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e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study

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 t...

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Autores principales: Smit, Marloes A, van Pelt, Gabi W, Dequeker, Elisabeth MC, Al Dieri, Raed, Tollenaar, Rob AEM, van Krieken, J Han JM, Mesker, Wilma E
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122297/
https://www.ncbi.nlm.nih.gov/pubmed/33739293
http://dx.doi.org/10.2196/19408
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author Smit, Marloes A
van Pelt, Gabi W
Dequeker, Elisabeth MC
Al Dieri, Raed
Tollenaar, Rob AEM
van Krieken, J Han JM
Mesker, Wilma E
author_facet Smit, Marloes A
van Pelt, Gabi W
Dequeker, Elisabeth MC
Al Dieri, Raed
Tollenaar, Rob AEM
van Krieken, J Han JM
Mesker, Wilma E
author_sort Smit, Marloes A
collection PubMed
description 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
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spelling pubmed-81222972021-06-02 e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study Smit, Marloes A van Pelt, Gabi W Dequeker, Elisabeth MC Al Dieri, Raed Tollenaar, Rob AEM van Krieken, J Han JM Mesker, Wilma E JMIR Form Res Original Paper 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 JMIR Publications 2021-03-19 /pmc/articles/PMC8122297/ /pubmed/33739293 http://dx.doi.org/10.2196/19408 Text en ©Marloes A Smit, Gabi W van Pelt, Elisabeth MC Dequeker, Raed Al Dieri, Rob AEM Tollenaar, J Han JM van Krieken, Wilma E Mesker, UNITED Group. Originally published in JMIR Formative Research (http://formative.jmir.org), 19.03.2021. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Formative Research, is properly cited. The complete bibliographic information, a link to the original publication on http://formative.jmir.org, as well as this copyright and license information must be included.
spellingShingle Original Paper
Smit, Marloes A
van Pelt, Gabi W
Dequeker, Elisabeth MC
Al Dieri, Raed
Tollenaar, Rob AEM
van Krieken, J Han JM
Mesker, Wilma E
e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study
title e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study
title_full e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study
title_fullStr e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study
title_full_unstemmed e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study
title_short e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study
title_sort e-learning for instruction and to improve reproducibility of scoring tumor-stroma ratio in colon carcinoma: performance and reproducibility assessment in the united study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122297/
https://www.ncbi.nlm.nih.gov/pubmed/33739293
http://dx.doi.org/10.2196/19408
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