0.80) or substantial (κ > 0.60) intraobserver agreement for all individual items between the two evaluations, except for BZH (stage), for which agreement was fair (κ = 0.24).</p><p id="para0040" class="elsevierStylePara elsevierViewall">The less experienced pathologists showed moderate intraobserver agreement for EI (grade), fair intraobserver agreement for EI (stage), fair to moderate intraobserver agreement for BZH (grade), poor to substantial intraobserver agreement for BZH (stage), moderate to substantial for intraobserver agreement EA (grade), moderate to substantial intraobserver agreement for EA (stage), moderate to fair intraobserver agreement for SL (grade and stage), poor to fair intraobserver agreement for DIS (grade), fair to substantial intraobserver agreement for DIS (stage), poor to moderate intraobserver agreement for (grade), poor to moderate intraobserver agreement for SEA (stage), poor to fair intraobserver agreement for DEC (grade), poor to moderate intraobserver agreement for DEC (stage), absent to poor intraobserver agreement for LPF (grade) and absent to fair intraobserver agreement for LPF (stage).</p><p id="para0041" class="elsevierStylePara elsevierViewall">The median ICC for the EoEHSS composite scores among the four pathologists were 0.70 (0.52 - 0.94) and 0.75 (0.64 - 0.90) for grade and stage, respectively. The most experienced pathologist showed excellent agreement for grade and stage, and the less experienced pathologists showed moderate to substantial agreement for grade and substantial agreement for the stage.</p><p id="para0042" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a> shows the estimated κ coefficients for the individual items (grade and stage) and the ICCs for the composite scores (grade and stage)<span class="elsevierStyleBold">.</span> Scatter plots (Intraobserver agreement) for the composite scores (grade and stage) are shown in Appendix 2.</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0014">Assessment of interobserver agreement (reproducibility)</span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0015">Individual EoEHSS items</span><p id="para0043" class="elsevierStylePara elsevierViewall">The κ coefficient for each of the variables evaluated the reproducibility of the results. For this analysis, the first measurement performed by each pathologist was considered. The null hypothesis of a κ coefficient equal to zero (lack of reproducibility in the results) was tested for each variable versus the alternative hypothesis of a non-zero κ coefficient.</p><p id="para0044" class="elsevierStylePara elsevierViewall">The interobserver agreement among all pathologists was moderate for EI (grade), poor for EI (stage), absent for BZH (grade), poor for BZH (stage), fair for EA (grade and stage), poor for SL (grade and stage), DIS (grade and stage), and SEA (grade and stage), and absent for DEC (grade and stage) and LPF (grade and stage).</p><p id="para0045" class="elsevierStylePara elsevierViewall">In <a class="elsevierStyleCrossRef" href="#tbl0002">Table 2</a>, the estimated κ coefficient, the p-value of the statistical test and the limits of the 95% confidence interval for the κ coefficient are presented for each variable. The best interobserver agreement was found for EI grade (moderate) and EA grade (fair).</p><elsevierMultimedia ident="tbl0002"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0016">EoEHSS scores (grade and stage)</span><p id="para0046" class="elsevierStylePara elsevierViewall">For the variable composite score (grade), the estimated ICC considering the four pathologists was equal to 0.33, indicating fair reproducibility.</p><p id="para0047" class="elsevierStylePara elsevierViewall">For the variable composite score (stage), the estimated ICC was 0.45, indicating moderate reproducibility.</p><p id="para0048" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0003">Table 3</a> shows the mean and standard deviation of the evaluations for each pathologist.</p><elsevierMultimedia ident="tbl0003"></elsevierMultimedia></span></span></span><span id="sec0011" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0017">Discussion</span><p id="para0049" class="elsevierStylePara elsevierViewall">The prevalence of EoE has increased steadily in the last 20 years.<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> According to the current consensuses, an eosinophil count ≥ 15 eos/HPF confirms the active disease. Histological evaluation of esophageal biopsies is essential to diagnose EoE as well as to monitor response to treatment.<a class="elsevierStyleCrossRefs" href="#bib0001"><span class="elsevierStyleSup">1–3</span></a></p><p id="para0050" class="elsevierStylePara elsevierViewall">The EoEHSS was developed to assess other histological changes in the mucosa present in EoE, in addition to the peak eosinophil count.<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a></p><p id="para0051" class="elsevierStylePara elsevierViewall">Most of the studies conducted to date on the histological findings have analyzed only EI by pathologists specialized in the analysis of biopsies from patients with EoE or by less experienced pathologists after specific training in the analysis of the findings in reference centers.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> The intraobserver and interobserver agreement of the individual EoEHSS components were evaluated only during the development of the system and subsequently by pathologists specializing in the diagnosis of EoE.<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a><span class="elsevierStyleSup">,</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a></p><p id="para0052" class="elsevierStylePara elsevierViewall">With the increased incidence and prevalence of the disease, many patients are managed outside reference centers where general pathologists are involved in the diagnosis of various diseases. The repeatability and reproducibility of the histological findings among pathologists not specialized in EoE have not been evaluated in clinical practice.</p><p id="para0053" class="elsevierStylePara elsevierViewall">In the present study, the intraobserver and interobserver agreement for the evaluation of EoEHSS individual items as well as the composite score was determined by pathologists with different degrees of experience in the diagnosis of EoE.</p><p id="para0054" class="elsevierStylePara elsevierViewall">Intra- and interobserver agreement for the identification of eosinophil counts ≥15 /high power field, essential for the diagnosis of EoE, was excellent for all pathologists, however, it varied per item and among the observers when assessing additional features of the EoEHSS.