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Variation in Pathologist Classification of Colorectal Adenomas and Serrated Polyps

Gourevitch, Rebecca A MS1; Rose, Sherri PhD1; Crockett, Seth D MD, MPH2; Morris, Michele BA3; Carrell, David S PhD4; Greer, Julia B MD, MPH5; Pai, Reetesh K MD6; Schoen, Robert E MD, MPH5; Mehrotra, Ateev MD, MPH1,7

American Journal of Gastroenterology: March 2018 - Volume 113 - Issue 3 - p 431–439
doi: 10.1038/ajg.2017.496

OBJECTIVES: Endoscopist quality measures such as adenoma detection rate (ADR) and serrated polyp detection rates (SPDRs) depend on pathologist classification of histology. Although variation in pathologic interpretation is recognized, we add to the literature by quantifying the impact of pathologic variability on endoscopist performance.

METHODS: We used natural language processing to abstract relevant data from colonoscopy and related pathology reports performed over 2 years at four clinical sites. We quantified each pathologist's likelihood of classifying polyp specimens as adenomas or serrated polyps. We estimated the impact on endoscopists' ADR and SPDR of sending their specimens to pathologists with higher or lower classification rates.

RESULTS: We observed 85,526 colonoscopies performed by 119 endoscopists; 50,453 had a polyp specimen, which were analyzed by 48 pathologists. There was greater variation across pathologists in classification of serrated polyps than in classification of adenomas. We estimate the endoscopist's average SPDR would be 0.5% if all their specimens were analyzed by the pathologist in our sample with the lowest classification rate and 12.0% if all their specimens were analyzed by the pathologist with the highest classification rate. In contrast, the endoscopist's average ADR would be 28.5% and 42.4% if their specimens were analyzed by the pathologist with lowest and highest classification rate, respectively.

CONCLUSIONS: There is significant variation in pathologic interpretation, which more substantially affects endoscopist SPDR than ADR.

1Harvard Medical School, Boston Massachusetts, USA

2Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA

3Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA

4Kaiser Permanente of Washington Health Research Institute (formerly Group Health Research Institute), Seattle, Washington, USA

5Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA

6Department of Pathology, UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania, USA

7Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Correspondence: A. Mehrotra, MD, MPH, Harvard Medical School, Department of Health Care Policy, 180 Longwood Ave, Boston, Massachusetts 02115, USA. E-mail:

published online 30 January 2018

SUPPLEMENTARY MATERIAL accompanies this paper at

Received 10 July 2017; accepted 15 October 2017

© The American College of Gastroenterology 2018. All Rights Reserved.
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