Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Erasmus University Medical Center, Rotterdam, the Netherlands.
Int J Gynecol Cancer. 2013 Jun;23(5):890-4. doi: 10.1097/IGC.0b013e318292da65.
The objective of this study was to assess the interobserver variability of pelvic examination under anesthesia (EUA) in cervical cancer.
Subsequent patients undergoing a staging procedure under anesthesia for primary cervical cancer were enrolled in the study. All clinicians assessed "blinded" tumor size, and the involvement of vagina, parametria, sacrouterine ligaments, pelvic sidewalls, bladder, and/or rectum. Items were scored varying from 1 ("certainly no involvement"), 2 ("not sure about involvement"), to 3 ("involvement"). Each individual decided on the International Federation of Gynecology and Obstetrics (FIGO) stage; also, the urge for imaging and treatment proposal were accounted for. Final FIGO staging was obtained by consensus of the team. Investigators were classified as experienced after more than 50 EUAs. All others were classified less experienced. The free-marginal κ values between experienced and less experienced investigators were calculated for all previously mentioned items.
Between February 2009 and December 2010, a total of 86 patients were enrolled. Among experienced investigators, a moderate interobserver agreement was found with regard to FIGO stage (free-marginal κ value of 0.49) and an excellent interobserver agreement on their proposed therapy (free-marginal κ value of 0.84). A lower level of agreement was found when comparing experienced with less experienced investigators: only a slight level of agreement on FIGO stage and a substantial agreement on their therapy proposal (free-marginal κ values of 0.03 and 0.66).
We describe only a moderate interobserver agreement on clinical staging of patients with cervical cancer. The interobserver agreement increases in the group of experienced doctors, indicating that EUA can be learned.
本研究旨在评估宫颈癌麻醉下盆腔检查（EUA）的观察者间变异性。
随后招募了因原发性宫颈癌接受麻醉分期手术的患者。所有临床医生均评估了“盲法”肿瘤大小以及阴道、宫旁组织、骶子宫韧带、骨盆侧壁、膀胱和/或直肠的受累情况。各项评分从 1（“肯定无受累”）、2（“不确定受累”）到 3（“受累”）不等。每位医生独立决定国际妇产科联合会（FIGO）分期；同时，还考虑了影像学检查的必要性和治疗建议。最终的 FIGO 分期由团队共识得出。具有 50 次以上 EUA 经验的研究者被归类为经验丰富，其余的则归类为经验较少。计算了经验丰富和经验较少的研究者之间所有上述项目的自由边缘κ值。
2009 年 2 月至 2010 年 12 月期间，共纳入 86 例患者。在经验丰富的研究者中，FIGO 分期的观察者间一致性为中度（自由边缘κ值为 0.49），而治疗建议的观察者间一致性为极好（自由边缘κ值为 0.84）。与经验较少的研究者相比，这种一致性程度较低：仅在 FIGO 分期上存在轻度一致性，而在治疗建议上存在高度一致性（自由边缘κ值分别为 0.03 和 0.66）。
我们仅描述了宫颈癌患者临床分期的观察者间中度一致性。在经验丰富的医生组中，观察者间的一致性增加，表明 EUA 是可以学习的。