</p><p id="para0055" class="elsevierStylePara elsevierViewall">For the most experienced pathologist, the intraobserver agreement was excellent or substantial in the evaluation of all individual items, except for BZH (stage), for which the agreement was fair. For the variable score (grade and stage), the intraobserver agreement was also excellent for the most experienced pathologist. These findings are equivalent to those observed in a study conducted with specialist pathologists trained in EoE reference centers that found an excellent intraobserver agreement for grade and stage composite scores and were at least substantial for all the other items except for DEC, which showed fair agreement.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a></p><p id="para0056" class="elsevierStylePara elsevierViewall">The less experienced pathologists showed intraobserver agreement ranging from absent to substantial in the evaluation of individual items. The highest κ values were observed for the evaluation of EA (grade and stage), followed by SL (grade and stage), EI (grade), and BZH (grade). In this group, for the variable score (grade and stage), the intraobserver agreement ranged from moderate to substantial.</p><p id="para0057" class="elsevierStylePara elsevierViewall">A study comparing specialist and non-specialist pathologists revealed that interobserver agreement was excellent for the determination of EI after a training session to identify the findings.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> That study did not analyze other histological features of EoE, which precludes comparison with the findings of our study but reinforces the need for training in the interpretation of histological findings.</p><p id="para0058" class="elsevierStylePara elsevierViewall">The interobserver agreement was moderate for EI (grade) and the composite score (stage), fair for the composite score (grade), and absent or fair for the other individual EoEHSS components. These findings contrast with a previous study conducted with specialist pathologists in EoE reference centers that revealed excellent interobserver agreement for the grade and stage composite scores and were at least moderate for all the other items except SEA, which showed fair agreement.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a> This discrepancy may be explained by the difference in reproducibility between the most experienced pathologist and the others, in addition to the absence of specific prior training for the reading and uniform interpretation of the features included in the EoEHSS.</p><p id="para0059" class="elsevierStylePara elsevierViewall">There are some limitations in interpreting the results of this study that need to be discussed.</p><p id="para0060" class="elsevierStylePara elsevierViewall">First, this study was conducted in a reference center for pediatric endoscopy with experience in EoE, where only one of the participant pathologists has worked in the routine reading of slides originated from patients diagnosed and treated at the unit. The other less experienced pathologists had not received formal training on the features of EoE histological findings and performed the analyses among other routine work activities. Second, the pathologists evaluated a small sample of slides under different microscopes that may have different illumination configurations, levels of magnification in the objective and ocular lens system, and image quality.</p><p id="para0061" class="elsevierStylePara elsevierViewall">In addition, the slides for the study were selected from biopsy material obtained by routine endoscopy. Fragments of well-oriented biopsies are not always obtained and/or processed consistently, and the slides used in this study did not always have well-oriented sections. The quality of the biopsies and orientation of the fragments may have compromised the analysis of some findings, especially LPF and BZH. Fragmentation of the biopsies and/or mechanical compression, as well as the resolution of the microscopes, may also have affected the reproducibility of the findings.</p><p id="para0062" class="elsevierStylePara elsevierViewall">In conclusion, the authors’ findings reveal that intra- and interobserver agreement for the identification of eosinophil counts ≥15 /high power field, required for the diagnosis of EoE, was excellent for all pathologists. The evaluation of the individual components of the EoEHSS shows intraobserver agreement in parameters comparable to previous studies when evaluated by a pathologist experienced in the diagnosis of this disease. Among non-specialist and less experienced pathologists, the intraobserver and interobserver agreement for the identification of EI grade and EA varied from moderate to fair but the additional histological features of EoE presented lower repeatability and reproducibility.</p><p id="para0063" class="elsevierStylePara elsevierViewall">These findings suggest that there is a need for specific training of pathologists to identify EoEHSS features in addition to eosinophil count, as they are considered useful to assess histologic abnormalities and may be important for the evaluation of response to treatment as well as for the correlation with clinical manifestations and endoscopic findings. Moreover, future studies with a larger sample size and more participants are needed to confirm the intra- and interobserver reliability of the EoEHSS in clinical practice.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1653737" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1470019" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0001" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "sec0002" "titulo" => "Materials and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0003" "titulo" => "Statistical analysis" ] ] ] 4 => array:3 [ "identificador" => "sec0004" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Demographics" ] 1 => array:2 [ "identificador" => "sec0006" "titulo" => "Assessment of eosinophilic infiltration (≥15 eos/HPF)" ] 2 => array:2 [ "identificador" => "sec0007" "titulo" => "Assessment of intraobserver agreement (EoEHSS individual items and composite scores)" ] 3 => array:3 [ "identificador" => "sec0008" "titulo" => "Assessment of interobserver agreement (reproducibility)" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0009" "titulo" => "Individual EoEHSS items" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "EoEHSS scores (grade and stage)" ] ] ] ] ] 5 => array:2 [ "identificador" => "sec0011" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "xack583076" "titulo" => "Acknowledgment" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2021-01-06" "fechaAceptado" => "2021-03-23" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1470019" "palabras" => array:4 [ 0 => "Eosinophilic esophagitis" 1 => "Endoscopy" 2 => "Histology" 3 => "Observer variation" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Objective</span><p id="spara008" class="elsevierStyleSimplePara elsevierViewall">To assess intra- and interobserver agreement among non-expert pathologists in identifying features of the eosinophilic esophagitis histologic scoring system (EoEHSS) in pediatric patients.