Korean Journal of Gastrointestinal Endoscopy 2005;31(1): 39-43.
조기 대장암의 육안적 심달도 진단에 있어 관찰자간 일치도
지정선·최 황·최규용·이보인·김경미*·김병욱·조세현·손성현·채현석·정인식
가톨릭대학교 의과대학 내과학교실, *병리과
Interobserver Agreement among Experts in Determining the Depth of Invasion of Early Colorectal Carcinoma
Jeong Seon Ji, M.D., Hwang Choi, M.D., Kyu Yong Choi, M.D., Bo In Lee, M.D., Kyoung Mee Kim, M.D.*, Byung Wook Kim, M.D., Se Hyun Cho, M.D., Seong Hyun Son, M.D., Hiun Suk Chae, M.D. and In Sik Chung, M.D.
Departments of Internal Medicine and *Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
Abstract
Background/Aims: Discrimination between mucosal and submucosal colorectal cancer is important because of different therapeutic plan. Although many characteristic endoscopic findings suggesting submucosal cancer were demonstrated, there are few reports about diagnostic accuracy and interobserver agreement among experienced endoscopists. So we studied about diagnostic accuracy and interobserver agreement about the diagnosis of submucosal invasive colorectal carcinoma by endoscopic findings. Methods: Fifty patients (58% male, mean age 64 years) diagnosed pathologically as early colorectal carcinoma after polypectomy and operation were randomly selected. Fifteen cases were submucosal invasive colorectal carcinoma. Three experienced endoscopists (A, B and C) blinded to the patient's data reviewed photographs. Results: Diagnostic accuracy of submucosal cancer by A, B and C were 82%, 74% and 78%, respectively. A to B and A to C showed moderate agreement in the diagnosis of submucosal invasion (kappa=0.504 and kappa=0.649). However, agreement power between B and C was somewhat weak (kappa=0.298). Among endoscopic findings, three experts strongly agreed on the features of white spots, hemorrhage and exudate (kappa=0;73, kappa=0.649 and kappa=0.641, respectively). Conclusions: Interobserver agreement in the diagnosis of submucosal colorectal carcinoma was moderate among three experts. More meticulous effort to improve interobserver agreement and accuracy in the diag-nosis of submucosal invasive colorectal carcinoma is mandatory. (Korean J Gastrointest Endosc 2005;31:3943)
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