Reproducibility of the Villous Component and High-grade Dysplasia in Colorectal Adenomas <1 cm: Implications for Endoscopic Surveillance
Reproducibility of the Villous Component and High-grade Dysplasia in Colorectal Adenomas <1 cm: Implications for Endoscopic Surveillance
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<1 cm 结直肠腺瘤绒毛成分和高度不典型增生的重现性：对内镜监测的意义
DOI：
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发表时间：
2013
影响因子：
5.6
通讯作者：
J. Goldblum
中科院分区：
文献类型：
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作者：
Dipti Mahajan;E. Downs‐Kelly;Xiuli Liu;R. Pai;Deepa T. Patil;L. Rybicki;A. Bennett;T. Plesec;O. Cummings;D. Rex;J. Goldblum
高度异型增生（HGD）或绒毛成分（VC）的存在定义了1或2个腺瘤<1 cm的患者中的晚期腺瘤（AA）。目前的共识指南建议AA患者接受更严格的息肉切除术后监测。在这些临床情况下，确定VC和HGD的观察者间可靠性将在这些共识指南的可信度中发挥重要作用。因此，本研究的目的是评估在胃肠道（GI）病理学家制定共识标准之前和之后，<1 cm息肉中VC和HGD的观察者间变异性。五位胃肠道病理学家独立评估了107例<1 cm的结直肠腺瘤，并将其分为管状腺瘤或伴有VC的腺瘤（A-VC）和低度异型增生或HGD。然后召开共识会议，通过小组评审制定了VC和HGD的共识标准。由相同的5名GI病理学家对同一组107张切片进行独立复查。在应用共识标准之前和之后，使用统计分析评估观察者间的变异性。使用单侧z检验确定共识会议后评分是否增加。共识会议前后观察者对A-VC、HGD和AA的评估一致性较差。这些数据使人们对基于这种区别的临床决策的有效性提出了质疑。
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 &kgr; statistical analysis before and after the application of consensus criteria was assessed. A 1-sided z-test was used to determine whether &kgr; 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.
影响因子：
29.4
作者：
Martínez ME;Baron JA;Lieberman DA;Schatzkin A;Lanza E;Winawer SJ;Zauber AG;Jiang R;Ahnen DJ;Bond JH;Church TR;Robertson DJ;Smith-Warner SA;Jacobs ET;Alberts DS;Greenberg ER
通讯作者：
Greenberg ER