</p></span> <span id="abss0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Patients and methods</span><p id="spara009" class="elsevierStyleSimplePara elsevierViewall">The authors used 50 slides from patients (aged 1-15 years; 72% male) with EoE. EoEHSS evaluates eosinophilic inflammation and other features including epithelial basal zone hyperplasia, eosinophilic abscesses, eosinophil surface layering, dilated intercellular spaces, surface epithelial alteration, dyskeratotic epithelial cells, and lamina propria fibrosis. Grade and stage of abnormalities are scored using a 4-point scale (0 normal; 3 maximum change). Four pathologists determined EoEHSS findings on two occasions. Intra- and interobserver agreement was assessed using Kappa (κ) statistics and intra-class correlation coefficients.</p></span> <span id="abss0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">Results</span><p id="spara010" class="elsevierStyleSimplePara elsevierViewall">Intra- and interobserver agreement for the identification of eosinophil counts ≥ 15/high power field (HPF) was excellent, however varied when assessing additional features of the EoEHSS. For the more experienced pathologist, agreement for most EoEHSS items and the composite scores was substantial to excellent. For the less experienced pathologists, intraobserver agreement ranged from absent to substantial for individual features and ranged from moderate to substantial for the composite scores.</p></span> <span id="abss0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Conclusion</span><p id="spara011" class="elsevierStyleSimplePara elsevierViewall">Most items of the EoEHSS had substantial to excellent reliability when assessed by a pathologist experienced in the diagnosis of EoE but presented lower repeatability among less experienced pathologists. These findings suggest that specific training of pathologists is required for the identification of EoEHSS characteristics beyond eosinophil count, as these features are considered useful in the evaluation of response to treatment and correlation with clinical manifestations and endoscopic findings.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abss0001" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abss0002" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abss0003" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abss0004" "titulo" => "Conclusion" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="notep0011">Study conducted at Hospital Pequeno Príncipe, Curitiba, PR, Brazil; Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil; and Universidade Federal do Paraná, Curitiba, PR, Brazil.</p>" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "<p id="para0068a" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="ecom0001"></elsevierMultimedia></p>" "etiqueta" => "Appendix" "titulo" => "Supplementary materials" "identificador" => "sec0014" ] ] ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig0001" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 941 "Ancho" => 1500 "Tamanyo" => 377623 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0001" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Histological features observed in EoE (Hematoxylin & Eosin, 10 ×).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0001" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0002" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spara003" class="elsevierStyleSimplePara elsevierViewall">PATH, pathologist; CI, confidence interval; EI, eosinophil inflammation; BZH, basal zone hyperplasia; EA, eosinophilic abscesses; SL, eosinophil surface layering; DIS, dilated intercellular spaces; SEA, surface epithelial alteration; DEC, dyskeratotic epithelial cells; LPF, lamina propria fibrosis; ICC, intra-class correlation coefficient.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0001"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0002"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">PATH 1 Kappa (CI 95%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0003"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">PATH 2 Kappa (CI 95%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">PATH3 Kappa (CI 95%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">PATH 4 Kappa (CI 95%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0006"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">EI (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0007"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.86 (0.58; 1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0008"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.47 (0.22; 0.72) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.50 (0.22; 0.78) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.47 (0.20; 0.75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0011"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">EI (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.63 (0.42; 0.84) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0013"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.25 (0.03; 047) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.29 (0.09; 0.5) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0015"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.37 (0.17; 0.58) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0016"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">BZH (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.72 (0.5; 0.94) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.38 (0.16; 0.6) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.40 (0.21; 0.59) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.51 (0.26; 0.77) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0021"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">BZH (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0022"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.24 (0.01; 0.49) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.11 (-0.03; 0.25) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.33 (0.14; 0.51) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">0.73</span> (0.51; 0.94) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0026"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">EA (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">0.94</span> (0.74; 1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">0.62</span> (0.43; 0.82) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0029"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.62 (0.43; 0.81) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.52 (0.35; 0.