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The Paris classification of colonic lesions Training to improve the interobserver agreement among international experts Sascha van Doorn, MD, PhD-student in CRC-reserach group of Evelien Dekker Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

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Page 1: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

The Paris classification of colonic lesions

Training to improve the interobserver agreement among international experts

Sascha van Doorn, MD, PhD-student in CRC-reserach group of Evelien

Dekker

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 2: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Introduction

• Japanese classification morphology of superficial lesions of the gastrointestinal tract

• 2002 international Endoscopic Classification Review Group: the Paris Classification of Neoplastic Lesions in the digestive tract

• Adequate description of polyp morphology and size of importance – Helps to determine appropriate method of treatment – Has a predictive value for submucosal invasion – Facilitates comparative research in colonoscopy practice

• However, thus far the validity and reproducibility of the classification has

not been assessed

….until now!

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 3: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Aim & Methods

• To evaluate the interobserver agreement of the Paris classification and size of colorectal neoplasms among 7 western expert endoscopists

• 7 expert endoscopists assessed the Paris classification of 85 colonic polyps in short video clips (10-25 seconds)

• A Fleiss kappa using an absolute agreement definition was used to measure interobserver agreement with an interpretation of kappa values according to Landis and Koch1

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

1. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-74.

Page 4: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Results

• The interobserver agreement of the Paris classification of 85 polyps among 7 experts was ‘moderate’ with a kappa of 0.42 (95% CI 0.39-0.45)

• When analysing the data on polyp morphology assessments into just two

categories, polypoid (Paris Ip, Isp, Is) vs. non-polypoid (Paris IIa, IIb, IIc, III) the Fleiss kappa remained ‘moderate’ with a kappa of 0.45 (95% CI of 0.40-0.49)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 5: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Conclusion

• Interobserver agreement of the Paris classification for polyp morphology was only moderate

• No improvement when polyp classification was dichotomized to polypoid

vs. non-polypoid categories • Before the Paris classification of colonic neoplasms can be adequately used

in western endoscopy units, it seems necessary to train endoscopists to achieve uniformity in classifying morphology of colonic lesions.

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 6: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Training

Training schedule • Step 1: basics • Step 2: examples • Step 3: training • Step 4: ‘feedback’ • Step 5: re-assessment of the same 85 polyps to evaluate

agreement again

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 7: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

• The Paris classification is based on the Japanese classification of superficial neoplastic lesions in the gastrointestinal tract

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Lambert R et al. Endoscopic Classification Review Group. Update on the Paris Classification of Superficial Neoplastic Lesion in the Digestive Tract. Endoscopy 2005

Page 8: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

• We will focus only on the main type of morphology (so no combined types)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Lambert R et al. Endoscopic Classification Review Group. Update on the Paris Classification of Superficial Neoplastic Lesion in the Digestive Tract. Endoscopy 2005

Page 9: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

• Protruding types (0-I) protrude above the surrounding surface at endoscopy:

– 0-Ip pedunculated

– 0-Isp subpedunculated

– 0-Is sessile

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Lambert R et al. Endoscopic Classification Review Group. Update on the Paris Classification of Superficial Neoplastic Lesion in the Digestive Tract. Endoscopy 2005

Page 10: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

Pedunculated (0-Ip): – Base is more narrow than top of lesion

– M= mucosa, mm= muscularis mucosae, sm= submucosa

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 11: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

Subpedunculated (0-Isp): – Intermediate and broad-based – Same management as (0-Is) sessile polyps

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Lambert R et al. Endoscopic Classification Review Group. Update on the Paris Classification of Superficial Neoplastic Lesion in the Digestive Tract. Endoscopy 2005

Page 12: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

Sessile (0-Is): – Base and top of lesion have same diameter

– The protrusion of the lesion is compared with the height of the closed cups of a biopsy forceps (2.5mm), dotted arrow passes under top of lesion

– M= mucosa, mm= muscularis mucosae, sm= submucosa

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 13: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

• Non-protruding non-excaved types (0-II):

– Slightly elevated (0-IIa)

– Completely flat (0-IIb)

– Slightly depressed (0-IIc)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Lambert R et al. Endoscopic Classification Review Group. Update on the Paris Classification of Superficial Neoplastic Lesion in the Digestive Tract. Endoscopy 2005

Page 14: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

Slightly elevated (0-IIa) – Slightly higher than adjacent mucosa

– The protrusion of the lesion is compared with the height of the closed cups of a biopsy forceps (2.5mm), dotted arrow passes under top of lesion

– M= mucosa, mm= muscularis mucosae, sm= submucosa

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 15: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

