Low accuracy and interobserver/intraobserver agreement for colorectal sessile serrated lesions: A multicenter diagnostic study

doi:10.3748/wjg.120411

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Nov 14, 2026; 32(42): 120411
Published online Nov 14, 2026. doi: 10.3748/wjg.120411

Table 1 Clinical characteristics of the included cases, mean ± SD/n (%)

Parameters		Number of cases
Age (years)		57.32 ± 12.00
Sex	Female	804 (68.4)
Sex	Male	372 (31.6)
Flat or sessile morphology	No	859 (73.0)
Flat or sessile morphology	Yes	317 (27.0)
Anatomical location	Cecum	72 (6.1)
	Ascending colon	191 (16.2)
	Hepatic flexure	82 (7.0)
	Transverse colon	264 (22.4)
	Splenic flexure	7 (0.6)
	Descending colon	136 (11.6)
	Sigmoid colon	267 (22.7)
	Rectum	157 (13.4)
Lesion size¹	≤ 0.5 cm	414 (35.2)
	0.5 < x ≤ 1 cm	427 (36.3)
	> 1 cm	133 (11.3)

¹Polyp size data of some cases are missing.

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Table 2 Diagnostic accuracy and interobserver agreement across reading rounds

Subtype	Round 1			Round 2			Round 3			P accuracy (round 1 vs round 3)	P accuracy (vs overall in round 1)
Subtype	Accuracy	κ	95%CI	Accuracy	κ	95%CI	Accuracy	κ	95%CI	P accuracy (round 1 vs round 3)	P accuracy (vs overall in round 1)
Overall	66%	0.393	0.385-0.400	69%	0.441	0.434-0.449	72%	0.415	0.407-0.423	< 0.001^a	reference
SSL	62%	0.409	0.394-0.423	60%	0.441	0.426-0.455	58%	0.301	0.286-0.316	0.032^a	0.014
SSL-D	33%	0.114	0.099-0.129	33%	0.132	0.117-0.147	49%	0.127	0.112-0.141	0.007^a	< 0.001
GCHP	71%	0.369	0.354-0.384	72%	0.402	0.387-0.417	69%	0.369	0.355-0.384	0.102	< 0.001
MVHP	62%	0.332	0.318-0.347	68%	0.425	0.411-0.440	65%	0.380	0.365-0.394	0.161	0.023
TSA	74%	0.587	0.572-0.602	75%	0.702	0.688-0.717	77%	0.703	0.688-0.718	0.238	0.004
TA	66%	0.429	0.415-0.444	71%	0.476	0.461-0.491	80%	0.487	0.472-0.52	< 0.001^a	0.987
VA/TVA	65%	0.470	0.456-0.485	67%	0.472	0.457-0.487	74%	0.542	0.527-0.556	0.016^a	0.815

^aP < 0.05 (round 3 vs round 1, uncorrected).

P < 0.0071 vs overall accuracy in round 1 (Bonferroni correction for 7 prespecified comparisons). Data from 1176 polyps assessed by 6 pathologists. κ: < 0.20, slight; 0.21-0.40, fair; 0.41-0.60, moderate; 0.61-0.80, substantial; > 0.80, almost perfect. GCHP: Goblet cell-rich hyperplastic polyp; MVHP: Microvesicular hyperplastic polyp; SSL: Sessile serrated lesion; SSL-D: Sessile serrated lesion with dysplasia; TA: Tubular adenoma; TSA: Traditional serrated adenoma; VA/TVA: Villous adenoma/tubulovillous adenoma.

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Table 3 Analysis of intraobserver agreement (κ) between the first and second reading rounds

Pathologists	Doc	Overall	SSL	SSL-D
Senior	Doc1	0.610	0.725	0.122
Senior	Doc2	0.733	0.742	0.416
Intermediate	Doc3	0.594	0.287	0.508
Intermediate	Doc4	0.659	0.733	0.229
Junior	Doc5	0.452	0.517	0.066
Junior	Doc6	0.432	0.664	0.082

Doc: Doctor; SSL: Sessile serrated lesion; SSL-D: Sessile serrated lesion with dysplasia.

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Table 4 Logistic regression analysis for diagnostic consensus for sessile serrated lesion and sessile serrated lesion with dysplasia, mean ± SD/n (%)

Variable		Consensus group	Discordance group	Univariate analysis	Multivariate analysis
Variable		n = 54	n = 99	P value	P value	OR (95%CI)
Age (years)		53.22 ± 11.50	55.59 ± 13.89	0.274	-	-
Sex	Female	19 (35.2)	38 (38.4)	0.696	-	-
Flat or sessile morphology	Yes	50 (92.6)	95 (96.0)	0.371	-	-
Lesion size¹	≤ 0.5 cm	15 (34.1)	32 (38.1)	0.164	-	-
Crypt orientation	Cross-sectional	4 (7.4)	37 (37.4)	< 0.001^a	0.006^b	5.27 (1.61-17.18)
Serrated region	Lower 1/3 crypt	52 (96.3)	73 (73.7)	0.001^a	0.044^b	0.20 (0.04-0.96)
Crypt dilation	Lower 1/3 crypt	53 (98.1)	73 (73.7)	< 0.001^a	-	-
Proliferative zone	Basal crypt	1 (1.9)	6 (6.1)	0.234	-	-
Abnormal crypt architecture	Yes	53 (98.1)	70 (70.7)	< 0.001^a	0.033^b	0.37 (0.15-0.92)
Number of serrated crypts	> 3	22 (40.7)	22 (22.2)	0.016^a	-	-
Nuclear alteration	Yes	4 (7.4)	34 (34.3)	< 0.001^a	< 0.001^b	10.45 (3.01-36.30)
Cytoplasmic eosinophilia	Prominent	24 (44.4)	43 (43.4)	0.904	-	-

¹Polyp size data of some cases are missing.

^aP < 0.1.

^bP < 0.05.

OR: Odds ratio.

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Citation: Hu H, Zhao SB, Zhao YD, Sui XY, Zhang S, Wei JH, Liu XF, Shi YC, Tang L, Zhang BB, Feng Z, Cheng W, Zhu MH, Zhu Z, Li ZS, He MX, Bai Y, Zhang J. Low accuracy and interobserver/intraobserver agreement for colorectal sessile serrated lesions: A multicenter diagnostic study. World J Gastroenterol 2026; 32(42): 120411
URL: https://www.wjgnet.com/1007-9327/full/v32/i42/120411.htm
DOI: https://dx.doi.org/10.3748/wjg.120411

Hu H, Zhao SB, Zhao YD, Sui XY, Zhang S, Wei JH, Liu XF, Shi YC, Tang L, Zhang BB, Feng Z, Cheng W, Zhu MH, Zhu Z, Li ZS, He MX, Bai Y, Zhang J. Low accuracy and interobserver/intraobserver agreement for colorectal sessile serrated lesions: A multicenter diagnostic study. World J Gastroenterol 2026; 32(42): 120411 [DOI: 10.3748/wjg.120411]

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