PMID- 33739293 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210604 IS - 2561-326X (Electronic) IS - 2561-326X (Linking) VI - 5 IP - 3 DP - 2021 Mar 19 TI - e-Learning for Instruction and to Improve Reproducibility of Scoring Tumor-Stroma Ratio in Colon Carcinoma: Performance and Reproducibility Assessment in the UNITED Study. PG - e19408 LID - 10.2196/19408 [doi] LID - e19408 AB - 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% stroma. Inter- and intraobserver agreements were determined based on the Cohen kappa 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 kappa 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. CI - (c)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. FAU - Smit, Marloes A AU - Smit MA AUID- ORCID: 0000-0002-3961-5040 AD - Department of Surgery, Leiden University Medical Center, Leiden, Netherlands. FAU - van Pelt, Gabi W AU - van Pelt GW AUID- ORCID: 0000-0003-1449-7348 AD - Department of Surgery, Leiden University Medical Center, Leiden, Netherlands. FAU - Dequeker, Elisabeth Mc AU - Dequeker EM AUID- ORCID: 0000-0001-5383-3178 AD - Department of Public Health and Primary Care, Biomedical Quality Assurance Research Unit, University of Leuven, Leuven, Belgium. FAU - Al Dieri, Raed AU - Al Dieri R AUID- ORCID: 0000-0002-2044-7489 AD - European Society of Pathology, Brussels, Belgium. FAU - Tollenaar, Rob Aem AU - Tollenaar RA AUID- ORCID: 0000-0002-6831-6082 AD - Department of Surgery, Leiden University Medical Center, Leiden, Netherlands. FAU - van Krieken, J Han Jm AU - van Krieken JHJ AUID- ORCID: 0000-0002-8105-0450 AD - Department of Pathology, Radboud University Medical Center, Nijmegen, Netherlands. FAU - Mesker, Wilma E AU - Mesker WE AUID- ORCID: 0000-0001-5533-4778 AD - Department of Surgery, Leiden University Medical Center, Leiden, Netherlands. CN - UNITED Group AD - Department of Surgery, Leiden University Medical Center, Leiden, Netherlands. LA - eng PT - Journal Article DEP - 20210319 PL - Canada TA - JMIR Form Res JT - JMIR formative research JID - 101726394 PMC - PMC8122297 OTO - NOTNLM OT - cancer OT - carcinoma OT - colon OT - colon cancer OT - diagnostic OT - e-Learning OT - implementation OT - online learning OT - prognosis OT - reproducibility OT - reproducibility study OT - tumor OT - tumor-stroma ratio OT - validation COIS- Conflicts of Interest: None declared. FIR - Archilla Sanz, I IR - Archilla Sanz I FIR - Bogdanovska Todorovska, M IR - Bogdanovska Todorovska M FIR - Brito, M IR - Brito M FIR - Cuatrecasas, M IR - Cuatrecasas M FIR - Dasgupta, K IR - Dasgupta K FIR - Faistova, H IR - Faistova H FIR - Farina Sarasqueta, A IR - Farina Sarasqueta A FIR - Flejou, J IR - Flejou JF FIR - Ilievski, B IR - Ilievski B FIR - Janevska, V IR - Janevska V FIR - Jankovic, R IR - Jankovic R FIR - Jevtic, J IR - Jevtic J FIR - Jonasson, J IR - Jonasson JG FIR - Kjaer-Frifeldt, S IR - Kjaer-Frifeldt S FIR - Kostadinova Kunovska, S IR - Kostadinova Kunovska S FIR - Krishna, J IR - Krishna J FIR - Lindebjerg, J IR - Lindebjerg J FIR - Manethova, M IR - Manethova M FIR - Marusic, Z IR - Marusic Z FIR - Neumann, J IR - Neumann J FIR - Natu, S IR - Natu S FIR - Petrusevska, G IR - Petrusevska G FIR - Ristovski, G IR - Ristovski G FIR - Ryska, A IR - Ryska A FIR - Shkurupii, B IR - Shkurupii B FIR - Solajic, N IR - Solajic N FIR - Souza, R IR - Souza R FIR - Terpstra, V IR - Terpstra V FIR - Trigka, E A IR - Trigka EA FIR - Valkova, M IR - Valkova M FIR - Zakhartseva, L IR - Zakhartseva L FIR - Zdravkovski, P IR - Zdravkovski P FIR - Zidar, N IR - Zidar N EDAT- 2021/03/20 06:00 MHDA- 2021/03/20 06:01 PMCR- 2021/03/19 CRDT- 2021/03/19 12:20 PHST- 2020/04/17 00:00 [received] PHST- 2021/03/03 00:00 [accepted] PHST- 2020/12/14 00:00 [revised] PHST- 2021/03/19 12:20 [entrez] PHST- 2021/03/20 06:00 [pubmed] PHST- 2021/03/20 06:01 [medline] PHST- 2021/03/19 00:00 [pmc-release] AID - v5i3e19408 [pii] AID - 10.2196/19408 [doi] PST - epublish SO - JMIR Form Res. 2021 Mar 19;5(3):e19408. doi: 10.2196/19408.