International Journal of Epidemiology, Vol 26, 716-720, Copyright © 1997 by International Epidemiological Association
M Plummer, E Buiatti, G Lopez, S Peraza, J Vivas, W Oliver and N Munoz
BACKGROUND: Within the framework of a chemoprevention trial on stomach
cancer, two substudies based on repeat measurement were undertaken to
evaluate reliability of histological diagnoses of gastric precancerous
lesions. METHODS: A subgroup of 45 subjects received two endoscopies
separated by a period of one month. The two biopsies were reviewed by a
single pathologist. A second subsample of 50 subjects had a single
endoscopy and the biopsy results were reviewed by two pathologists.
Agreement between the two diagnoses was assessed by Cohen's Kappa and by
repeat frequency. RESULTS: When the same samples were reviewed by the
pathologists involved in the trial, agreement was very high for advanced
lesions (repeat frequency = 0.96 for intestinal metaplasia and 1.00 for
dysplasia) but lower for less advanced lesions (repeat frequency = 0.73 for
superficial gastritis and chronic gastritis, 0.65 for atrophic gastritis).
When the same pathologist reviewed two sets of biopsies taken less than 2
months apart, the combination of random observer error and biopsy sampling
error gave rise to quite low agreement, especially for early lesions,
mainly attributable to biopsy sampling error. Comparison of diagnoses made
at routine reading and at review by the same pathologist and by different
pathologists showed substantial overall agreement with the exception of one
pathologist for whom agreement was moderate. CONCLUSIONS: These results
confirm that misclassification of histological diagnosis may be a relevant
problem in chemoprevention trials of stomach cancer, more so when baseline
diagnosis is taken into account in the analysis to estimate progression and
regression rates of precancerous lesions. Further, the results suggest that
misclassification is limited to early lesions, while diagnostic reliability
of severe lesions is quite high.
ARTICLES
Histological diagnosis of precancerous lesions of the stomach: a reliability study
International Agency for Research on Cancer, Lyon, France.
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