Slightly elevated (0-IIa) vs Sessile (0-Is) – Easily misclassified

– Classification is made easier by placing a biopsy forceps as a calibrating gauge, for the height of the lesion

– Lesions protruding above the level of the closed jaws of the biopsy forceps (2.5mm), are classified as 0-Is, lesions protruding below this level are classified as 0-IIa

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 16: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

Completely flat (0-IIb) – Lesion does not protrude above mucosal surface

– M= mucosa, mm= muscularis mucosae, sm= submucosa

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 17: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics Slightly depressed (0-IIc)

– Superficial erosions in a depressed lesion involve only the most superficial layers – Absolutely depressed: level of depression is lower then the surface of the adjacent

mucosa – Relatively depressed: level of depression is still higher than the surface of the adjacent

mucosa

– M= mucosa, mm= muscularis mucosae, sm= submucosa

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 18: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 1: basics

Excavated/Ulcerated (0-III) – Lesion with deep ulcer below mucosa – Loss of the mucosa and often of the submucosa

– Distinction between a slightly depressed (0-IIc) and excavated (0-III) lesion: based on the depth of the depression from the adjacent mucosa

– Cut-off limit is 1.2 mm in columnar epithelium – However: 0-III extremely rare in the colon

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 19: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Assessing drawings is easier than assessing movies • You will now see 8 examples of polyps in video clips with different types

of morphology according to the Paris classification, some next to a biopsy forceps

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 20: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Difference between sessile (0-Is) and slightly elevated (0-IIa) is difficult • Forceps cups next to lesion make differentiation easier • Most of the examples will show sessile or slightly elevated lesions, as we

think this causes the most interobserver variability

• If you click on the picture, the movie will start (duration varies from 10-25 seconds)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 21: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Example 1: pedunculated polyp (0-Ip)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 22: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Example 2: sessile polyp (0-Is)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 23: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Example 3: slightly elevated lesion (0-IIa)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 24: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Example 4: slightly elevated lesion (0-IIa)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 25: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Example 5: completely flat lesion (0-IIb)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 26: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Example 6: sessile polyp (0-Is)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 27: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Example 7: slightly elevated lesion (0-IIa)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 28: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Example 8: slightly elevated lesion (0-IIa)

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 29: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• In preparation of the photo training, 6 photo examples are shown from the original article of the Paris workshop 2002

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 30: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Photo example 1: 0-Is

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 31: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Photo example 2: 0-IIa

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 32: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Photo example 3: 0-IIa

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 33: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Photo example 4: 0-IIc

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 34: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Photo example 5: 0-IIc + IIa

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 35: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 2: examples

• Photo example 6: 0-IIc

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon. November 30 to December 1, 2002. Paris Workshop Participants. Volume 58, No. 6 (Suppl), 2003 Gastrointestinal Endoscopy.

Page 36: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

• Next you will see 32 photographs of polyps • Please classify the morphology of these polyps according to the Paris

classification on the Training Assessment Form (word document in the WeTransfer file)

• Please do not look at the Feedback Form before you filled in the Assessment form

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 37: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 1

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 38: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 2

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 39: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 3

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 40: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 4

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 41: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 5

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 42: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 6

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 43: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 7

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 44: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 8

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 45: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 9

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 46: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 10

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 47: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 11

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 48: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 12

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 49: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 13

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 50: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 14

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 51: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 15

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 52: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 16

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 53: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 17

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 54: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 18

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 55: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 19

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 56: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 20

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 57: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 21

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 58: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 22

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 59: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 23

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 60: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 24

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 61: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 25

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 62: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 26

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 63: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 27

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 64: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 28

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 65: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 29

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 66: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 30

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 67: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 31

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 68: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

Photo 32

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 69: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 3: training

END of TRAINING

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 70: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 4: feedback

• You can now check your answers with the Feedback form (word document in the WeTransfer file)

• As there is no ‘golden standard’, the ‘correct’ classifications were determined by an panel of 3 physicians. Only the 32 polyps with total agreement were used for the training.

• The purpose of the training is to evaluate if the interobserver agreement improves after all 7 experts have been through the same basics and examples of the classification

• Your answers are private, no need to send these to the researcher

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology

Page 71: The Paris classification of colonic lesions · 2017-06-14 · • No improvement when polyp classification was dichotomized to polypoid vs. non-polypoid categories • Before the

Step 5: re-assessment

• Please watch the 85 polyp movies again • Classify them according to the Paris classification • Also re-evaluate the other items • The Clinical Record Form of the movies can be send to researcher by

mail/email/fax • Thank you very much!!

