Reproducibility of the villous component and high-grade dysplasia in colorectal adenomas <1 cm: Implications for endoscopic surveillance

Dipti Mahajan, Erinn Downs-Kelly, Xiuli Liu, Rish K. Pai, Deepa T. Patil, Lisa Rybicki, Ana E. Bennett, Thomas Plesec, Oscar Cummings, Douglas Rex, John R. Goldblum

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

The presence of high-grade dysplasia (HGD) or villous component (VC) defines an advanced adenoma (AA) in patients with 1 or 2 adenomas <1 cm in size. Current consensus guidelines recommend that patients with AA undergo more intense postpolypectomy surveillance. In these clinical situations, the interobserver reliability in determining VC and HGD would play a major role in the credibility of these consensus guidelines. Therefore, the purpose of this study was to evaluate interobserver variability of VC and HGD in polyps <1 cm before and after the development of consensus criteria among gastrointestinal (GI) pathologists. Five GI pathologists independently evaluated 107 colorectal adenomas <1 cm, and classified them into tubular adenomas or adenomas with a VC (A-VC) and into low-grade dysplasia or HGD. Then a consensus conference was held and consensus criteria for VC and HGD were developed by group review. The same set of 107 slides were rereviewed independently by the same 5 GI pathologists. Interobserver variability using κ statistical analysis before and after the application of consensus criteria was assessed. A 1-sided z-test was used to determine whether κ scores increased after the consensus conference. Interobserver agreement before and after the consensus conference was poor for assessment of A-VC, HGD, and AA. These data calls into question the validity of basing clinical decisions on this distinction.

Original languageEnglish (US)
Pages (from-to)427-433
Number of pages7
JournalAmerican Journal of Surgical Pathology
Volume37
Issue number3
DOIs
StatePublished - Mar 1 2013

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Keywords

  • adenoma
  • advanced adenoma
  • High-grade dysplasia
  • villous component

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine
  • Surgery

Cite this

Mahajan, D., Downs-Kelly, E., Liu, X., Pai, R. K., Patil, D. T., Rybicki, L., Bennett, A. E., Plesec, T., Cummings, O., Rex, D., & Goldblum, J. R. (2013). Reproducibility of the villous component and high-grade dysplasia in colorectal adenomas <1 cm: Implications for endoscopic surveillance. American Journal of Surgical Pathology, 37(3), 427-433. https://doi.org/10.1097/PAS.0b013e31826cf50f