Pak Martin Wai, Vlantis Alexander C, Chow Samuel, van Hasselt Charles Andrew
Department of Otorhinolaryngology, Head and Neck Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong SAR, China.
Laryngoscope. 2009 Mar;119(3):523-7. doi: 10.1002/lary.20060.
OBJECTIVES/HYPOTHESIS: To evaluate diagnostic reliability of contact rhinoscopy in patients with nasopharyngeal carcinoma.
A cross-sectional randomized single-blinded study was carried out to evaluate the reliability of the findings of contact rhinoscopy in patients with nasopharyngeal carcinoma assessed by different observers.
Random images of contact endoscopy of 157 subjects including normal patients and patients with nasopharyngeal carcinoma, both prior to external beam radiation therapy (RT), the non-RT group, and after external beam radiation therapy, the post-RT group, were available for analysis. Three independent observers of varying clinical experience and histopathologic knowledge viewed the images and made a diagnosis for each image. The diagnosis of each image was correlated with the histology of the biopsy from the corresponding patient.
In the non-RT group, Kappa values for inter- and intraobserver reliability to differentiate normal epithelium from primary nasopharyngeal carcinoma were 0.894, 1.000, 0.794 and 0.694, 1.000, 0.776 for the house officer, radiologist, and pathologist, respectively. There were no significant differences in interobserver and intraobserver reliabilities between the assessors. In the post-RT group, Kappa values for the inter- and intraobserver reliability to diagnose recurrent carcinoma or atypia, squamous metaplasia, and radiation change for the three observers were 0.820, 0.718, 0.775 and 0.731, 0.622, 0.734, respectively. There were no significant differences in interobserver and intraobserver reliabilities between the assessors.
The clinical diagnosis of nasopharyngeal carcinoma by contact endoscopy is highly reliable and is not dependent on the clinical experience or knowledge of histopathology of the observers.
目的/假设：评估接触式鼻内镜检查在鼻咽癌患者中的诊断可靠性。
开展一项横断面随机单盲研究，以评估不同观察者对鼻咽癌患者接触式鼻内镜检查结果的可靠性。
可获取157名受试者（包括正常患者和鼻咽癌患者）的接触式内镜随机图像进行分析，这些受试者分为两组，一组为外照射放疗（RT）前的非RT组，另一组为外照射放疗后的RT后组。三名具有不同临床经验和组织病理学知识的独立观察者查看图像并对每张图像进行诊断。每张图像的诊断结果与相应患者活检的组织学结果相关。
在非RT组中，住院医师、放射科医生和病理科医生区分正常上皮与原发性鼻咽癌的观察者间及观察者内可靠性的Kappa值分别为0.894、1.000、0.794和0.694、1.000、0.776。评估者之间的观察者间和观察者内可靠性无显著差异。在RT后组中，三名观察者诊断复发性癌或异型增生、鳞状化生和放射改变的观察者间及观察者内可靠性的Kappa值分别为0.820、0.718、0.775和0.731、0.622、0.734。评估者之间的观察者间和观察者内可靠性无显著差异。
通过接触式内镜对鼻咽癌进行临床诊断具有高度可靠性，且不依赖于观察者的临床经验或组织病理学知识。
