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

  1. Paul G van Putten1,
  2. Lieke Hol1,
  3. Herman van Dekken2,
  4. J Han van Krieken3,
  5. Marjolein van Ballegooijen4,
  6. Ernst J Kuipers1,5,
  7. Monique E van Leerdam1

Article first published online: 17 MAY 2011

DOI: 10.1111/j.1365-2559.2011.03822.x

Issue

Histopathology

Histopathology

Volume 58, Issue 6, pages 974–981, May 2011

Additional Information

How to Cite

van Putten, P. G., Hol, L., van Dekken, H., Han van Krieken, J., van Ballegooijen, M., Kuipers, E. J. and van Leerdam, M. E. (2011), Inter-observer variation in the histological diagnosis of polyps in colorectal cancer screening. Histopathology, 58: 974–981. doi: 10.1111/j.1365-2559.2011.03822.x

Author Information

  1. 1

    Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam

  2. 2

    Department of Pathology, St Lucas Andreas Hospital, Amsterdam

  3. 3

    Department of Pathology, University Nijmegen Medical Centre, Nijmegen

  4. 4

    Department of Public Health

  5. 5

    Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands

*P G van Putten, MD, Department of Gastroenterology and Hepatology, Erasmus MC, University Medical Centre Rotterdam, Dr Molewaterplein 40, Room Ba 393 A, 3015 GD Rotterdam, The Netherlands. e-mail: p.g.vanputten@erasmusmc.nl

  1. P.G.v.P and L.H. contributed equally to this work.

Publication History

  1. Issue published online: 17 MAY 2011
  2. Article first published online: 17 MAY 2011
  3. Date of submission 13 January 2010 Accepted for publication 10 August 2010

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Keywords:

  • colorectal cancer screening;
  • colorectal polyps;
  • histological diagnosis;
  • interobserver variation

van Putten P G, Hol L, van Dekken H, Han van Krieken J, van Ballegooijen M, Kuipers E J & van Leerdam M E (2011) Histopathology 58, 974–981 Inter-observer variation in the histological diagnosis of polyps in colorectal cancer screening

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.

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