Department of Internal Medicine, Division of Gastroenterology and Hepatology, Mayo Clinic Florida, 4500 San Pablo Rd., Jacksonville, FL 32224, USA.
Dig Dis Sci. 2011 Nov;56(11):3204-8. doi: 10.1007/s10620-011-1725-8. Epub 2011 May 14.
Endoscopic ultrasound (EUS) is used to locally stage aerodigestive malignancies. Endosonographic features are used to predict malignant lymph nodes (MLN). Interobserver agreement on the endosonographic features of MLN has not been described.
To evaluate the interobserver agreement among endosonographers on the EUS features of MLN in aerodigestive malignancies along with the specific feature used to make this distinction.
A total of 760 procedures of suspected LN were reviewed. Cases were selected based on cytology-proven malignant or benign LN involvement by FNA with correspondent photodocumentation. Images of each LN were de-identified and distributed to three expert endosonographers. The experts recorded the LN's echogenicity (hypoechoic or other), shape (round or other), border (sharp or fuzzy) and subjective diagnosis (benign or malignant). The relationship between the endosonographers' subjective as well as the pathological diagnosis and LN's endosonographic features were analyzed using logistic regression analysis. Pair-wise comparison between endoscopist and interobserver agreement (kappa statistics) were performed.
Images of 41 malignant and 35 benign LN were evaluated. There was fair agreement on shape, Κ = 0.35 (95% CI 0.2-0.5), and moderate agreement on echogenicity and borders, Κ = 0.46 (95% CI 0.31-0.61) and 0.43 (95% CI 0.27-0.58) respectively. The agreement on malignant LN was good, Κ = 0.65 (95% CI 0.5-0.8). The overall diagnostic predictive accuracy ranged from 70 to 77% among the three endoscopists.Two of the three endoscopists assessed shape as the most predictive feature of malignancy (OR 39.4, 95% CI 3.29-470.96).
The inter-observer agreement on the individual lymph node features as obtained by EUS is moderate with good overall agreement on the diagnosis. Round shape was the feature most strongly associated with a diagnosis of MLN.
内镜超声（EUS）用于局部分期呼吸道和消化道恶性肿瘤。超声内镜特征用于预测恶性淋巴结（MLN）。关于 MLN 的超声内镜特征的观察者间一致性尚未描述。
评估内镜超声医师在呼吸道和消化道恶性肿瘤中 MLN 的 EUS 特征的观察者间一致性，以及用于做出这种区分的具体特征。
共回顾了 760 例疑似淋巴结的操作。根据 FNA 细胞学证实的恶性或良性淋巴结受累情况选择病例，并伴有相应的光记录。每个淋巴结的图像均进行去识别处理，并分发给三位专家内镜超声医师。专家记录了淋巴结的回声特性（低回声或其他）、形状（圆形或其他）、边界（清晰或模糊）和主观诊断（良性或恶性）。使用逻辑回归分析分析内镜超声医师的主观诊断以及病理诊断与淋巴结的超声内镜特征之间的关系。进行内镜超声医师之间的两两比较和观察者间一致性（kappa 统计）。
评估了 41 个恶性和 35 个良性淋巴结的图像。在形状上有适度的一致性，Κ=0.35（95%CI 0.2-0.5），在回声特性和边界上有中度的一致性，Κ=0.46（95%CI 0.31-0.61）和 0.43（95%CI 0.27-0.58）。恶性淋巴结的一致性良好，Κ=0.65（95%CI 0.5-0.8）。三位内镜超声医师的总体诊断预测准确性范围为 70%至 77%。三位内镜超声医师中有两位将形状评估为恶性的最具预测性特征（OR 39.4，95%CI 3.29-470.96）。
EUS 获得的单个淋巴结特征的观察者间一致性为中度，总体诊断一致性良好。圆形是与 MLN 诊断最密切相关的特征。