Academic Medical Centre, University of Amsterdam, Department of Gastroenterology & Hepatology


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Polypoid Adenosquamous Carcinosarcoma of the Epiglottis ... · POLYPOID ADENOSQUAMOUS CARCINOSARCOMA OF THE EPIGLOTTIS 417 keratin and epithelial membrane anti gen, positive immunoperoxidase

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Gastric polypoid lesions - mucosalimmunology.ch · • Response to a chronic inflammatory environment, particularly H. pylori gastritis Risk of malignancy • Neoplastic progression

Gastric polypoid lesions - mucosalimmunology.ch · • Response to a chronic inflammatory environment, particularly H. pylori gastritis Risk of malignancy • Neoplastic progression

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Evidence for a dichotomized sensory system - n.neurology.org · Articles Patterns of sensory abnormality in cortical stroke Evidence for a dichotomized sensory system Jong S. Kim,

Evidence for a dichotomized sensory system - n.neurology.org · Articles Patterns of sensory abnormality in cortical stroke Evidence for a dichotomized sensory system Jong S. Kim,

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CASE REPORT Open Access Polypoid nodular histiocytic … · 2017-04-05 · CASE REPORT Open Access Polypoid nodular histiocytic hyperplasia associated with endometrioid adenocarcinoma

CASE REPORT Open Access Polypoid nodular histiocytic … · 2017-04-05 · CASE REPORT Open Access Polypoid nodular histiocytic hyperplasia associated with endometrioid adenocarcinoma

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Paris classification (2003) - EndoTODAY · 2013-04-28 · JGCA classification - Japanese Gastric Cancer Association - • Type 0 – superficial polypoid, flat/depressed, or excavated

Paris classification (2003) - EndoTODAY · 2013-04-28 · JGCA classification - Japanese Gastric Cancer Association - • Type 0 – superficial polypoid, flat/depressed, or excavated

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Dichotomized Typology

Dichotomized Typology

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Evidence for a dichotomized sensory systempons, 4) unreliable sensory examination due to any reasons such as severe aphasia, dementia, or confusion, and 5) lesions primarily located

Evidence for a dichotomized sensory systempons, 4) unreliable sensory examination due to any reasons such as severe aphasia, dementia, or confusion, and 5) lesions primarily located

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Histopathology and treatment of a huge overhanging ...€¦ · overhanging filtering bleb showed polypoid structures covered with flattened corneal epithelium and filled with myxedematoid

Histopathology and treatment of a huge overhanging ...€¦ · overhanging filtering bleb showed polypoid structures covered with flattened corneal epithelium and filled with myxedematoid

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491-2013: DICHOTOMIZED D: A SAS® Macro for …support.sas.com/resources/papers/proceedings13/491-2013.pdfDICHOTOMIZED_D: A SAS® Macro for Computing Effect Sizes for Artificially

491-2013: DICHOTOMIZED D: A SAS® Macro for …support.sas.com/resources/papers/proceedings13/491-2013.pdfDICHOTOMIZED_D: A SAS® Macro for Computing Effect Sizes for Artificially

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10 Clinical Review GenerAlSUrGerynewS.Com / GenerAl ......Figure 2. PolyPoid AnAl melAnomA (bottom Arrow) with Pigment At bAse oF PolyPoid tumor (toP Arrow). From: weyandt GH, eggert

10 Clinical Review GenerAlSUrGerynewS.Com / GenerAl ......Figure 2. PolyPoid AnAl melAnomA (bottom Arrow) with Pigment At bAse oF PolyPoid tumor (toP Arrow). From: weyandt GH, eggert

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Open Access Polypoid Arteriovenous Malformation Presenting ... · Polypoid Arteriovenous Malformation Presenting with Jejunojejunal Intussusceptions in an Adult Doo-Ho Lim 1, Ji Yong

Open Access Polypoid Arteriovenous Malformation Presenting ... · Polypoid Arteriovenous Malformation Presenting with Jejunojejunal Intussusceptions in an Adult Doo-Ho Lim 1, Ji Yong

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Polypoid Lesions of the Gall- bladder: Disease Spectrum ... · Polypoid Lesions of the Gall-bladder: ... report when gallbladder polyps are discovered. ... further action to open

Polypoid Lesions of the Gall- bladder: Disease Spectrum ... · Polypoid Lesions of the Gall-bladder: ... report when gallbladder polyps are discovered. ... further action to open

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Hematochezia with Colonic Polypoid Angiodysplasia in a Young

Hematochezia with Colonic Polypoid Angiodysplasia in a Young

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ESETISMERTETÉS Endometrialis stromadaganatok: tíz · PDF fileEndometrialis stromadaganatok: tíz eset ismertetése és az irodalom áttekintése 57 polypoid, és a méh üregébe

