Menakaya U, Infante F, Lu C, Phua C, Model A, Messyne F, Brainwood M, Reid S, Condous G
Acute Gynaecology, Early Pregnancy and Advanced Endosurgery Unit, Nepean Medical School, Nepean Hospital, University of Sydney, Kingswood, NSW, Australia.
Aberystwyth University, Aberystwyth, Wales, UK.
Ultrasound Obstet Gynecol. 2016 Jul;48(1):113-20. doi: 10.1002/uog.15661. Epub 2016 May 23.
To determine inter- and intraobserver agreement, diagnostic accuracy and the learning curve required for interpreting the 'sliding sign' and predicting pouch of Douglas (POD) obliteration.
This was an inter-/intraobserver, diagnostic-accuracy and learning-curve study involving six observers with different medical backgrounds, clinical skill sets and prior gynecological ultrasound experience: five non-specialist observers who had performed 0-750 previous gynecological scans and an expert sonologist who had performed > 15 000. Following a formal theoretical and practical training session, they each viewed 64 offline transvaginal ultrasound (TVS) 'sliding-sign' videos from two anatomical locations (retrocervix and posterior uterine fundus (PUF)) in 32 women presenting with chronic pelvic pain, interpreting the videos as positive or negative for sliding sign and predicting, on that basis, the POD status. For intraobserver agreement analysis they re-analyzed the same video sets, in a different order, at least 7 days later. The expert sonologist was the reference standard for interpreting the sliding sign and the gold standard, laparoscopy, was used for the POD analysis. Learning-curve cumulative summation (LC-CUSUM) tests were conducted to assess if observer performance reached acceptable levels, using LC-CUSUM score < -2.45 as a cut-off.
With respect to interpretation of the sliding sign, the overall multiple-rater agreement was moderate (Fleiss' kappa, K = 0.499). Observers were more consistent in their interpretation of the second compared with the first observation set (K = 0.547 vs 0.453) and for the retrocervical compared with the PUF region (K = 0.556 vs 0.346). Regarding prediction of POD status, the accuracy, sensitivity, specificity and positive and negative predictive values for individual observers ranged from 65.4 to 96.2%, 80.0 to 100%, 64.7 to 100%, 50.0 to 100% and 94.7 to 100%, respectively. Using LC-CUSUM score < -2.45, the observer with experience of 200 previous gynecological scans reached acceptable levels for predicting POD obliteration and interpreting the sliding sign at each region (retrocervix and PUF) at 39, 54 and 28 videos and the observer with experience of 750 scans at 56, 53 and 53 videos.
Performance of a minimum number of gynecological ultrasound examinations is necessary for interpreting offline videos of the real-time dynamic sliding sign and predicting POD obliteration. Non-specialist observers with prior experience of 200 or more gynecological scans were more consistent in interpreting the sliding sign at the retrocervix vs PUF. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
确定观察者间及观察者内的一致性、诊断准确性以及解读“滑动征”和预测Douglas陷凹（POD）闭塞所需的学习曲线。
这是一项观察者间/观察者内、诊断准确性和学习曲线研究，涉及六名具有不同医学背景、临床技能组合和既往妇科超声经验的观察者：五名非专科观察者，他们之前进行过0 - 750次妇科扫描，以及一名专家级超声科医生，其进行过超过15000次扫描。在经过正式的理论和实践培训后，他们每人观看了来自32名慢性盆腔疼痛女性的两个解剖位置（宫颈后和子宫后壁（PUF））的64个离线经阴道超声（TVS）“滑动征”视频，将视频解读为滑动征阳性或阴性，并在此基础上预测POD状态。对于观察者内一致性分析，他们至少在7天后以不同顺序重新分析相同的视频集。专家级超声科医生是解读滑动征的参考标准，而金标准腹腔镜检查用于POD分析。进行学习曲线累积总和（LC - CUSUM）测试，以评估观察者的表现是否达到可接受水平，使用LC - CUSUM评分＜ - 2.45作为临界值。
关于滑动征的解读，总体多评分者一致性为中等（Fleiss' kappa，K = 0.499）。与第一组观察相比，观察者对第二组观察的解读更一致（K = 0.547对0.453），并且对宫颈后区域的解读比对PUF区域更一致（K = 0.556对0.346）。关于POD状态的预测，个体观察者的准确性、敏感性、特异性以及阳性和阴性预测值分别在65.4%至96.2%、80.0%至100%、64.7%至100%、50.0%至100%和94.7%至100%之间。使用LC - CUSUM评分＜ - 2.45，既往有200次妇科扫描经验的观察者在观看39、54和28个视频时，在预测POD闭塞和解读每个区域（宫颈后和PUF）的滑动征方面达到了可接受水平，而有750次扫描经验的观察者在观看56、53和53个视频时达到了可接受水平。
进行最少次数的妇科超声检查对于解读实时动态滑动征的离线视频和预测POD闭塞是必要的。既往有200次或更多妇科扫描经验的非专科观察者在解读宫颈后区域与PUF区域的滑动征时更具一致性。版权所有© 2015国际妇产科超声学会。由John Wiley & Sons Ltd出版。