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0031"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">EA (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.90 (0.68; 1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.54 (0.32; 0.75) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">0.69</span> (0.46; 0.93) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.29 (0.1; 0.49) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">SL (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.85 (0.59; 1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.53 (0.28; 0.77) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.22 (0.01; 0.42) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.50 (0.3; 0.71) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0041"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">SL (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.89 (0.65; 1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0043"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.60 (0.34; 0.87) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.26 (0.08; 0.44) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.46 (0.26; 0.66) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0046"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">DIS (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.77 (0.56; 0.98) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.00 (- - -) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.29 (0.07; 0.5) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0050"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.00 (- - -) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0051"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">DIS (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.85 (0.65; 1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.30 (0.1; 0.5) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.43 (0.24; 0.62) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.65 (0.44; 0.85) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0056"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">SEA (Grade</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0057"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.62 (0.44; 0.81) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.18 (-0.02; 0.38) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.43 (0.26; 0.6) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.31 (0.1; 0.51) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0061"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">SEA (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.78 (0.61; 0.95) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.22 (-0.01; 0.45) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0064"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.39 (0.23; 0.55) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.08 (-0.08; 0.24) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0066"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">DEC (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.91 (0.63; 1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.38 (0.16; 0.6) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.40 (0.2; 0.59) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.20 (0.02; 0.37) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">DEC (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.83 (0.56; 1) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.37 (0.09; 0.65) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.49 (0.25; 0.73) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.05 (-0.11; 0.21) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0076"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">LPF (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.69 (0.47; 0.91) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0078"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.50 (-0.75; -0.25) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0079"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.12 (-0.09; 0.32) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0080"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.20 (-0.01; 0.41) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0081"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">LPF (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0082"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.76 (0.53; 0.98) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0083"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.35 (0.13; 0.57) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0084"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.03 (-0.2; 0.14) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0085"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.17 (-0.01; 0.36) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0086"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0087"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">ICC (CI 95%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0088"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">ICC (CI 95%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0089"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">ICC (CI 95%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0090"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">ICC (CI 95%)</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0091"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">SCORE (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0092"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.94 (0.91;0.97) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0093"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.52 (0.29; 0.70) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0094"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.77 (0.63; 0.86) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0095"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.64 (0.44; 0.78) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0096"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">SCORE (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0097"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.90 (0.83; 0.94) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0098"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.64 (0.45; 0.78) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0099"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.71 (0.54; 0.82) \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0100"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.80 (0.68; 0.88) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2810638.