Interobserver variation in assessment of gastric premalignant lesions

Leja, Mārcis; Funka, Konrāds; Jančiauskas, Dainius; Putnins, Viesturs; Ruskule, Agnese; Ķikuste, Ilze; Kojalo, Una; Tolmanis, Ivars; Misiņš, Jānis; Purmalis, Karlis; Пиманов, С. И.; Makarenko, Jelena; Kupčinskas, Limas; Vikmanis, Uldis

doi:10.1097/meg.0b013e32835e3397

Cited by 30 publications

(13 citation statements)

References 34 publications

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“…Several researchers have reported interobserver and intraobserver agreement in the histopathologic assessment of H. pylori -associated chronic gastritis [ 6 – 8 ]. Although interobserver agreement among pathologists for intestinal metaplasia is good to excellent, that for glandular atrophy is mild to moderate according to these studies.…”

Section: Discussionmentioning

confidence: 99%

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Interobserver and intraobserver agreement for gastric mucosa atrophy

et al. 2015

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BackgroundThe grade of gastric mucosa atrophy caused by Helicobacter pylori (H. pylori) infection is closely associated with the risk of gastric cancer, especially of the intestinal type. Interobserver and intraobserver agreement for endoscopic gastric mucosa atrophy in subjects with H. pylori-uninfected, currently infected and past infected was investigated.MethodsEndoscopic images of 91 patients, 34 images per patient, were assessed. The assessors were 4 endoscopist groups: Japanese and Vietnamese experienced (≥7, ≤ 15 year experience with endoscopy) and Japanese and Vietnamese beginner (≤ 3 year experience) groups. Each group comprised 3 endoscopists. The grades of atrophy were classified as 3: none to mild (C-0 and C-1), moderate (C-2 and C-3), and severe (O-1, O-2, and O-3) using the Kimura-Takemoto Classification. After a period of 2 weeks, images of all patients were reevaluated by the investigators. Interobserver and intraobserver agreement was calculated by kappa statistics.ResultsThe kappa values for the interobserver agreement in the groups of Japanese and Vietnamese experienced, and Japanese and Vietnamese beginner were 0.474, 0.408, 0.291, and 0.373, respectively. The kappa value of intraobsever agreement in the Japanese and Vietnamese experienced endoscoists ranged from 0.585 to 0.871. On the other hand, the value in the beginner endoscopists ranged wider than that in experienced endoscopists, from 0.264 to 0.866.ConclusionsOur results indicated that, although intraobserver agreement for gastric mucosa atrophy was good to excellent, interobserver agreement was moderate in experienced endoscopists. This suggests that better guidelines and firm criteria may be needed to properly diagnose and grade gastric atrophy.

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Section: Discussionmentioning

confidence: 99%

“…Several researchers have reported interobserver and intraobserver agreement in the histopathologic assessment of H. pylori -associated chronic gastritis [ 6 – 8 ]. However, there have been no studies on interobserver and intraobserver agreement in the endoscopic assessment of gastric mucosa atrophy.…”

Section: Introductionmentioning

confidence: 99%

Interobserver and intraobserver agreement for gastric mucosa atrophy

et al. 2015

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“…38 39 While higher stages of CAG and GIM by these methods (stages III and IV) are predictive of increased GC risk, current histopathologic staging methods to risk stratify these patients are all fraught with significant limitations and poor interobserver and intraobserver reproducibility. 40 This may explain widely varying estimates of risk between studies.…”

Section: Assessing Cancer Risk Of Premalignant Lesionsmentioning

confidence: 99%

Recent advances in the detection and management of early gastric cancer and its precursors

Waddingham

Nieuwenburg

Carlson

et al. 2020

Frontline Gastroenterol

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Despite declines in incidence, gastric cancer remains a disease with a poor prognosis and limited treatment options due to its often late stage of diagnosis. In contrast, early gastric cancer has a good to excellent prognosis, with 5-year survival rates as high as 92.6% after endoscopic resection. There remains an East-West divide for this disease, with high incidence countries such as Japan seeing earlier diagnoses and reduced mortality, in part thanks to the success of a national screening programme. With missed cancers still prevalent at upper endoscopy in the West, and variable approaches to assessment of the high-risk stomach, the quality of endoscopy we provide must be a focus for improvement, with particular attention paid to the minority of patients at increased cancer risk. High-definition endoscopy with virtual chromoendoscopy is superior to white light endoscopy alone. These enhanced imaging modalities allow the experienced endoscopist to accurately and robustly detect high-risk lesions in the stomach. An endoscopy-led staging strategy would mean biopsies could be targeted to histologically confirm the endoscopic impression of premalignant lesions including atrophic gastritis, gastric intestinal metaplasia, dysplasia and early cancer. This approach to quality improvement will reduce missed diagnoses and, combined with the latest endoscopic resection techniques performed at expert centres, will improve early detection and ultimately patient outcomes. In this review, we outline the latest evidence relating to diagnosis, staging and treatment of early gastric cancer and its precursor lesions.

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“…At present, European Society of Gastrointestinal Endoscopy management of precancerous conditions and lesions in the stomach (ESGE MAPS) guidelines 56 recommend 3-yearly surveillance for those with extensive CAG or GIM, with random biopsies taken as per the geographic locations of the updated Sydney protocol, and histological samples staged using the OLGA/OLGIM systems ( Figure 3A and B ). This approach has inherent limitations; in clinical practice, these systems can be difficult to apply, the OLGA system is limited by considerable inter- and intra-observer variability, and, while the OLGIM system reduces this with increased inter-observer agreement 55 , it may nonetheless lead to over- or under-diagnosis due to random biopsy sampling error 54 , 57 , 58 . In short, while higher stages of CAG and GIM are predictive of increased gastric cancer risk, current histopathologic staging methods to risk stratify CAG patients are all fraught with significant drawbacks, which likely explains widely varying estimates between studies.…”

Section: Risk Factors For the Development Of Chronic Atrophic Gastritmentioning

confidence: 99%

The evolving role of endoscopy in the diagnosis of premalignant gastric lesions

et al. 2018

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Gastric adenocarcinoma is a disease that is often detected late, at a stage when curative treatment is unachievable. This must be addressed through changes in our approach to the identification of patients at increased risk by improving the detection and risk assessment of premalignant changes in the stomach, including chronic atrophic gastritis and intestinal metaplasia. Current guidelines recommend utilising random biopsies in a pathology-led approach in order to stage the extent and severity of gastritis and intestinal metaplasia. This random method is poorly reproducible and prone to sampling error and fails to acknowledge recent advances in our understanding of the progression to gastric cancer as a non-linear, branching evolutionary model. Data suggest that recent advances in endoscopic imaging modalities, such as narrow band imaging, can achieve a high degree of accuracy in the stomach for the diagnosis of these premalignant changes. In this review, we outline recent data to support a paradigm shift towards an endoscopy-led approach to diagnosis and staging of premalignant changes in the stomach. High-quality endoscopic interrogation of the chronically inflamed stomach mucosa, supported by targeted biopsies, will lead to more accurate risk assessment, with reduced rates of under or missed diagnoses.

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Interobserver variation in assessment of gastric premalignant lesions

Cited by 30 publications

References 34 publications

Interobserver and intraobserver agreement for gastric mucosa atrophy

Interobserver and intraobserver agreement for gastric mucosa atrophy

Recent advances in the detection and management of early gastric cancer and its precursors

The evolving role of endoscopy in the diagnosis of premalignant gastric lesions

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