Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX.
Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA.
Int Forum Allergy Rhinol. 2019 Jan;9(1):39-45. doi: 10.1002/alr.22200. Epub 2018 Sep 14.
Inconsistencies in the nomenclature of structures of the frontal sinus have impeded the development of a validated "reference standard" classification system that surgeons can reliably agree upon. The International Frontal Sinus Anatomy Classification (IFAC) system was developed as a consensus document, based on expert opinion, attempting to address this issue. The purposes of this study are to: establish the reliability of the IFAC as a tool for classifying cells in the frontal recess among an international group of rhinologists; and improve communication and teaching of frontal endoscopic sinus surgery (ESS).
Forty-two computed tomography (CT) scans, each with a marked frontal cell, were reviewed by 15 international fellowship-trained rhinologists. Each marked cell was classified into 1 of 7 categories described in the IFAC, on 2 occasions separated by 2 weeks. Inter- and intrarater reliability were evaluated using Light's kappa (κ), the interclass correlation coefficient (ICC), and simple proportion of agreement.
Interrater reliability showed pairwise κ values ranging from 0.7248 to 1.0, with a mean of 0.9162 (SD, 0.0537). The ICC was 0.98. Intrarater reliability showed κ values ranging from 0.8613 to 1.0, with a mean of 0.9407 (SD, 0.0376). The within-rater ICC was 0.98.
Among a diverse sample of rhinologists (raters), there was substantial to almost perfect agreement between raters, and among individual raters at different timepoints. The IFAC is a reliable tool for classification of cells in the frontal sinus. Further outcome studies are still needed to determine the validity of the IFAC.
额窦结构命名法的不一致性阻碍了验证性“参考标准”分类系统的发展，而外科医生可以可靠地达成一致。国际额窦解剖分类（IFAC）系统是作为共识文件开发的，基于专家意见，试图解决这个问题。本研究的目的是：在国际鼻科医生群体中，确定 IFAC 作为额窦隐窝细胞分类工具的可靠性；并改善经鼻内镜鼻窦手术（ESS）的沟通和教学。
由 15 名国际 fellowship培训的鼻科医生对 42 份 CT 扫描进行了回顾，每份 CT 扫描均标记有额窦细胞。每个标记的细胞在 2 周的间隔内，通过 2 次评估，被分为 IFAC 中描述的 7 个类别的 1 个。使用 Light's kappa（κ）、组内相关系数（ICC）和简单一致性比例评估组内和组间可靠性。
组间可靠性显示，两两 κ 值范围为 0.7248 至 1.0，平均为 0.9162（SD，0.0537）。ICC 为 0.98。组内可靠性显示 κ 值范围为 0.8613 至 1.0，平均为 0.9407（SD，0.0376）。个体观察者的 ICC 为 0.98。
在一组多样化的鼻科医生（观察者）中，观察者之间以及不同时间点的个体观察者之间存在明显的几乎完全一致的情况。IFAC 是额窦细胞分类的可靠工具。仍需要进一步的结果研究来确定 IFAC 的有效性。