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Intraobserver level of agreement.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0002" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0003" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spara005" class="elsevierStyleSimplePara elsevierViewall">EI, eosinophil inflammation; BZH, basal zone hyperplasia; EA, eosinophilic abscesses; SL, eosinophil surface layering; DIS, dilated intercellular spaces; SEA, surface epithelial alteration; DEC, dyskeratotic epithelial cells; LPF, lamina propria fibrosis; CI, confidence interval.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0101"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Variable \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0102"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Kappa \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0103"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0104"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">CI 95% \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0105"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Reproducibility \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0106"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">EI (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0107"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">0.41</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0108"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0109"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.29; 0.52 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0110"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">Moderate</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0111"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">EI (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0112"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.13 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0113"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.003 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0114"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.05; 0.22 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0115"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0116"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">BZH (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0117"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.02 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0118"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.691 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0119"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.1; 0.06 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0120"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">No agreement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0121"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">BZH (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0122"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.01 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0123"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.727 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0124"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.07; 0.1 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0125"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0126"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">EA (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0127"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">0.39</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0128"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0129"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.31; 0.46 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0130"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">Fair</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0131"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">EA (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0132"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">0.33</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0133"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0134"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.24; 0.41 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0135"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">Fair</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0136"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">SL (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0137"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.14 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0138"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.004 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0139"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.05 0.23 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0140"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0141"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">SL (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0142"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.17 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0143"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0144"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.08; 0.25 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0145"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0146"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">DIS (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0147"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.03 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0148"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.505 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0149"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.06; 0.12 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0150"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0151"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">DIS (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0152"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.20 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0153"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">< 0.001 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0154"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.12; 