Zannoni L, Savelli L, Jokubkiene L, Di Legge A, Condous G, Testa A C, Sladkevicius P, Valentin L
Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy; Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Lund University, Malmö, Sweden.
Ultrasound Obstet Gynecol. 2014 Jul;44(1):100-8. doi: 10.1002/uog.13273. Epub 2014 Jun 1.
To estimate intraobserver repeatability and interobserver agreement in assessing the presence of papillary projections in adnexal masses and in classifying adnexal masses using the International Ovarian Tumor Analysis terminology for ultrasound examiners with different levels of experience. We also aimed to identify ultrasound findings that cause confusion and might be interpreted differently by different observers, and to determine if repeatability and agreement change after consensus has been reached on how to interpret 'problematic' ultrasound images.
Digital clips (two to eight clips per adnexal mass) with gray-scale and color/power Doppler information of 83 adnexal masses in 80 patients were evaluated independently four times, twice before and twice after a consensus meeting, by four experienced and three less experienced ultrasound observers. The variables analyzed were tumor type (unilocular, unilocular solid, multilocular, multilocular solid, solid) and presence of papillary projections. Intraobserver repeatability was evaluated for each observer (percentage agreement, Cohen's kappa). Interobserver agreement was estimated for all seven observers (percentage agreement, Fleiss kappa, Cohen's kappa).
There was uncertainty about how to define a solid component and a papillary projection, but consensus was reached at the consensus meeting. Interobserver agreement for tumor type was good both before and after the consensus meeting, with no clear improvement after the meeting, mean percentage agreement being 76.0% (Fleiss kappa, 0.695) before the meeting and 75.4% (Fleiss kappa, 0.682) after the meeting. Interobserver agreement with regard to papillary projections was moderate both before and after the consensus meeting, with no clear improvement after the meeting, mean percentage agreement being 86.6% (Fleiss kappa, 0.536) before the meeting and 82.7% (Fleiss kappa, 0.487) after it. There was substantial variability in pairwise agreement for papillary projections (Cohen's kappa, 0.148-0.787). Intraobserver repeatability with regard to tumor type was very good and similar before and after the consensus meeting (agreement 87-95%, kappa, 0.83-0.94). With regard to papillary projections intraobserver repeatability was good or very good both before and after the consensus meeting (agreement 88-100%, kappa, 0.64-1.0).
Despite uncertainty about how to define solid components, interobserver agreement was good for tumor type. The interobserver agreement for papillary projection was moderate but very variable between observer pairs. The term 'papillary projection' might need a more precise definition. The consensus meeting did not change inter- or intraobserver agreement.
评估不同经验水平的超声检查者在使用国际卵巢肿瘤分析术语评估附件包块中乳头样突起的存在情况以及对附件包块进行分类时的观察者内重复性和观察者间一致性。我们还旨在识别可能导致混淆且不同观察者可能有不同解读的超声表现，并确定在就如何解读“有问题的”超声图像达成共识后，重复性和一致性是否会发生变化。
对80例患者的83个附件包块的数字片段（每个附件包块有2至8个片段）进行评估，这些片段包含灰阶和彩色/能量多普勒信息，由4名经验丰富和3名经验较少的超声观察者独立评估4次，在共识会议前评估2次，会后评估2次。分析的变量包括肿瘤类型（单房、单房实性、多房、多房实性、实性）和乳头样突起的存在情况。对每位观察者评估观察者内重复性（一致性百分比、Cohen's kappa值）。对所有7名观察者评估观察者间一致性（一致性百分比、Fleiss kappa值、Cohen's kappa值）。
在如何定义实性成分和乳头样突起方面存在不确定性，但在共识会议上达成了共识。在共识会议前后，观察者间对肿瘤类型的一致性均良好，会议后无明显改善，会议前平均一致性百分比为76.0%（Fleiss kappa值为0.695），会议后为75.4%（Fleiss kappa值为0.682）。在共识会议前后，观察者间关于乳头样突起的一致性均为中等，会议后无明显改善，会议前平均一致性百分比为86.6%（Fleiss kappa值为0.536），会后为82.7%（Fleiss kappa值为0.487）。乳头样突起的两两一致性存在很大差异（Cohen's kappa值为0.148 - 0.787）。在共识会议前后，观察者内关于肿瘤类型的重复性都非常好且相似（一致性为87 - 95%，kappa值为0.83 - 0.94）。关于乳头样突起，观察者内重复性在共识会议前后均为良好或非常好（一致性为88 - 100%，kappa值为0.64 - 1.0）。
尽管在如何定义实性成分方面存在不确定性，但观察者间对肿瘤类型的一致性良好。观察者间关于乳头样突起的一致性为中等，但观察者对之间差异很大。“乳头样突起”这一术语可能需要更精确的定义。共识会议并未改变观察者间或观察者内的一致性。
