Kalmin Bruce, Hoffman Brenda, Hawes Robert, Romagnuolo Joseph
Digestive Disease Center, Divission of Gastroenterology and Hepatology, Department of Medicine, Medical University of South Carolina, Charleston, South Dakota 29425, USA.
Can J Gastroenterol. 2011 May;25(5):261-4. doi: 10.1155/2011/302382.
The Rosemont criteria (RC) were recently proposed by expert consensus to standardize endoscopic ultrasound (EUS) features and thresholds for diagnosing chronic pancreatitis (CP); however, they are cumbersome and are not validated.
To determine interobserver agreement between RC and conventional criteria (CC), and to assess intertest agreement in the diagnosis of CP.
Thirty-six consecutive patients who underwent EUS for abdominal pain or pancreatitis were retrospectively reviewed. Anonymized images were independently chosen as best representations of the pancreatic body and reviewed by three experts who recorded the presence of CC and RC features. Agreement (proportion and kappa statistic) between CC and RC was calculated. Interobserver agreement within the CC and RC was assessed. Secondary comparisons with endoscopic retrograde cholangiopancreatography were made where available.
Using CC, 60 readings (83.3%) were negative for CP, while 12 readings (16.7%) were positive. Using RC, 59 readings (81.9%) were negative for CP, while 13 (18.1%) were positive. The weighted kappa for interobserver agreement for CC (four categories: normal⁄low probability, indeterminate, high probability or calcific) was 0.50, with 80.0% overall agreement, versus 0.27 and 68.1% for the four RC categories (normal, indeterminate, suggestive of and consistent with). Agreement on a positive diagnosis with CC was 86.1% (P=0.38 [McNemar's exact test]), with a kappa of 0.47; for RC, agreement was lower at 80.6% (P=0.016 [McNemar's exact test]), with a kappa of 0.38. For patients who underwent endoscopic retrograde cholangiopancreatography (n=12), false-negative and false-positive rates between CC and RC did not appear to be different.
The RC do not appear to achieve the goals of improving accuracy and interobserver agreement for diagnosing CP.
罗斯蒙特标准（RC）最近由专家共识提出，以规范内镜超声（EUS）诊断慢性胰腺炎（CP）的特征和阈值；然而，它们繁琐且未经验证。
确定RC与传统标准（CC）之间的观察者间一致性，并评估CP诊断中的检验间一致性。
回顾性分析36例因腹痛或胰腺炎接受EUS检查的连续患者。匿名图像被独立选为胰体的最佳代表，并由三位专家进行评估，他们记录CC和RC特征的存在情况。计算CC和RC之间的一致性（比例和kappa统计量）。评估CC和RC内的观察者间一致性。在可行的情况下，与内镜逆行胰胆管造影进行二次比较。
使用CC，60次读数（83.3%）CP为阴性，而12次读数（16.7%）为阳性。使用RC，59次读数（81.9%）CP为阴性，而13次（18.1%）为阳性。CC观察者间一致性的加权kappa（四类：正常/低概率、不确定、高概率或钙化）为0.50，总体一致性为80.0%，而RC四类（正常、不确定、提示和符合）为0.27和68.1%。CC阳性诊断的一致性为86.1%（P=0.38[McNemar精确检验]），kappa为0.47；对于RC，一致性较低，为80.6%（P=0.016[McNemar精确检验]），kappa为0.38。对于接受内镜逆行胰胆管造影的患者（n=12），CC和RC之间的假阴性和假阳性率似乎没有差异。
RC似乎未实现提高CP诊断准确性和观察者间一致性的目标。
