Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, USA.
Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah, USA.
BJOG. 2017 Jan;124(2):220-229. doi: 10.1111/1471-0528.13711. Epub 2015 Oct 5.
To determine agreement on endometriosis diagnosis between real-time laparoscopy and subsequent expert review of digital images, operative reports, magnetic resonance imaging (MRI), and histopathology, viewed sequentially.
Inter-rater agreement study.
Five urban surgical centres.
Women, aged 18-44 years, who underwent a laparoscopy regardless of clinical indication. A random sample of 105 women with and 43 women without a postoperative endometriosis diagnosis was obtained from the ENDO study.
Laparoscopies were diagnosed, digitally recorded, and reassessed.
Inter-observer agreement of endometriosis diagnosis and staging according to the revised American Society for Reproductive Medicine criteria. Prevalence and bias-adjusted kappa values (κ) were calculated for diagnosis, and weighted κ values were calculated for staging.
Surgeons and expert reviewers had substantial agreement on diagnosis and staging after viewing digital images (n = 148; mean κ = 0.67, range 0.61-0.69; mean κ = 0.64, range 0.53-0.78, respectively) and after additionally viewing operative reports (n = 148; mean κ = 0.88, range 0.85-0.89; mean κ = 0.85, range 0.84-0.86, respectively). Although additionally viewing MRI findings (n = 36) did not greatly impact agreement, agreement substantially decreased after viewing histological findings (n = 67), with expert reviewers changing their assessment from a positive to a negative diagnosis in up to 20% of cases.
Although these findings suggest that misclassification bias in the diagnosis or staging of endometriosis via visualised disease is minimal, they should alert gynaecologists who review operative images in order to make decisions on endometriosis treatment that operative reports/drawings and histopathology, but not necessarily MRI, will improve their ability to make sound judgments.
Endometriosis diagnosis and staging agreement between expert reviewers and operating surgeons was substantial.
确定实时腹腔镜检查与随后对数字图像、手术报告、磁共振成像（MRI）和组织病理学的专家审查之间在子宫内膜异位症诊断上的一致性，这些检查结果依次查看。
观察者间一致性研究。
五个城市手术中心。
年龄在 18-44 岁之间的接受腹腔镜检查的女性，无论临床指征如何。从 ENDO 研究中随机抽取了 105 例术后诊断为子宫内膜异位症的女性和 43 例术后未诊断为子宫内膜异位症的女性。
对腹腔镜检查进行诊断、数字记录和重新评估。
根据修订后的美国生殖医学协会标准，评估子宫内膜异位症诊断和分期的观察者间一致性。计算了诊断的阳性和偏倚调整后的κ值（κ），并计算了分期的加权κ值。
在观看数字图像（n=148）后，外科医生和专家审查员在诊断和分期方面具有实质性的一致性（平均κ=0.67，范围为 0.61-0.69；平均κ=0.64，范围为 0.53-0.78），在观看手术报告（n=148）后也具有实质性的一致性（平均κ=0.88，范围为 0.85-0.89；平均κ=0.85，范围为 0.84-0.86）。尽管额外观看 MRI 结果（n=36）并没有显著影响一致性，但在观看组织学结果（n=67）后，一致性大大降低，专家审查员在多达 20%的病例中改变了他们的评估，从阳性诊断变为阴性诊断。
尽管这些发现表明通过可视化疾病进行子宫内膜异位症诊断或分期的分类错误偏倚最小，但它们应该提醒审查手术图像以做出子宫内膜异位症治疗决策的妇科医生，手术报告/绘图和组织病理学，但不一定是 MRI，将提高他们做出正确判断的能力。
专家审查员和手术外科医生在子宫内膜异位症诊断和分期方面的一致性很高。
