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Histopathology. 2011 May;58(6):974-81. doi: 10.1111/j.1365-2559.2011.03822.x.

Inter-observer variation in the histological diagnosis of polyps in colorectal cancer screening.

Author information

  • 1Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands. p.g.vanputten@erasmusmc.nl

Abstract

AIM:

To determine the inter-observer variation in the histological diagnosis of colorectal polyps.

METHODS AND RESULTS:

Four hundred and forty polyps were randomly selected from a colorectal cancer screening programme. Polyps were first evaluated by a general (324 polyps) or expert (116 polyps) pathologist, and subsequently re-evaluated by an expert pathologist. Conditional agreement was reported, and inter-observer agreement was determined using kappa statistics. In 421/440 polyps (96%), agreement for their non-adenomatous or adenomatous nature was obtained, corresponding to a very good kappa value of 0.88. For differentiation of adenomas as non-advanced and advanced, consensus was obtained in 266/322 adenomas (83%), with a moderate kappa value of 0.58. For the non-adenomatous or adenomatous nature, both general and expert pathologists, and expert pathologists between each other, showed very good agreement {kappa values of 0.89 [95% confidence interval (CI) 0.83-0.95] and 0.86 (95% CI 0.73-0.98), respectively}. For categorization of adenomas as non-advanced and advanced, moderate agreement was found between general and expert pathologists, and between expert pathologists [kappa values of 0.56 (95% CI 0.44-0.67) and 0.64 (95% CI 0.43-0.85), respectively].

CONCLUSIONS:

General and expert pathologists demonstrate very good inter-observer agreement for differentiating non-adenomas from adenomas, but only moderate agreement for non-advanced and advanced adenomas. The considerable variation in differentiating non-advanced and advanced adenomas suggests that more objective criteria are required for risk stratification in screening and surveillance guidelines.

© 2011 Blackwell Publishing Limited.

PMID:
21585430
[PubMed - indexed for MEDLINE]
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