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Reproducibility of the Villous Component and High-grade Dysplasia in Colorectal Adenomas <1 cm: Implications for Endoscopic Surveillance

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

The American Journal of Surgical Pathology: March 2013 - Volume 37 - Issue 3 - p 427–433
doi: 10.1097/PAS.0b013e31826cf50f
Original Articles

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.

Departments of *Anatomic Pathology

Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH

Departments of Anatomic Pathology

§Gastroenterology, Indiana University Hospital, Indianapolis, IN

Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

Correspondence: John R. Goldblum, MD, Cleveland Clinic, 9500 Euclid Avenue L25, Cleveland, OH 44195 (e-mail:

© 2013 Lippincott Williams & Wilkins, Inc.