title: Implementation of an e-learning module improves consistency in the histopathological diagnosis of sessile serrated lesions within a nationwide population screening programme.
abstract: OBJECTIVE
  Distinguishing premalignant sessile serrated lesions (SSLs) from hyperplastic polyps (HPs) is difficult for pathologists in daily practice. We aimed to evaluate nationwide variability within histopathology laboratories in the frequency of diagnosing an SSL as compared with an HP within the Dutch population-based screening programme for colorectal cancer and to assess the effect of an e-learning module on interlaboratory consistency.
  
  
  RESULTS
  Data were retrieved from the Dutch Pathology Registry from the start of the nationwide population screening programme, January 2014, until December 2015. An obligatory e-learning module was implemented among pathologists in October 2014. The ratio between SSL and HP diagnosis was determined per laboratory. Odds ratios (ORs) for the diagnosis of an SSL per laboratory were compared with the laboratory with the median odds (median laboratory), before and after implementation of the e-learning module. In total, 14 997 individuals with 27 879 serrated polyps were included; 6665 (23.9%) were diagnosed as SSLs, and 21 214 as HPs (76.1%). The ratio of diagnosing an SSL ranged from 5% to 47% (median 23%) within 44 laboratories. Half of the laboratories showed a significantly different OR (range 3.47-0.16) for diagnosing an SSL than the median laboratory. Variability decreased after implementation of the e-learning module (P = 0.02). Of all pathology laboratories, 70% became more consistent with the median laboratory after e-learning implementation.
  
  
  CONCLUSIONS
  We demonstrated substantial interlaboratory variability in the histopathological diagnosis of SSLs, which significantly decreased after implementation of a structured e-learning module. Widespread implementation of education might contribute to more homogeneous practice among pathologists.
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Joep E G
authors.initials: JE
authors.lastname: IJspeert
authors.affiliation: Foundation PALGA (the nationwide network and registry of histo- and cytopathology in the Netherlands), Houten, The Netherlands.|Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Ariana
authors.initials: A
authors.lastname: Madani
authors.affiliation: Foundation PALGA (the nationwide network and registry of histo- and cytopathology in the Netherlands), Houten, The Netherlands.
authors.forename: Lucy I H
authors.initials: LI
authors.lastname: Overbeek
authors.affiliation: Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: Evelien
authors.initials: E
authors.lastname: Dekker
authors.affiliation: Department of Pathology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Iris D
authors.initials: ID
authors.lastname: Nagtegaal
mesh_terms: D000328:Adult; D000368:Aged; D003111:Colonic Polyps / Q000175:diagnosis*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D004501:Education, Medical / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D007753:Laboratories / Q000592:standards; D008297:Male; D008875:Middle Aged; D010338:Pathology, Clinical / Q000193:education*; D011230:Precancerous Conditions / Q000175:diagnosis*
keywords: cancer prevention; colorectal cancer screening; colorectal neoplasm; histopathology