A colon biopsy sample under a magnifying glass, symbolizing the intersection of Chinese and global medical expertise in IBD diagnosis.

Decoding IBD: How Accurate Are Diagnoses Across Borders?

Mira Elwood in Health & Wellness December 2025 • 4 min read.

"A look into a new study that questions how well inflammatory bowel disease is diagnosed in China compared to the US."

Inflammatory Bowel Disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), is becoming more common in Asia, especially in China. While IBD is well-studied, the risk of colorectal cancer (CAC) in Asian patients with UC is similar to that of Western patients. This means that preventing CAC through colonoscopic surveillance is increasingly important in Asia.

The challenge? Most pathology in China is done in general practice, not by specialists. Since identifying dysplasia (irregular cell changes) is key for managing IBD, ensuring accurate diagnosis is crucial. This is where a new study comes in, aiming to evaluate how well pathologists in China diagnose IBD-related issues compared to gastrointestinal (GI) experts in the United States.

Telepathology, which involves remote diagnosis using digital images, offers a unique way to compare diagnostic accuracy across different regions. This approach helps to ensure that patients receive appropriate care, regardless of where they live. The study leverages this technology to assess and improve the diagnostic process in IBD.

Is There a Diagnostic Gap in IBD Across Continents?

A colon biopsy sample under a magnifying glass, symbolizing the intersection of Chinese and global medical expertise in IBD diagnosis.

The study included eight GI pathologists from the US and four pathologists from China, all experienced in GI pathology. They examined 50 colon biopsies from Chinese patients with a history of IBD. These samples, taken from eight different medical centers in China between 1999 and 2016, were digitized using an Aperio system.

One US pathologist reviewed all the images and selected key areas of interest at various magnifications. The other pathologists then evaluated these images and chose the most fitting diagnostic category for each case: negative, indefinite, low-grade dysplasia (LGD), high-grade dysplasia (HGD), or carcinoma. Statistical analyses, including Fleiss' kappa coefficient, were used to measure agreement among the pathologists.

Substantial Agreement in China: The four Chinese pathologists showed significant agreement in their diagnoses, with a kappa value of 0.68.
Agreement with US Consensus: The agreement between the Chinese pathologists and the consensus diagnosis from the US experts ranged from 0.75 to 0.80.
Diagnostic Categories: The consensus diagnoses included negative (22 cases), LGD (22 cases), HGD (3 cases), carcinoma (2 cases), and indefinite for dysplasia (1 case).

These results indicate that Chinese pathologists are quite accurate in diagnosing IBD-associated neoplasia, aligning well with the diagnoses of their US counterparts. This suggests that telepathology can effectively bridge diagnostic gaps and improve patient care.

Why This Matters for IBD Patients

This study highlights the potential of telepathology to standardize and improve diagnostic accuracy in IBD, regardless of geographical location. By leveraging digital imaging and remote consultation, healthcare professionals can ensure that patients receive the most accurate diagnoses and appropriate treatment plans. This is particularly important in regions where specialized expertise may not be readily available.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1155/2018/8715263, Alternate LINK

Title: Interobserver Agreement In The Diagnosis Of Inflammatory Bowel Disease-Associated Neoplasia In China In Comparison To Subspecialized American Gastrointestinal Pathologists

Subject: Gastroenterology

Journal: Gastroenterology Research and Practice

Publisher: Hindawi Limited

Authors: Xian-Rui Wu, Hua-Shan Liu, Xue-Ying Shi, Wei-Xun Zhou, Zhi-Nong Jiang, Yan Huang, Dipti M. Karamchandani, John R. Goldblum, Shu-Yuan Xiao, Hong-Fa Zhu, Michael M. Feely, Amy L. Collinsworth, Ashwini Esnakula, Hao Xie, Bo Shen, Ping Lan, Xiu-Li Liu

Published: 2018-01-01

Everything You Need To Know

What exactly is Inflammatory Bowel Disease (IBD), and why is accurate diagnosis so important?

Inflammatory Bowel Disease (IBD) includes conditions like ulcerative colitis (UC) and Crohn's disease (CD). These diseases are characterized by chronic inflammation of the digestive tract. Diagnosing IBD often involves identifying dysplasia, which are irregular cell changes that can indicate a higher risk of colorectal cancer (CAC). Accurate diagnosis is important for effective disease management and preventing complications like CAC, especially through colonoscopic surveillance.

Could you explain what telepathology is and why it's relevant to diagnosing IBD?

Telepathology is a method of remote diagnosis that uses digital images. In the context of IBD, telepathology allows pathologists in different locations to review and diagnose biopsy samples. This is particularly important for ensuring accurate and consistent diagnoses across different regions, especially where access to specialized expertise may be limited. It helps in standardizing the diagnostic process and improving patient care, regardless of geographical location.

What does the Fleiss' kappa coefficient measure, and what does the value of 0.68 signify in the context of the Chinese pathologists' diagnoses?

The Fleiss' kappa coefficient is a statistical measure used to assess the level of agreement among multiple raters or pathologists. A higher kappa value indicates better agreement. In the study, a kappa value of 0.68 among the Chinese pathologists suggests substantial agreement in their diagnoses of IBD-associated issues. This level of agreement is significant because it reflects consistency in diagnostic interpretations within the group.

What are the different diagnostic categories used for IBD, such as low-grade dysplasia (LGD) or high-grade dysplasia (HGD), and why are these distinctions important?

The diagnostic categories used in this study included: negative (no dysplasia), indefinite for dysplasia, low-grade dysplasia (LGD), high-grade dysplasia (HGD), and carcinoma. These categories represent the spectrum of cell changes that can occur in IBD patients, with carcinoma being the most severe. Accurate categorization is crucial because it determines the appropriate management and treatment strategies, such as the frequency of colonoscopic surveillance to detect and prevent colorectal cancer (CAC).

Why is it important to compare the agreement between Chinese pathologists and US experts in diagnosing IBD?

The agreement between Chinese pathologists and US experts is important because it highlights the potential for achieving consistent diagnostic accuracy across different healthcare systems. The study found that the agreement ranged from 0.75 to 0.80, suggesting that Chinese pathologists are aligning well with the diagnostic standards of their US counterparts. This is significant for improving patient care by ensuring that individuals receive appropriate and consistent diagnoses, regardless of where they are treated. It also validates the utility of telepathology in bridging diagnostic gaps.