Interobserver reliability of methods to determine complete resection of adenomas in colonoscopy

Background Forceps margin biopsy and polypectomy specimen margins have both been used to assess for polypectomy resection adequacy. The interobserver reliability of the two methods has not been well described. Methods The interpretability of polypectomy specimens for presence of residual neoplasia at the margin was assessed by two blinded pathologists. Next, the concordance of forceps margin biopsy interpretations between three blinded pathologists was evaluated by calculation of interobserver kappa. Results Rates of polypectomy specimen margin interpretability were low: 24/92 (26%) for pathologist A, 28/92 (30.4%) for pathologist B. Concordance of forceps margin biopsy interpretations (n = 129) between pathologists was high. Two internal pathologists showed substantial agreement in margin biopsy interpretations (kappa 0.779; 95%CL 0.543, 0.912). The concordance remained strong after biopsies were reviewed by a third, external pathologist (kappa 0.829; 95 %CL 0.658, 0.924). There was complete agreement on 123/129 (95.3%) between all three pathologists for presence of neoplasia. Conclusion The majority of polypectomy specimen margins were uninterpretable by pathologists for presence of residual neoplasia. Forceps margin biopsy shows strong interobserver reliability in adenomatous lesions.