0.29 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0155"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0156"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">SEA (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0157"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.10 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0158"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.014 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0159"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.02; 0.18 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0160"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0161"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">SEA (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0162"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.07 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0163"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.036 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0164"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.01; 0.14 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0165"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">Poor \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0166"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">DEC (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0167"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.04 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0168"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.337 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0169"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.13; 0.05 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0170"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">No agreement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0171"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">DEC (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0172"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.05 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0173"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.366 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0174"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.16; 0.06 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0175"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">No agreement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0176"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">LPF (Grade)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0177"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.05 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0178"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.283 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0179"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.13; 0.04 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0180"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">No agreement \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0181"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">LPF (Stage)</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0182"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.03 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0183"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.533 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0184"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">-0.11; 0.06 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0185"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">No agreement \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2810639.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara004" class="elsevierStyleSimplePara elsevierViewall">Interobserver agreement (all pathologists).</p>" ] ] 3 => array:8 [ "identificador" => "tbl0003" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0004" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spara007" class="elsevierStyleSimplePara elsevierViewall">ICC, intra-class correlation coefficient.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><a name="en0186"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0187"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Pathologist 1 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0188"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Pathologist 2 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0189"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Pathologist 3 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0190"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Pathologist 4 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><a name="en0191"></a><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="top" scope="col" style="border-bottom: 2px solid black">ICC \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0192"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Grade</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0193"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.46 ± 0.12 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0194"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.39 ± 0.08 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0195"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.47 ± 0.15 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0196"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.60 ± 0.12 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0197"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">0.33</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><a name="en0198"></a><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="" valign="top"><span class="elsevierStyleBold">Stage</span> \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0199"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.52 ± 0.12 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0200"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.42 ± 0.11 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0201"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.43 ± 0.16 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0202"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top">0.53 ± 0.16 \t\t\t\t\t\t\n \t\t\t\t</td><a name="en0203"></a><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="top"><span class="elsevierStyleBold">0.45</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2810637.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spara006" class="elsevierStyleSimplePara elsevierViewall">EoEHSS scores.