Jang Byung Ik, Lee Si Hyung, Moon Jeong-Seop, Cheung Dae Young, Lee In Seok, Kim Jin Oh, Cheon Jae Hee, Park Cheol Hee, Byeon Jeong-Sik, Park Youn Sun, Shim Ki-Nam, Kim Yong-Sik, Kim Kyung-Jo, Lee Kwang Jae, Ryu Ji-Kon, Chang Dong Kyung, Chun Hoon Jai, Choi Myung-Gyu
Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea.
Scand J Gastroenterol. 2010 Mar;45(3):370-4. doi: 10.3109/00365520903521574.
Capsule endoscopy (CE) is a novel investigation for the diagnosis of small-bowel disease but its interpretation is highly subjective. We studied the inter-observer agreement and accuracy of the interpretation of CE findings based on capsule endoscopy structured terminology (CEST).
Fifty-six CE video clips were collected from eight university hospitals in South Korea and were independently reviewed by 13 gastroenterology experts and 10 trainees. All investigators recorded their findings based on CEST. To determine the accuracy of individual viewers, we defined the 'gold standard' as a joint review by four experts.
The 56 CE video clips included five normal cases, 19 cases of protruding lesions, 21 cases of depressed lesions, three cases of flat lesions, one case of abnormal mucosa, six cases with blood in the lumen, and one case of stenotic lumen. The overall mean accuracies for the experts and trainees were 74.3% +/- 22.6% and 61.7% +/- 25.4%, respectively. The overall accuracy for the trainee group was significantly lower than that for the expert group (P < 0.001), especially in normal, tumor, venous structure, and ulcer cases. The accuracies of the two groups varied with the CE findings. The accuracies were higher in cases with more prominent intraluminal changes (e.g. active small-bowel bleeding, ulcer, tumor, stenotic lumen). In contrast, subtle mucosal lesions, such as erosion, angioectasia, and diverticulum, had lower accuracies. The mean kappa values for the experts and trainees were 0.61 (range 0.39-0.97) and 0.46 (range 0.17-0.66), respectively.
Our results showed that there was substantial agreement between experts and moderate agreement between trainees. In order to achieve higher accuracies and better inter-observer agreement, we need not only more experience with CE but also consensus regarding CEST terminology.
胶囊内镜（CE）是诊断小肠疾病的一种新型检查方法，但其解读具有高度主观性。我们基于胶囊内镜结构化术语（CEST）研究了观察者间的一致性以及CE检查结果解读的准确性。
从韩国八所大学医院收集了56个CE视频片段，由13名胃肠病学专家和10名实习生独立进行评估。所有研究者均根据CEST记录其检查结果。为确定个体观察者的准确性，我们将由四名专家联合评估定义为“金标准”。
56个CE视频片段包括5例正常病例、19例隆起性病变、21例凹陷性病变、3例平坦性病变、1例黏膜异常、6例肠腔内出血病例以及1例肠腔狭窄病例。专家和实习生的总体平均准确率分别为74.3%±22.6%和61.7%±25.4%。实习生组的总体准确率显著低于专家组（P<0.001），尤其是在正常、肿瘤、静脉结构和溃疡病例中。两组的准确率随CE检查结果而变化。腔内变化更明显的病例（如活动性小肠出血、溃疡、肿瘤、肠腔狭窄）准确率更高。相比之下，糜烂、血管扩张和憩室等细微黏膜病变的准确率较低。专家和实习生的平均kappa值分别为0.61（范围0.39 - 0.97）和0.46（范围0.17 - 0.66）。
我们的结果表明，专家之间存在高度一致性，实习生之间存在中等程度一致性。为了获得更高的准确率和更好的观察者间一致性，我们不仅需要更多的CE经验，还需要就CEST术语达成共识。
