Gress F, Schmitt C, Savides T, Faigel D O, Catalano M, Wassef W, Roubein L, Nickl N, Ciaccia D, Bhutani M, Hoffman B, Affronti J
Divisions of Gastroenterology and Hepatology, Winthrop-University Hospital/SUNY at Stony Brook, Long Island NY 11501, USA.
Gastrointest Endosc. 2001 Jan;53(1):71-6. doi: 10.1067/mge.2001.111384.
EUS is an accurate means of evaluating and diagnosing submucosal lesions of the GI tract. The aim of this study was to prospectively determine interobserver agreement for the EUS classification of submucosal masses among endosonographers with different levels of training and experience from multiple centers.
Twenty patients with submucosal mass lesions diagnosed by upper endoscopy underwent EUS. Surgical findings were available for 16 patients. In 4 patients with obvious cystic/vascular structures (i.e., varices) no surgical specimen was necessary. A blinded observer developed a study videotape of critical endoscopic and EUS real-time imaging for each lesion. The videotape was distributed to 10 endosonographers, each with at least 1 year of experience, who independently reviewed the videotape and recorded their diagnosis based on EUS features. These endosonographers used previously agreed-upon standardized EUS diagnostic criteria for each category of lesion. A kappa (kappa) statistic, used to evaluate agreement, was calculated for each lesion category for the 10 endosonographers as a group and individually. An overall kappa statistic was also calculated. Significance was analyzed with a two-tailed t test.
Agreement was excellent for cystic lesions (kappa = 0.80) and extrinsic compressions (kappa = 0.94), good for lipoma (kappa = 0.65), fair for leiomyoma and vascular lesions (kappa = 0.53 and 0.54, respectively), and poor for other submucosal lesions (kappa = 0.34). Overall agreement among observers was good (kappa = 0.63). Furthermore, a significant association was noted between total years of EUS experience and the number of correct answers (p = 0.01).
Interobserver agreement is good for characterizing submucosal masses by EUS. However, it appears to be better for some lesions than others. The overall length of experience with EUS appears to play an important role in the accuracy of this modality in the evaluation of submucosal lesions.
超声内镜（EUS）是评估和诊断胃肠道黏膜下病变的一种准确方法。本研究的目的是前瞻性地确定来自多个中心、具有不同培训水平和经验的内镜超声医师对黏膜下肿块进行EUS分类时的观察者间一致性。
20例经上消化道内镜诊断为黏膜下肿块病变的患者接受了EUS检查。16例患者有手术结果。4例有明显囊性/血管结构（即静脉曲张）的患者无需手术标本。一名盲法观察者为每个病变制作了包含关键内镜和EUS实时成像的研究录像带。该录像带分发给10名内镜超声医师，每人至少有1年经验，他们独立观看录像带并根据EUS特征记录诊断结果。这些内镜超声医师对每类病变使用先前商定的标准化EUS诊断标准。为10名内镜超声医师作为一个整体以及个体计算用于评估一致性的kappa（κ）统计量。还计算了总体kappa统计量。采用双侧t检验分析显著性。
对于囊性病变（κ = 0.80）和外压性病变（κ = 0.94），一致性极佳；对于脂肪瘤（κ = 0.65），一致性良好；对于平滑肌瘤和血管性病变（分别为κ = 0.53和0.54），一致性中等；对于其他黏膜下病变（κ = 0.34），一致性较差。观察者间的总体一致性良好（κ = 0.63）。此外，还发现EUS总经验年限与正确答案数量之间存在显著关联（p = 0.01）。
通过EUS对黏膜下肿块进行特征描述时，观察者间一致性良好。然而，对于某些病变似乎比其他病变更好。EUS的总体经验时长似乎在这种方式评估黏膜下病变的准确性方面起着重要作用。
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