Interobserver agreement of the Taulí-pT1 classification in rectal pT1 adenocarcinoma
Por:
Gener-Jorge, C, Piñas, JCF, Garcia, ABM, Rivera, DSM, Casalots, A, Nonell, A, Espina, B, Caro-Tarragó, A, Serra-Aracil, X
Publicada:
17 sep 2025
Resumen:
PurposeIn pT1 rectal adenocarcinoma, adverse pathological features guide the indication for radical surgery; however, they are present in only 10-15% of cases. Therefore, in most patients, accurate en bloc local excision with clear margins and precise submucosal invasion assessment is essential for appropriate risk stratification. Beyond absolute depth, a major challenge is the wide interindividual variability in submucosal thickness. The Taul & iacute;-pT1 classification, based on the measurement of healthy residual submucosa (hrSB) from the muscularis propria, has been proposed as an objective and reproducible system. This study aimed to validate this classification.MethodAn interobserver study was conducted on 30 patients with pT1 rectal adenocarcinoma treated by transanal endoscopic surgery. Four pathologists with varying experience levels independently evaluated digitized histological slides, measuring hrSB, total submucosal thickness, and invasion depth. They also classified specimens as sm1, sm2, or sm3. Interobserver agreement was assessed using intraclass correlation coefficients (ICC), and Fleiss' and Cohen's kappa indices.ResultsExcellent interobserver agreement was observed for hrSB (ICC = 0.99; 95% CI: 0.98-0.99), total submucosal thickness (ICC = 0.96; 95% CI: 0.93-0.98), and depth of invasion (ICC = 0.94; 95% CI: 0.9-0.97). The Taul & iacute;-pT1 classification demonstrated good agreement (Fleiss' kappa = 0.71). Identification of the muscularis mucosae showed moderate agreement (kappa = 0.612).ConclusionThe Taul & iacute;-pT1 classification demonstrates high interobserver reproducibility, even among pathologists with varying levels of experience, supporting its utility as an objective and standardized tool for the assessment of pT1 rectal adenocarcinoma.Clinical trial registrationClinicalTrials.gov Identifier: NCT06218108.
Filiaciones:
Gener-Jorge, C:
Univ Autonoma Barcelona, Inst Invest & Innovacio Parc Tauli I3PT, Dept Pathol, CERCA,Parc Tauli Hosp Univ, Sabadell, Spain
Piñas, JCF:
Univ Autonoma Barcelona, Inst Invest & Innovacio Parc Tauli I3PT, Dept Pathol, CERCA,Parc Tauli Hosp Univ, Sabadell, Spain
Garcia, ABM:
Univ Autonoma Barcelona, Inst Invest & Innovacio Parc Tauli I3PT, Dept Pathol, CERCA,Parc Tauli Hosp Univ, Sabadell, Spain
Rivera, DSM:
Univ Autonoma Barcelona, Inst Invest & Innovacio Parc Tauli I3PT, Dept Pathol, CERCA,Parc Tauli Hosp Univ, Sabadell, Spain
Casalots, A:
CLILAB Diagnost, Dept Pathol, Consorci Lab Intercomarcal Alt Penedes & El Garraf, Barcelona, Spain
Nonell, A:
Univ Autonoma Barcelona, Parc Tauli Hosp Univ, Inst Invest & Innovacio Parc Tauli I3PT, Dept Surg,CERCA, Sabadell, Spain
Espina, B:
Univ Autonoma Barcelona, Hosp La Santa Creu & St Pau, Dept Surg, Inst Recerca St Pau IR St Pau, Barcelona, Spain
Caro-Tarragó, A:
Hosp Univ Joan XXIII, Dept Surg, Tarragona, Spain
Serra-Aracil, X:
Univ Autonoma Barcelona, Parc Tauli Hosp Univ, Inst Invest & Innovacio Parc Tauli I3PT, Dept Surg,CERCA, Sabadell, Spain
Univ Autonoma Barcelona, Dept Surg, Barcelona, Spain
Green Submitted, hybrid
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