</p>" ] ] 4 => array:6 [ "identificador" => "ecom0001" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "detalles" => array:1 [ 0 => array:3 [ "identificador" => "alt0005" "detalle" => "Image, application " "rol" => "short" ] ] "Ecomponente" => array:2 [ "fichero" => "mmc1.docx" "ficheroTamanyo" => 55470 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "cebibsec1" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0001" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "AJ Lucendo" 1 => "J Molina-Infante" 2 => "Á Arias" 3 => "U von Arnim" 4 => "AJ Bredenoord" 5 => "C Bussmann" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "United Eur Gastroenterol J" "fecha" => "2017" "volumen" => "5" "paginaInicial" => "335" "paginaFinal" => "358" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0002" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "ES Dellon" 1 => "CA Liacouras" 2 => "J Molina-Infante" 3 => "GT Furuta" 4 => "JM Spergel" 5 => "N Zevit" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2018.07.009" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2018" "volumen" => "155" "paginaInicial" => "1022" "paginaFinal" => "1033" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30009819" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0003" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic esophagitis-Where are we today?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "CT Ferreira" 1 => "MC Vieira" 2 => "GT Furuta" 3 => "FC Barros" 4 => "M. Chehade" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Pediatr (Rio J)" "fecha" => "2019" "volumen" => "95" "paginaInicial" => "275" "paginaFinal" => "281" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0004" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic esophagitis in a patient with vigorous achalasia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "RT Landres" 1 => "GG Kuster" 2 => "WB. Strum" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "1978" "volumen" => "74" "paginaInicial" => "1298" "paginaFinal" => "1301" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/648822" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0005" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "SE Attwood" 1 => "TC Smyrk" 2 => "TR Demeester" 3 => "JB. Jones" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/BF01296781" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "1993" "volumen" => "38" "paginaInicial" => "109" "paginaFinal" => "116" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8420741" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0006" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic esophagitis: updated consensus recommendations for children and adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "CA Liacouras" 1 => "GT Furuta" 2 => "I Hirano" 3 => "D Atkins" 4 => "SE Attwood" 5 => "PA Bonis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jaci.2011.02.040" "Revista" => array:6 [ "tituloSerie" => "J Allergy Clin Immunol" "fecha" => "2011" "volumen" => "128" "paginaInicial" => "3" "paginaFinal" => "20" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21477849" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0007" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "GT Furuta" 1 => "CA Liacouras" 2 => "MH Collins" 3 => "SK Gupta" 4 => "C Justinich" 5 => "PE Putnam" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2007.08.017" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2007" "volumen" => "133" "paginaInicial" => "1342" "paginaFinal" => "1363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17919504" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0008" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "I Hirano" 1 => "N Moy" 2 => "MG Heckman" 3 => "CS Thomas" 4 => "N Gonsalves" 5 => "SR. Achem" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/gutjnl-2011-301817" "Revista" => array:6 [ "tituloSerie" => "Gut" "fecha" => "2013" "volumen" => "62" "paginaInicial" => "489" "paginaFinal" => "495" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22619364" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0009" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pathology of eosinophilic esophagitis: what the clinician needs to know" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "RD. Odze" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2009" "volumen" => "104" "paginaInicial" => "485" "paginaFinal" => "490" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0010" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A novel histologic scoring system to evaluate mucosal biopsies from patients with eosinophilic esophagitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C Protheroe" 1 => "SA Woodruff" 2 => "G de Petris" 3 => "V Mukkada" 4 => "SI Ochkur" 5 => "S Janarthanan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cgh.2009.03.022" "Revista" => array:6 [ "tituloSerie" => "Clin Gastroenterol Hepatol" "fecha" => "2009" "volumen" => "7" "paginaInicial" => "749" "paginaFinal" => "755" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19345285" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0011" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopathologic features of eosinophilic esophagitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "MH. Collins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.giec.2007.09.014" "Revista" => array:6 [ "tituloSerie" => "Gastrointest Endosc Clin N Am" "fecha" => "2008" "volumen" => "18" "paginaInicial" => "59" "paginaFinal" => "71" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18061102" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0012" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopathologic diagnosis of eosinophilic conditions in the gastrointestinal tract" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "JM Hurrell" 1 => "RM Genta" 2 => "SD. Melton" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PAP.0b013e318229bfe2" "Revista" => array:6 [ "tituloSerie" => "Adv Anat Pathol" "fecha" => "2011" "volumen" => "18" "paginaInicial" => "335" "paginaFinal" => "348" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21841404" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0013" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Histopathology of eosinophilic esophagitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "MH. Collins" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000357012" "Revista" => array:6 [ "tituloSerie" => "Dig Dis" "fecha" => "2014" "volumen" => "32" "paginaInicial" => "68" "paginaFinal" => "73" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24603383" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0014" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Newly developed and validated eosinophilic esophagitis histology scoring system and evidence that it outperforms peak