Interobserver Agreement in Assessing Dysplasia in Colorectal Adenomatous Polyps: A Multicentric Iranian Study

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Abstract

Background & Objective:

Most colorectal cancers (CRCs) arise from adenomatous polyps, and clinical management of this type of polyp is highly dependent on the reliability and validity of the pathological diagnosis. The aim of this study was to examine the interobserver agreement of five pathologists in assessing dysplasia in adenomatous polyps.

Methods:

In this study, a total of 146 adenomatous polyps of patients undergoing colonoscopy were selected from hospitals of Shahid Beheshti University of Medical Sciences, Tehran, Iran between 2017 and 2018. Five pathologists independently classified adenomatous polyps according to histologic type, nuclear pseudostratification, mitotic activity, nuclear polarity, nuclear pleomorphism, nuclear shape, nucleolus, chromatin pattern, cytology grade, architectural features, dysplasia, and final diagnosis. The overall kappa statistic (k) was used to assess agreement among pathologists.

Results:

The mean age of the patients was 62.06 ± 13.06 (mean ± SD) with a male-to-female ratio of 2.2:1. The most common site of resection was the sigmoid colon (28.1%). The highest agreement was found for dysplasia grade ( k=0.415) and histologic type ( k=0.401), whereas the lowest agreement was found for mitotic activity ( k=0.185), nuclear shape ( k=0.187), and nucleolus ( k=0.196).

Conclusion:

Our findings indicate that agreement among pathologists in assessing dysplasia in adenomatous polyps is within fair to moderate levels of agreement. Therefore, there is a vital need to better clarify the current diagnostic criteria.

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Most cited references 19

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Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

Monika Ferlitsch, Alan Moss, Cesare Hassan … (2017)

1 ESGE recommends cold snare polypectomy (CSP) as the preferred technique for removal of diminutive polyps (size ≤ 5 mm). This technique has high rates of complete resection, adequate tissue sampling for histology, and low complication rates. (High quality evidence, strong recommendation.)2 ESGE suggests CSP for sessile polyps 6 - 9 mm in size because of its superior safety profile, although evidence comparing efficacy with hot snare polypectomy (HSP) is lacking. (Moderate quality evidence, weak recommendation.)3 ESGE suggests HSP (with or without submucosal injection) for removal of sessile polyps 10 - 19 mm in size. In most cases deep thermal injury is a potential risk and thus submucosal injection prior to HSP should be considered. (Low quality evidence, strong recommendation.)4 ESGE recommends HSP for pedunculated polyps. To prevent bleeding in pedunculated colorectal polyps with head ≥ 20 mm or a stalk ≥ 10 mm in diameter, ESGE recommends pretreatment of the stalk with injection of dilute adrenaline and/or mechanical hemostasis. (Moderate quality evidence, strong recommendation.)5 ESGE recommends that the goals of endoscopic mucosal resection (EMR) are to achieve a completely snare-resected lesion in the safest minimum number of pieces, with adequate margins and without need for adjunctive ablative techniques. (Low quality evidence; strong recommendation.)6 ESGE recommends careful lesion assessment prior to EMR to identify features suggestive of poor outcome. Features associated with incomplete resection or recurrence include lesion size > 40 mm, ileocecal valve location, prior failed attempts at resection, and size, morphology, site, and access (SMSA) level 4. (Moderate quality evidence; strong recommendation.)7 For intraprocedural bleeding, ESGE recommends endoscopic coagulation (snare-tip soft coagulation or coagulating forceps) or mechanical therapy, with or without the combined use of dilute adrenaline injection. (Low quality evidence, strong recommendation.)An algorithm of polypectomy recommendations according to shape and size of polyps is given (Fig. 1).

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Incidence of colorectal adenomas: birth cohort analysis among 4.3 million participants of screening colonoscopy.

Hermann Brenner, Lutz Altenhofen, Christian Stock … (2014)

Most colorectal cancers develop from adenomas. We aimed to estimate sex- and age-specific incidence rates of colorectal adenomas and to assess their potential implications for colorectal cancer screening strategies.

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Reproducibility of the Villous Component and High-grade Dysplasia in Colorectal Adenomas <1 cm

Dipti Mahajan, Erinn Downs-Kelly, Xiuli Liu … (2013)

The presence of high-grade dysplasia (HGD) or villous component (VC) defines an advanced adenoma (AA) in patients with 1 or 2 adenomas <1 cm in size. Current consensus guidelines recommend that patients with AA undergo more intense postpolypectomy surveillance. In these clinical situations, the interobserver reliability in determining VC and HGD would play a major role in the credibility of these consensus guidelines. Therefore, the purpose of this study was to evaluate interobserver variability of VC and HGD in polyps <1 cm before and after the development of consensus criteria among gastrointestinal (GI) pathologists. Five GI pathologists independently evaluated 107 colorectal adenomas <1 cm, and classified them into tubular adenomas or adenomas with a VC (A-VC) and into low-grade dysplasia or HGD. Then a consensus conference was held and consensus criteria for VC and HGD were developed by group review. The same set of 107 slides were rereviewed independently by the same 5 GI pathologists. Interobserver variability using κ statistical analysis before and after the application of consensus criteria was assessed. A 1-sided z-test was used to determine whether κ scores increased after the consensus conference. Interobserver agreement before and after the consensus conference was poor for assessment of A-VC, HGD, and AA. These data calls into question the validity of basing clinical decisions on this distinction.

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Author and article information

Journal

Journal ID (nlm-ta): Iran J Pathol

Journal ID (iso-abbrev): Iran J Pathol

Journal ID (publisher-id): IJP

Title: Iranian Journal of Pathology

Publisher: Iranian Society of Pathology (Tehran, Iran )

ISSN (Print): 1735-5303

ISSN (Electronic): 2345-3656

Publication date (Print): Summer 2020

Publication date (Electronic): 5 April 2020

Volume: 15

Issue: 3

Pages: 167-174

Affiliations

[1 ] Department of Pathology, Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

[2 ] Department of Pathology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

[3 ] Department of Pathology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

[4 ] Department of Pathology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

[5 ] Department of Biostatistics, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran

Author notes

[* ]Corresponding Information: Behrang Kazeminezhad, Clinical Research Development Center, Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.. Email: dkazeminezhad@sbmu.ac.ir

Article

DOI: 10.30699/ijp.2020.115021.2250

PMC ID: 7354064

PubMed ID: 32754211

SO-VID: cf2619d3-84bc-437e-88a1-5561ae9ea067

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-noncommercial 4.0 International License, ( https://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Interobserver Agreement in Assessing Dysplasia in Colorectal Adenomatous Polyps: A Multicentric Iranian Study

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Abstract

Background & Objective:

Methods:

Results:

Conclusion:

Related collections

Karger: Oncology

Most cited references 19

Colorectal polypectomy and endoscopic mucosal resection (EMR): European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline.

Incidence of colorectal adenomas: birth cohort analysis among 4.3 million participants of screening colonoscopy.

Reproducibility of the Villous Component and High-grade Dysplasia in Colorectal Adenomas <1 cm

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