ESETISMERTETÉS Endometrialis stromadaganatok: tíz · PDF fileEndometrialis stromadaganatok: tíz eset ismertetése és az irodalom áttekintése 57 polypoid, és a méh üregébe

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Unusual presentation of more common disease/injury ...polypoid granuloma, usually of the palpebral conjunctiva, and preauricular lymphadenopathy. Inoculation is usually by hand-eye

Unusual presentation of more common disease/injury ...polypoid granuloma, usually of the palpebral conjunctiva, and preauricular lymphadenopathy. Inoculation is usually by hand-eye

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Classification of malocclusion · Classification of malocclusion. 1-primary classification (Lischer) 2-Classification by body type (Berger) 3-classification according to etiology

Classification of malocclusion · Classification of malocclusion. 1-primary classification (Lischer) 2-Classification by body type (Berger) 3-classification according to etiology

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Crinoid Cirri as Available Substrata for Polypoid ... · epizoic, and their colonies have been observed living on various benthic invertebrates (mainly sponges, cnidarians, molluscs,

Crinoid Cirri as Available Substrata for Polypoid ... · epizoic, and their colonies have been observed living on various benthic invertebrates (mainly sponges, cnidarians, molluscs,

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POLYPOID CYSTITIS - Poiesispoiesismedical.com/wp-content/uploads/2012/03/9.-Catheter-Tip-Areas-of... · Altogether, polypoid cystitis (see below) was found in 40 bladders: 22 and

POLYPOID CYSTITIS - Poiesispoiesismedical.com/wp-content/uploads/2012/03/9.-Catheter-Tip-Areas-of... · Altogether, polypoid cystitis (see below) was found in 40 bladders: 22 and

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Lecture 7: Concentration of Media Ownership. Thus far, I have dichotomized news organizations (and journalist) from the rest of the media industry. The

Lecture 7: Concentration of Media Ownership. Thus far, I have dichotomized news organizations (and journalist) from the rest of the media industry. The

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Singapore’s Dichotomized Financial System...The financial markets in Singapore are small and open, and have high capital mobility. Singapore has a prudent government char-acterized

Singapore’s Dichotomized Financial System...The financial markets in Singapore are small and open, and have high capital mobility. Singapore has a prudent government char-acterized

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대장암으로 오인된 장결핵 - Yonsei University · Fig. 1. Initial colonoscopic find-ings. A protruding polypoid mass with surface nodularity is noted at the ileocecal area

대장암으로 오인된 장결핵 - Yonsei University · Fig. 1. Initial colonoscopic find-ings. A protruding polypoid mass with surface nodularity is noted at the ileocecal area

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Case Report Polypoid adenomyoma of the gastric … unusual case of adenomyoma of the fundus of the stomach, which presented as a polyp on endoscopy, and was found to be a polypoid,

Case Report Polypoid adenomyoma of the gastric … unusual case of adenomyoma of the fundus of the stomach, which presented as a polyp on endoscopy, and was found to be a polypoid,

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Latent Trait Standardization of the Benzodiazepine ...€¦ · Analogously to this earlier study, the items of the Bendep-SRQ scales, which were originally 5-point rated, were dichotomized

Latent Trait Standardization of the Benzodiazepine ...€¦ · Analogously to this earlier study, the items of the Bendep-SRQ scales, which were originally 5-point rated, were dichotomized

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Polypoid lesions of the gallbladder less than 10 mm ... … · Tumores Benignos do Fígado Author: CEUDI Created Date: 4/19/2019 9:58:28 PM

Polypoid lesions of the gallbladder less than 10 mm ... … · Tumores Benignos do Fígado Author: CEUDI Created Date: 4/19/2019 9:58:28 PM

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Prostate Adenocarcinoma vs. Urothelial Carcinoma · Polypoid Cystitis •Reaction to ... 44% with >50% involvement of LP •Most cases (61%) had prominent nucleoli •All had mild

Prostate Adenocarcinoma vs. Urothelial Carcinoma · Polypoid Cystitis •Reaction to ... 44% with >50% involvement of LP •Most cases (61%) had prominent nucleoli •All had mild

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Polypoid nodular histiocytic hyperplasia associated with

Polypoid nodular histiocytic hyperplasia associated with

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Ganglioneuroma Masquerading as Rectal Polyp: Clinical ... · Biopsy of the rectal polyp showed ganglioneuroma. This represents a case of polypoid ganglioneuromatosis. These polyps

Ganglioneuroma Masquerading as Rectal Polyp: Clinical ... · Biopsy of the rectal polyp showed ganglioneuroma. This represents a case of polypoid ganglioneuromatosis. These polyps

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