Interobserver Agreement in the Diagnosis of Inflammatory Bowel Disease-Associated Neoplasia in China in Comparison to Subspecialized American Gastrointestinal Pathologists

Abstract

Background The aim of this study was to evaluate the interobserver variability in diagnosing inflammatory bowel disease (IBD)-associated neoplasia among practicing pathologists from China using telepathology, a practice of remote diagnostic consultation increasingly used nationally and internationally, and its comparison with the interpretation of subspecialized gastrointestinal (GI) pathologists from the United States (US). Methods Eight GI pathologists from the US and 4 pathologists from China with an interest in GI pathology participated in this study. A total of 50 colonic biopsies from patients with a clinical history of IBD from 8 medical centers in China were included. All microscopic slides in each case were digitized using an Aperio system. One pathologist (XL) reviewed the digitized full-slide images, and selected areas of interest were captured at low, medium, and high magnifications at a resolution of 1712 × 1072 pixels and saved as tagged image file format (TIFF) files on read-only DVD. Each pathologist evaluated the images and selected the most appropriate diagnostic category for each case (negative, indefinite, low-grade dysplasia [LGD], high-grade dysplasia [HGD], and carcinoma). A Fleiss' kappa coefficient (K) analysis was performed to determine interobserver agreement and the agreement of each pathologist from China with the consensus diagnosis (defined as diagnostic agreement by at least 4 participating US GI pathologists). Results There was substantial interobserver agreement among 4 pathologists from China on the interpretation of IBD-associated neoplasia (kappa value 0.68, 95% confidence interval: 0.56–0.78). A consensus diagnosis included negative (n = 22), LGD (n = 22), HGD (n = 3), carcinoma (n = 2), and indefinite for dysplasia (n = 1). Using consensus diagnoses as references, the agreement between each pathologist from China and the consensus diagnosis was substantial with kappa values ranging from 0.75 to 0.80. Conclusions This study reveals substantial interobserver agreement for the interpretation of colonic neoplasia in IBD using digitized images among Chinese pathologists as well as between each Chinese pathologist and a consensus diagnosis generated by US GI pathologists.

Telepathological evaluation of paediatric histological specimens in support of a hospital in Tanzania

“…In this way a clinically useful diagnosis could be given in 84%, despite limited resources 4 . This result is not consistent with the requirements stipulated for regular histopathological services, but is provisionally acceptable in the given local setting and comparable with results found in the literature [5][6][7] . The aim of the study presented here was to analyse diagnostic findings generated from specimens of children and adolescents up to 18 years, extracted from the total of 5230 cases (mostly adults) which were diagnosed via TP over a period of ten years in the ongoing project.…”

Diagnostic validity of static telepathology supporting hospitals without local pathologists in low-income countries

“…Deviations between the diagnostic results given by general pathologists when compared with specialised experts must be evaluated differently than when similarly qualified pathologists exchange opinions on an equal footing. The data of an investigation by Wu et al 15 on the diagnosis of neoplasia in inflammatory bowel disease for instance show diverging kappa values of between 0.68 and 0.75-0.80 16 depending on the assignment of the primary and secondary investigator. In a comparison study to identify specific diagnostic criteria for breast cancer on scanned virtual slides compared with conventional slides, kappa values from 0.37-0.78 (between histopathologists in the UK and Australia) were found for the identification of lymphangioinvasion, necrosis or the presence of a central scar.…”

“…In some projects with experienced pathologists, a better concordance between the diagnoses could be found, in others however the concordance was worse. 14,15 The reasons for this are varied so hardly any comparable investigations could be identified. In the absence of generally acknowledged stipulations, there are for instance no specifications concerning the degree of complexity of the included cases.…”

Diagnostic interobserver variability in Crohn’s disease- and ulcerative colitis-associated dysplasia: a multicenter digital survey from the IG-IBD Pathologists Group

“…Pathologists were recruited both from the United States and from China. In that instance, the agreement resulted to be good, ranging kappa values from 0.75 to 0.80 [33]. TP has been also used in assessing diagnostic concordance in other gastrointestinal disease [34].…”