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

Bhatt, Aditi ; Sharma, Vivekanand ; Pawar, Ajinkya ; Alyami, Mohammad ; Badgwell, Brian ; Bijelic, Lana ; Brigand, Cecile ; Cascales, Pedro ; Cashin, Peter and Cecil, Tom , et al. (2026) In Annals of Surgical Oncology
Abstract

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... (More)

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.

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organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
Interobserver variability, Lesion Score, Morphology of peritoneal malignancy, Peritoneal Cancer Index, Peritoneal malignancy
in
Annals of Surgical Oncology
publisher
Springer
external identifiers
  • scopus:105033467562
  • pmid:41807839
ISSN
1068-9265
DOI
10.1245/s10434-026-19344-3
language
English
LU publication?
yes
additional info
Publisher Copyright: © Society of Surgical Oncology 2026.
id
256c3aed-13ab-4564-97ad-2888026ea5d1
date added to LUP
2026-04-08 11:09:09
date last changed
2026-06-03 16:43:36
@article{256c3aed-13ab-4564-97ad-2888026ea5d1,
  abstract     = {{<p>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 &lt; 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.</p>}},
  author       = {{Bhatt, Aditi and Sharma, Vivekanand and Pawar, Ajinkya and Alyami, Mohammad and Badgwell, Brian and Bijelic, Lana and Brigand, Cecile and Cascales, Pedro and Cashin, Peter and Cecil, Tom and Choudry, Haroon M. and Deraco, Marcello and Dumont, Frederic and de Hingh, Ignace and Fotopoulou, Christina and Goere, Diane and Heriot, Alexander and Kok, Neils and Lambert, Laura and Levine, Edward and Li, Yan and Ma, Ruiqing and Mehta, Sanket and Mohamed, Faheez and Moran, Brendan and Gonzalez-Moreno, Santiago and Morris, David and Alzharani, Nayef and Nissan, Aviram and Perez, Fernando Pereira and Piso, Pompiliu and Pocard, Marc and Rau, Beate and Sammartino, Paolo and Sanchez, Alvaro Arjona and Sardi, Armando and Sideris, Lucas and Spiliotis, John and Stepanyan, Artem and Van Der Speeten, Kurt and Verwaal, Victor and Sugarbaker, Paul and Kazi, Mufaddal and Kusamura, Shigeki and Glehen, Olivier}},
  issn         = {{1068-9265}},
  keywords     = {{Interobserver variability; Lesion Score; Morphology of peritoneal malignancy; Peritoneal Cancer Index; Peritoneal malignancy}},
  language     = {{eng}},
  publisher    = {{Springer}},
  series       = {{Annals of Surgical Oncology}},
  title        = {{MORPHology and Inter-observer Variation in Peritoneal Disease Assessment Among Expert Peritoneal Malignancy SUrgeonS : The MORPHEUS study}},
  url          = {{http://dx.doi.org/10.1245/s10434-026-19344-3}},
  doi          = {{10.1245/s10434-026-19344-3}},
  year         = {{2026}},
}