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

Wu, Xian; Liu, Hua Shan; Shi, Xiaoming; Zhou, Wei; Jiang, Zhi Nong; Huang, Yan; Karamchandani, Dipti M.; Goldblum, John R.; Xiao, Shu Yuan; Zhu, Hong Fa; Feely, Michael; Collinsworth, Amy; Esnakula, Ashwini; Xie, Hao; Shen, Bo; Lan, Ping; Liu, Xiu Li

doi:10.1155/2018/8715263

Cited by 7 publications

(7 citation statements)

References 21 publications

(40 reference statements)

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“…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.…”

Section: Introductionsupporting

confidence: 62%

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

Voelker¹,

Poetzl²,

Strehl³

et al. 2020

Afr H. Sci.

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Background/Objective: In a project of telepathology (TP) between German pathologists and a hospital in Tanzania, trained technical assistants have uploaded digital histological images onto the internet-based platform ipath. The diagnoses from 486 paediatric specimens were analysed. Methods: The investigation included diagnoses, either primarily done via TP or secondarily after a further workup of the paraffin-embedded tissue, which was sent to Germany for cases which could not be solved via TP. In the latter, the initial TP-diagnoses were compared with the results after re-evaluation. Results: The median age was 11 years. The cohort comprised 390 benign diseases (80.2%) and 96 malignant diseases (19.8%). For benign diseases, the most frequent anatomic sites were lymph nodes, skin, and soft tissue, breast, and head&- neck. Frequent diagnoses were non-specific inflammations and benign tumors. In malignant diseases, the most sites were lymph nodes, skin, soft tissue, head&neck, and ovary and the most frequent diseases sarcomas and lymphomas. The paraffin embedded tissue of 179 cases (36.3%) was shipped to Germany. With the concordance analysis, we could discover the man- datory necessity for the possibility of second opinion in difficult cases. Conclusion: An exclusively TP-support cannot meet all requirements of modern medical diagnostics. The education of local pathologists is imperative. Keywords: Telepathology; low income country; ipath; paediatric.

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Section: Introductionsupporting

confidence: 62%

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

Voelker¹,

Poetzl²,

Strehl³

et al. 2020

Afr H. Sci.

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Voelker

Stauch²,

Strehl

et al. 2018

J Telemed Telecare

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Introduction Static telepathology (TP) was used to support a hospital in Tanzania that cannot employ a resident pathologist but has a basic laboratory. Histological slides were prepared by the local technical staff and digital images were uploaded into an Internet-based system; consultant pathologists in Germany could give their opinion. The aim of the study was to examine the diagnostic validity of this project without local pathologists. Methods The set-up period for special training of local technical assistants was 10 weeks. Diagnoses of the first 545 cases that were processed via TP were compared with the results of a second opinion on the basis of routine slides created from the corresponding paraffin blocks, which were sent to Germany. Results Of all cases, 384 (70%) TP diagnoses were completely confirmed by the second opinion. Minor deviations (e.g. divergent subtypes of tumours or other aetiology of non-specific reactive processes) were documented in 76 cases (14%), so that overall, 84% of diagnoses were useful in the setting of the available therapeutic possibilities. The results were better in some subgroups of diseases (90–100% useful diagnoses) and suboptimal (minimum 63%) in a few subgroups with rare diseases. Thirty (5%) malignant diseases were primarily misinterpreted as being benign and 12 (2%) benign diseases as malignant. Forty-three (8%) cases were insufficient for diagnosis using TP and could not be provided with a primary assessment. Discussion Static TP can help support medical services in low-income countries in the absence of local pathologists with a potentially high diagnostic validity, especially for selected groups of diseases. The procedure can significantly improve the diagnostic procedures before commencement of therapy – a substantial contribution within a globalised world.

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“…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].…”

Section: Discussionmentioning

confidence: 97%

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

et al. 2020

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Background Crohn's disease (CD) and ulcerative colitis, two forms of inflammatory bowel disease (IBD), are chronic and relapsing conditions of the gastrointestinal tract both characterized by long lasting chronic inflammation and increased risk of dysplasia and colorectal cancer (CRC). The aim of our study was to evaluate the interobserver agreement about IBDassociated dysplasia among pathologists belonging to the Italian Group for Inflammatory Bowel Diseases (IG-IBD P). Methods The present multicenter survey was performed using telepathology, supported by an open source E-learning platform. Biopsy specimens from 30 colonoscopies and from 20 patients were included. The glass slides of any case, including clinical and endoscopic data, were digitalized and uploaded on the E-learning platform. All the digital slides were grouped in 54 diagnostic "blocks". Blinded histopathological evaluation on all the digital slides was performed by 20 gastrointestinal pathologists. Closed-ended questions about (1) the occurrence of IBD; (2) the classification of IBD (as UC or CD); (3) the presence of active versus quiescent disease; (4) the presence of dysplasia; (5) the possible association of dysplasia with the sites of disease (dysplasia-associated lesion or mass-DALM vs adenoma-like mass-ALM); (6) the grading of dysplasia according to the ECCO guidelines (negative, indefinite, low grade, high grade categories) and (7) the presence of associated serrated features, were proposed in each case. Inter-observer agreement was evaluated by mean agreement percentage and kappa statistic, when suitable. Results The diagnosis of IBD was confirmed in 19 of 20 patients, 17 of 19 being classified as UC, 2 as CD. The mean interobserver agreement percentages about (1) the evidence of IBD, (2) the presence of either UC or CD and (3) the activity grading resulted to be 80%, 69% and 86%, respectively. Dysplasia was detected in 8/20 patients, with moderate agreement between pathologists (mean 72%, k 0.48). Particularly, low grade dysplasia was found in 13 biopsies (combined k 0.38), whereas high grade dysplasia in 8 (combined k 0.47). When the endoscopic and histopathological data were combined, features consistent with DALM were found in 6 of 20 patients with low grade dysplasia and those consistent with ALM in 2 patients with low grade dysplasia in a single biopsy (mean agreement: 86%). An associated serrated pattern was discovered in 4 patients (7 biopsies). Conclusions Our study showed moderate interobserver agreement about the histopathological detection and classification of IBD-associated dysplasia. Further efforts should be undertaken to integrate the histopathological data with both the ancillary tests and molecular investigations.

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

Cited by 7 publications

References 21 publications

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

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

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

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

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