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.

The results suggest that conventional medical follow-up is interchangeable with nurse-led follow-up. A cost utility study is necessary to determine the preferred frequency and duration of the home visits.

The nurse endoscopists performed colonoscopies according to the internationally recognized quality standards and with high patient satisfaction.

No abstract

SUMMARY BackgroundNurse endoscopists may provide a solution for the insufficient endoscopic capacity in colorectal cancer (CRC) screening.