用于指导及提高结肠癌肿瘤-基质比评分可重复性的电子学习： UNITED研究中的性能与可重复性评估
e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study.
作者信息
Smit Marloes A, van Pelt Gabi W, Dequeker Elisabeth Mc, Al Dieri Raed, Tollenaar Rob Aem, van Krieken J Han Jm, Mesker Wilma E
机构信息
Department of Surgery, Leiden University Medical Center, Leiden, Netherlands.
Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Leuven, Belgium.
出版信息
JMIR Form Res. 2021 Mar 19;5(3):e19408. doi: 10.2196/19408.
BACKGROUND
The amount of stroma in the primary tumor is an important prognostic parameter. The tumor-stroma ratio (TSR) was previously validated by international research groups as a robust parameter with good interobserver agreement.
OBJECTIVE
The Uniform Noting for International Application of the Tumor-Stroma Ratio as an Easy Diagnostic Tool (UNITED) study was developed to bring the TSR to clinical implementation. As part of the study, an e-Learning module was constructed to confirm the reproducibility of scoring the TSR after proper instruction.
METHODS
The e-Learning module consists of an autoinstruction for TSR determination (instruction video or written protocol) and three sets of 40 cases (training, test, and repetition sets). Scoring the TSR is performed on hematoxylin and eosin-stained sections and takes only 1-2 minutes. Cases are considered stroma-low if the amount of stroma is ≤50%, whereas a stroma-high case is defined as >50% stroma. Inter- and intraobserver agreements were determined based on the Cohen κ score after each set to evaluate the reproducibility.
RESULTS
Pathologists and pathology residents (N=63) with special interest in colorectal cancer participated in the e-Learning. Forty-nine participants started the e-Learning and 31 (63%) finished the whole cycle (3 sets). A significant improvement was observed from the training set to the test set; the median κ score improved from 0.72 to 0.77 (P=.002).
CONCLUSIONS
e-Learning is an effective method to instruct pathologists and pathology residents for scoring the TSR. The reliability of scoring improved from the training to the test set and did not fall back with the repetition set, confirming the reproducibility of the TSR scoring method.
TRIAL REGISTRATION
The Netherlands Trial Registry NTR7270; https://www.trialregister.nl/trial/7072.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13464.
背景
原发性肿瘤中的基质含量是一个重要的预后参数。肿瘤-基质比（TSR）先前已得到国际研究小组的验证，是一个具有良好观察者间一致性的可靠参数。
目的
开展肿瘤-基质比作为简易诊断工具的国际统一应用标注（UNITED）研究，以将TSR应用于临床实践。作为该研究的一部分，构建了一个电子学习模块，以确认在经过适当指导后对TSR进行评分的可重复性。
方法
电子学习模块包括用于TSR测定的自动指导（指导视频或书面方案）以及三组各40例病例（训练集、测试集和重复集）。在苏木精和伊红染色切片上对TSR进行评分，仅需1 - 2分钟。如果基质含量≤50%，则病例被视为基质含量低，而基质含量高的病例定义为基质含量>50%。在每组病例后，根据科恩κ评分确定观察者间和观察者内的一致性，以评估可重复性。
结果
对结直肠癌有特别兴趣的病理学家和病理住院医师（N = 63）参与了电子学习。49名参与者开始了电子学习，31名（63%）完成了整个周期（3组）。从训练集到测试集观察到显著改善；κ评分中位数从0.72提高到0.77（P = 0.002）。
结论
电子学习是指导病理学家和病理住院医师对TSR进行评分的有效方法。评分的可靠性从训练集到测试集有所提高，并且在重复集时没有下降，证实了TSR评分方法的可重复性。
试验注册
荷兰试验注册中心NTR7270；https://www.trialregister.nl/trial/7072。
国际注册报告识别码（IRRID）：RR2-10.2196/13464。
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