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Background <p>The Peritoneal Cancer Index recorded at laparotomy is based on visual and palpable inspection of peritoneal surfaces for disease. This study aimed to analyze interobserver variation in assigning the lesion score (LS) and morphologic term (MT) to characterize peritoneal lesions (PL) and predict the probability of malignancy (POM) among surgeons with expertise in cytoreductive surgery (CRS) for peritoneal malignancies.</p> Methods <p>The study selected 80 intraoperative images of PLs depicting different morphologic appearances of PLs arising from different primary tumors in various peritoneal regions. In the study, 50 expert peritoneal malignancy surgeons were asked to assign an LS to the region in question, select the MT or MTs to describe the PL, and predict the POM. Information on the presence of disease on histopathology was not provided at this point. Inter-observer reliability was evaluated using Krippendorff’s alpha (<i>α</i>). A consensus was reached if any option received more than 75% of the votes.</p> Results <p>The study participants comprised 41 (82%) of 50 experts. Consensus on LS was achieved for 18 images (22.5%), with low agreement (<i>α</i> = 0.174). For MTs, a consensus was reached for 21 images (26.5%; <i>α</i> = 0.0902, denoting low and unreliable agreement. Of these 21 images, the MT used was “tumor nodule” for 90.4% of the images (<i>p</i> &lt; 0.001). The POM was accurately predicted in 52.5% of the cases (<i>α</i> = 0.155). Administration of neoadjuvant chemotherapy had no impact on the surgeons’ assessment of the three parameters.</p> Conclusions <p>Even the most experienced CRS surgeons showed high interobserver variation and unreliable agreement in the description and accurate characterization of PLs on pictorial records. A Delphi consensus to standardize the MT used and scoring of PL could reduce discordance.</p>

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MORPHology and Inter-observer Variation in Peritoneal Disease Assessment Among Expert Peritoneal Malignancy SUrgeonS: The MORPHEUS study

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Aditi Bhatt,
  • Vivekanand Sharma,
  • Ajinkya Pawar,
  • Mohammad Alyami,
  • Brian Badgwell,
  • Lana Bijelic,
  • Cecile Brigand,
  • Pedro Cascales,
  • Peter Cashin,
  • Tom Cecil,
  • Haroon M. Choudry,
  • Marcello Deraco,
  • Frederic Dumont,
  • Ignace de Hingh,
  • Christina Fotopoulou,
  • Diane Goere,
  • Alexander Heriot,
  • Neils Kok,
  • Laura Lambert,
  • Edward Levine,
  • Yan Li,
  • Ruiqing Ma,
  • Sanket Mehta,
  • Faheez Mohamed,
  • Brendan Moran,
  • Santiago Gonzalez-Moreno,
  • David Morris,
  • Nayef Alzharani,
  • Aviram Nissan,
  • Fernando Pereira Perez,
  • Pompiliu Piso,
  • Marc Pocard,
  • Beate Rau,
  • Paolo Sammartino,
  • Alvaro Arjona-Sanchez,
  • Armando Sardi,
  • Lucas Sideris,
  • John Spiliotis,
  • Artem Stepanyan,
  • Kurt Van Der Speeten,
  • Victor Verwaal,
  • Paul Sugarbaker,
  • Mufaddal Kazi,
  • Shigeki Kusamura,
  • Olivier Glehen

摘要

Background

The Peritoneal Cancer Index recorded at laparotomy is based on visual and palpable inspection of peritoneal surfaces for disease. This study aimed to analyze interobserver variation in assigning the lesion score (LS) and morphologic term (MT) to characterize peritoneal lesions (PL) and predict the probability of malignancy (POM) among surgeons with expertise in cytoreductive surgery (CRS) for peritoneal malignancies.

Methods

The study selected 80 intraoperative images of PLs depicting different morphologic appearances of PLs arising from different primary tumors in various peritoneal regions. In the study, 50 expert peritoneal malignancy surgeons were asked to assign an LS to the region in question, select the MT or MTs to describe the PL, and predict the POM. Information on the presence of disease on histopathology was not provided at this point. Inter-observer reliability was evaluated using Krippendorff’s alpha (α). A consensus was reached if any option received more than 75% of the votes.

Results

The study participants comprised 41 (82%) of 50 experts. Consensus on LS was achieved for 18 images (22.5%), with low agreement (α = 0.174). For MTs, a consensus was reached for 21 images (26.5%; α = 0.0902, denoting low and unreliable agreement. Of these 21 images, the MT used was “tumor nodule” for 90.4% of the images (p < 0.001). The POM was accurately predicted in 52.5% of the cases (α = 0.155). Administration of neoadjuvant chemotherapy had no impact on the surgeons’ assessment of the three parameters.

Conclusions

Even the most experienced CRS surgeons showed high interobserver variation and unreliable agreement in the description and accurate characterization of PLs on pictorial records. A Delphi consensus to standardize the MT used and scoring of PL could reduce discordance.