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• W2121577736 abstract "Purpose: When polyps are detected during colonoscopy, instaneous decision making regarding the treatment of choice is mandatory to avoid treatment delay and the need of reexamination. Endoscopic diagnosis of the depth of invasion is important to determine the treatment modality of choice. There are reports that several endoscopic stigmata are associated with substantial submucosal invasion, however, the objectivity of these findings have not been scientifically evaluated so far. The aim of this study is to clarify whether the described stigmata are amenable for objective evaluation by endoscopists. Patients and Methods: Fifty consecutive colorectal polyps equal to or larger than 10mm; found during endoscopy at our hospital; were analyzed. All pictures taken during endoscopy were collected. Three experienced board certified endoscopists (EBCE) and three less experienced physician (LEP) assessed six stigmata: bleeding, white coat, expansive appearance, fold convergence, deep depression and irregular surface. Corelation of these six endoscopic stigmata to deep submucosal invasion was performed. Kappa analysis was performed to evaluate the interobserver viability EBCE and LEP. Kappa values of >0.4 indicated objectivity. Results: Kappa values of EBCE were higher than those of LEP in all six findings. In the LEP group, a kappa value of 0.4 was not reached in all 6 stigmata, suggesting poor agreement. On the other hand, the kappa values of five out of six stigmata (with the exception of irregularity) were over 0.4 in EBCE group. (Kappa values for EBCE/LEP: bleeding; 0.6172/0.3257, white coat; 0.7021/0.1334, expansive appearance; 0.5388/-0.0002, fold convergency; 0.4195/.0.01, deep depression; 0.4601/0.35, and irregular surface; 0.3379/-0.0504). Although irregularity was found to be the least objective parameter for endoscopic assessment, its accuracy and positive predictive value for deep submucosal invasion was the highest of the 6 stigmata when considered separately. Of the remaining 5 stigmata that could be assessed objectively; accuracy, positive and negative predictive values of 94%, 80% and 96% respectively were found when at least 3 of the 5 features were present. Conclusion: Assessment of these endoscopic stigmata by expert endoscopists was highly consistent and can be used as objective predictors of deep invasion. The objective endoscopic stigmata found in this study were highly predictive of deeper invasion. Experience and education are important in reducing interobserver variability. To further improve the objectivity of endoscopic diagnosis, consensus meeting with special regards to perception of irregularity is needed." @default.
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• W2121577736 date "2009-04-01" @default.
• W2121577736 modified "2023-09-24" @default.
• W2121577736 title "Interobserver Variance of Endoscopic Findings and Objective Diagnosis of Submucosal Invasion of Colorectal Cancer" @default.
• W2121577736 doi "https://doi.org/10.1016/j.gie.2009.03.534" @default.
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