eosinophil count for disease diagnosis and monitoring" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "MH Collins" 1 => "LJ Martin" 2 => "ES Alexander" 3 => "JT Boyd" 4 => "R Sheridan" 5 => "H He" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/dote/dox050" "Revista" => array:6 [ "tituloSerie" => "Dis Esophagus" "fecha" => "2017" "volumen" => "30" "paginaInicial" => "1" "paginaFinal" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30052901" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0015" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reliability of histologic assessment in patients with eosinophilic oesophagitis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "MJ Warners" 1 => "CA Ambarus" 2 => "AJ Bredenoord" 3 => "J Verheij" 4 => "GY Lauwers" 5 => "JC Walsh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/apt.14559" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2018" "volumen" => "47" "paginaInicial" => "940" "paginaFinal" => "950" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29460418" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0016" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The measurement of observer agreement for categorical data" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "JR Landis" 1 => "GG. Koch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Biometrics" "fecha" => "1977" "volumen" => "33" "paginaInicial" => "159" "paginaFinal" => "174" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/843571" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0017" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intraclass correlations: uses in assessing rater reliability" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "PE Shrout" 1 => "JL. Fleiss" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1037//0033-2909.86.2.420" "Revista" => array:6 [ "tituloSerie" => "Psychol Bull" "fecha" => "1979" "volumen" => "86" "paginaInicial" => "420" "paginaFinal" => "428" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18839484" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0018" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of eosinophilic esophagitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "ES. Dellon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gtc.2014.02.002" "Revista" => array:6 [ "tituloSerie" => "Gastroenterol Clin North Am" "fecha" => "2014" "volumen" => "43" "paginaInicial" => "201" "paginaFinal" => "218" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24813510" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0019" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology and Natural History of Eosinophilic Esophagitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "ES Dellon" 1 => "I. Hirano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2017.06.067" "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "2018" "volumen" => "154" "paginaInicial" => "319" "paginaFinal" => "332" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28774845" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0020" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determination of esophageal eosinophil counts and other histologic features of eosinophilic esophagitis by pathology trainees is highly accurate" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:8 [ 0 => "S Rusin" 1 => "S Covey" 2 => "I Perjar" 3 => "J Hollyfield" 4 => "O Speck" 5 => "K Woodward" 6 => "JT Woosley" 7 => "ES. Dellon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.humpath.2016.12.017" "Revista" => array:6 [ "tituloSerie" => "Hum Pathol" "fecha" => "2017" "volumen" => "62" "paginaInicial" => "50" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28041975" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0021" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inter- and intraobserver reliability and validation of a new method for determination of eosinophil counts in patients with esophageal eosinophilia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "ES Dellon" 1 => "KJ Fritchie" 2 => "TC Rubinas" 3 => "JT Woosley" 4 => "NJ. Shaheen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-009-1005-z" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2010" "volumen" => "55" "paginaInicial" => "1940" "paginaFinal" => "1949" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19830560" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack583076" "titulo" => "Acknowledgment" "texto" => "<p id="para0069" class="elsevierStylePara elsevierViewall">The authors would like to thank Dr. Eloisa M. P. Guimarães for her encouragement and contribution to data collection and tabulation. We also gratefully appreciate the valuable inputs and comments provided for the study by Dr. Carlos A. Riedi, Dr. Dante L. Escuissato, Dr. Evaldo Macedo Filho, Dr. Victor Horácio S. Costa Jr., and Dr. Solena Z. Kusma.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/00217557/0000009800000001/v1_202201230524/S0021755721000577/v1_202201230524/en/main.assets" "Apartado" => array:4 [ "identificador" => "10179" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/00217557/0000009800000001/v1_202201230524/S0021755721000577/v1_202201230524/en/main.pdf?idApp=UINPBA000049&text.app=https://jped.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0021755721000577?idApp=UINPBA000049" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 5 | 12 |
| 2024 October | 28 | 22 | 50 |
| 2024 September | 47 | 49 | 96 |
| 2024 August | 46 | 55 | 101 |
| 2024 July | 46 | 39 | 85 |
| 2024 June | 32 | 32 | 64 |
| 2024 May | 30 | 29 | 59 |
| 2024 April | 46 | 29 | 75 |
| 2024 March | 33 | 19 | 52 |
| 2024 February | 60 | 26 | 86 |
| 2024 January | 42 | 22 | 64 |
| 2023 December | 54 | 30 | 84 |
| 2023 November | 59 | 35 | 94 |
| 2023 October | 67 | 38 | 105 |
| 2023 September | 37 | 42 | 79 |
| 2023 August | 35 | 28 | 63 |
| 2023 July | 29 | 13 | 42 |
| 2023 June | 31 | 18 | 49 |
| 2023 May | 39 | 24 | 63 |
| 2023 April | 41 | 28 | 69 |
| 2023 March | 76 | 26 | 102 |
| 2023 February | 47 | 18 | 65 |
| 2023 January | 50 | 48 | 98 |
| 2022 December | 78 | 41 | 119 |
| 2022 November | 60 | 34 | 94 |
| 2022 October | 83 | 45 | 128 |
| 2022 September | 57 | 54 | 111 |
| 2022 August | 60 | 47 | 107 |
| 2022 July | 59 | 93 | 152 |
| 2022 June | 48 | 39 | 87 |
| 2022 May | 48 | 47 | 95 |
| 2022 April | 93 | 66 | 159 |
| 2022 March | 108 | 99 | 207 |
| 2022 February | 102 | 64 | 166 |
| 2022 January | 132 | 56 | 188 |
| 2021 December | 29 | 20 | 49 |
| 2021 November | 19 | 17 | 36 |
| 2021 October | 20 | 17 | 37 |
| 2021 September | 20 | 13 | 33 |
| 2021 August | 11 | 6 | 17 |
| 2021 July | 24 | 6 | 30 |
| 2021 June | 10 | 8 | 18 |
| 2021 May | 12 | 6 | 18 |
Show all
