Inter-observer and intra-observer variability in the diagnosis of dysplasia in patients with inflammatory bowel disease

Correlation of pathological and endoscopic findings

D. Allende, M. Elmessiry, W. Hao, G. Dasilva, S. D. Wexner, P. Bejarano, M. Berho

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Aim: Colonic epithelial dysplasia is deemed the precursor lesion of cancer arising in inflammatory bowel disease (IBD). It has been suggested that many dysplastic lesions could be endoscopically detected to obtain target biopsies, leading to better yield. However, the clinical impact of a diagnosis of dysplasia may be hampered by a significant degree of histological and endoscopic intra-observer and inter-observer variability. This study aimed to evaluate intra-observer and inter-observer variability in the microscopic diagnosis of dysplasia in IBD and correlate endoscopic and histological findings. Method: In total, 158 cases of ulcerative colitis and 14 of Crohn's disease with dysplasia were selected from a pathology database. Slides were blindly reviewed twice by two expert gastrointestinal pathologists. Results of endoscopic examinations were extracted from the reports. The degree of intra-observer and inter-observer variability was determined by kappa statistics. Results: Overall, there was an excellent degree of histopathological inter-observer agreement (κ = 0.786). The lowest level of agreement in the dysplasia group was for indefinite dysplasia (κ = 0.251). Negative and high grade dysplasia diagnosis reached the highest level of agreement with κ values of 0.822 [95% confidence interval (CI) 0.673-0.971] and 1.00 (95% CI 0.850-1.149), respectively. Intra-observer agreement was good and increased during the latter period of the study (κ = 0.734, 95% CI 0.642-0.826). Endoscopic-histological correlation was poor among the negative endoscopies, as up to 43% of cases were diagnosed with at least focal high grade dysplasia. The endoscopic-histological correlation improved when evaluating suspicious endoscopic lesions. Conclusion: Dysplasia is reliably diagnosed by expert gastrointestinal pathologists but has poor correlation with an endoscopic diagnosis of dysplasia.

Original languageEnglish
Pages (from-to)710-718
Number of pages9
JournalColorectal Disease
Volume16
Issue number9
DOIs
StatePublished - Jan 1 2014

Fingerprint

Observer Variation
Inflammatory Bowel Diseases
Confidence Intervals
Ulcerative Colitis
Crohn Disease
Endoscopy
Databases
Pathology
Biopsy
Neoplasms
Pathologists

Keywords

  • Crohn's disease
  • Dysplasia
  • Inflammatory bowel disease
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Inter-observer and intra-observer variability in the diagnosis of dysplasia in patients with inflammatory bowel disease : Correlation of pathological and endoscopic findings. / Allende, D.; Elmessiry, M.; Hao, W.; Dasilva, G.; Wexner, S. D.; Bejarano, P.; Berho, M.

In: Colorectal Disease, Vol. 16, No. 9, 01.01.2014, p. 710-718.

Research output: Contribution to journalArticle

Allende, D. ; Elmessiry, M. ; Hao, W. ; Dasilva, G. ; Wexner, S. D. ; Bejarano, P. ; Berho, M. / Inter-observer and intra-observer variability in the diagnosis of dysplasia in patients with inflammatory bowel disease : Correlation of pathological and endoscopic findings. In: Colorectal Disease. 2014 ; Vol. 16, No. 9. pp. 710-718.
@article{6d9a227eee8f4e87a4199a00786fae18,
title = "Inter-observer and intra-observer variability in the diagnosis of dysplasia in patients with inflammatory bowel disease: Correlation of pathological and endoscopic findings",
abstract = "Aim: Colonic epithelial dysplasia is deemed the precursor lesion of cancer arising in inflammatory bowel disease (IBD). It has been suggested that many dysplastic lesions could be endoscopically detected to obtain target biopsies, leading to better yield. However, the clinical impact of a diagnosis of dysplasia may be hampered by a significant degree of histological and endoscopic intra-observer and inter-observer variability. This study aimed to evaluate intra-observer and inter-observer variability in the microscopic diagnosis of dysplasia in IBD and correlate endoscopic and histological findings. Method: In total, 158 cases of ulcerative colitis and 14 of Crohn's disease with dysplasia were selected from a pathology database. Slides were blindly reviewed twice by two expert gastrointestinal pathologists. Results of endoscopic examinations were extracted from the reports. The degree of intra-observer and inter-observer variability was determined by kappa statistics. Results: Overall, there was an excellent degree of histopathological inter-observer agreement (κ = 0.786). The lowest level of agreement in the dysplasia group was for indefinite dysplasia (κ = 0.251). Negative and high grade dysplasia diagnosis reached the highest level of agreement with κ values of 0.822 [95{\%} confidence interval (CI) 0.673-0.971] and 1.00 (95{\%} CI 0.850-1.149), respectively. Intra-observer agreement was good and increased during the latter period of the study (κ = 0.734, 95{\%} CI 0.642-0.826). Endoscopic-histological correlation was poor among the negative endoscopies, as up to 43{\%} of cases were diagnosed with at least focal high grade dysplasia. The endoscopic-histological correlation improved when evaluating suspicious endoscopic lesions. Conclusion: Dysplasia is reliably diagnosed by expert gastrointestinal pathologists but has poor correlation with an endoscopic diagnosis of dysplasia.",
keywords = "Crohn's disease, Dysplasia, Inflammatory bowel disease, Ulcerative colitis",
author = "D. Allende and M. Elmessiry and W. Hao and G. Dasilva and Wexner, {S. D.} and P. Bejarano and M. Berho",
year = "2014",
month = "1",
day = "1",
doi = "10.1111/codi.12667",
language = "English",
volume = "16",
pages = "710--718",
journal = "Colorectal Disease",
issn = "1462-8910",
publisher = "Wiley-Blackwell",
number = "9",

