Inter-Observer Agreement in the Endoscopic Classification
of Colorectal Laterally Spreading Tumors: A Multicenter Study
Between Experts and Trainees
- Affiliated Author(s)
- 이유진; 김은수; 박경식; 조광범; 이미영
- Alternative Author(s)
- Lee, Yoo Jin; Kim, Eun Soo; Park, Kyung Sik; Cho, Kwang Bum; Lee, Mi Young
- Journal Title
- Digestive Diseases and Sciences
- Issued Date
- Background and Aim The risk of cancer varies with the
subtype of colorectal ‘‘laterally spreading tumors’’ (LSTs).
However, visual interpretations vary among endoscopists.
The aim of this study was to evaluate inter-observer
agreement and accuracy in the endoscopic classification of
LST subtypes among experts and trainees.
Methods In total, 40 LST images were collected and
reviewed independently by 14 gastroenterology experts
and 10 trainees. All investigators recorded their findings as
one of the following four categories: homogeneous, nodular
mixed, flat-elevated, and pseudo-depressed. Agreement
was assessed in terms of the kappa (j) statistic and
AC1 estimate. Accuracy is reported as percentage
agreement with the gold standard, based on the gross
morphology of the resected specimens.
Results Of the possible 91 pair-wise j estimates among
experts, 41 (45.1 %) were [0.75, indicating excellent
agreement, while only 2 (4.44 %) of the 45 pair-wise
j estimates among trainees were [0.75. Agreements for
individual LST subtypes in the trainee group were significantly
lower than those in the expert group. The j and
AC1 estimates showed similar values in individual subtypes
of LSTs. The overall accuracy of LST was also
significantly higher for the experts than the trainees (85.9
vs. 72.5 %, P\0.001). Notably, the flat-elevated subtype
showed the lowest agreement and accuracy and was frequently
misclassified as the pseudo-depressed subtype by
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