}

TY - JOUR

T1 - Inter-observer and intra-observer variability in the diagnosis of dysplasia in patients with inflammatory bowel disease

T2 - Correlation of pathological and endoscopic findings

AU - Allende, D.

AU - Elmessiry, M.

AU - Hao, W.

AU - Dasilva, G.

AU - Wexner, S. D.

AU - Bejarano, P.

AU - Berho, M.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Aim: Colonic epithelial dysplasia is deemed the precursor lesion of cancer arising in inflammatory bowel disease (IBD). It has been suggested that many dysplastic lesions could be endoscopically detected to obtain target biopsies, leading to better yield. However, the clinical impact of a diagnosis of dysplasia may be hampered by a significant degree of histological and endoscopic intra-observer and inter-observer variability. This study aimed to evaluate intra-observer and inter-observer variability in the microscopic diagnosis of dysplasia in IBD and correlate endoscopic and histological findings. Method: In total, 158 cases of ulcerative colitis and 14 of Crohn's disease with dysplasia were selected from a pathology database. Slides were blindly reviewed twice by two expert gastrointestinal pathologists. Results of endoscopic examinations were extracted from the reports. The degree of intra-observer and inter-observer variability was determined by kappa statistics. Results: Overall, there was an excellent degree of histopathological inter-observer agreement (κ = 0.786). The lowest level of agreement in the dysplasia group was for indefinite dysplasia (κ = 0.251). Negative and high grade dysplasia diagnosis reached the highest level of agreement with κ values of 0.822 [95% confidence interval (CI) 0.673-0.971] and 1.00 (95% CI 0.850-1.149), respectively. Intra-observer agreement was good and increased during the latter period of the study (κ = 0.734, 95% CI 0.642-0.826). Endoscopic-histological correlation was poor among the negative endoscopies, as up to 43% of cases were diagnosed with at least focal high grade dysplasia. The endoscopic-histological correlation improved when evaluating suspicious endoscopic lesions. Conclusion: Dysplasia is reliably diagnosed by expert gastrointestinal pathologists but has poor correlation with an endoscopic diagnosis of dysplasia.

AB - Aim: Colonic epithelial dysplasia is deemed the precursor lesion of cancer arising in inflammatory bowel disease (IBD). It has been suggested that many dysplastic lesions could be endoscopically detected to obtain target biopsies, leading to better yield. However, the clinical impact of a diagnosis of dysplasia may be hampered by a significant degree of histological and endoscopic intra-observer and inter-observer variability. This study aimed to evaluate intra-observer and inter-observer variability in the microscopic diagnosis of dysplasia in IBD and correlate endoscopic and histological findings. Method: In total, 158 cases of ulcerative colitis and 14 of Crohn's disease with dysplasia were selected from a pathology database. Slides were blindly reviewed twice by two expert gastrointestinal pathologists. Results of endoscopic examinations were extracted from the reports. The degree of intra-observer and inter-observer variability was determined by kappa statistics. Results: Overall, there was an excellent degree of histopathological inter-observer agreement (κ = 0.786). The lowest level of agreement in the dysplasia group was for indefinite dysplasia (κ = 0.251). Negative and high grade dysplasia diagnosis reached the highest level of agreement with κ values of 0.822 [95% confidence interval (CI) 0.673-0.971] and 1.00 (95% CI 0.850-1.149), respectively. Intra-observer agreement was good and increased during the latter period of the study (κ = 0.734, 95% CI 0.642-0.826). Endoscopic-histological correlation was poor among the negative endoscopies, as up to 43% of cases were diagnosed with at least focal high grade dysplasia. The endoscopic-histological correlation improved when evaluating suspicious endoscopic lesions. Conclusion: Dysplasia is reliably diagnosed by expert gastrointestinal pathologists but has poor correlation with an endoscopic diagnosis of dysplasia.

KW - Crohn's disease

KW - Dysplasia

KW - Inflammatory bowel disease

KW - Ulcerative colitis

UR - http://www.scopus.com/inward/record.url?scp=84905825832&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84905825832&partnerID=8YFLogxK

U2 - 10.1111/codi.12667

DO - 10.1111/codi.12667

M3 - Article

VL - 16

SP - 710

EP - 718

JO - Colorectal Disease

JF - Colorectal Disease

SN - 1462-8910

IS - 9

ER -