Choi Eun Jung, Lee Eun Hye, Kim You Me, Chang Yun-Woo, Lee Jin Hwa, Park Young Mi, Kim Keum Won, Kim Young Joong, Jun Jae Kwan, Hong Seri
Department of Radiology and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.
Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea.
Ultrasonography. 2019 Apr;38(2):172-180. doi: 10.14366/usg.18012. Epub 2018 Sep 22.
The purpose of this study was to record and evaluate interobserver agreement as quality control for the modified categorization of screening breast ultrasound developed by the Alliance for Breast Cancer Screening in Korea (ABCS-K) for the Mammography and Ultrasonography Study for Breast Cancer Screening Effectiveness (MUST-BE) trial.
Eight breast radiologists with 4-16 years of experience participated in 2 rounds of quality control testing for the MUST-BE trial. Two investigators randomly selected 125 and 100 cases of breast lesions with different ratios of malignant and benign lesions. Two versions of the modified categorization were tested. The initially modified classification was developed after the first quality control workshop, and the re-modified classification was developed after the second workshop. The re-modified categorization established by ABCS-K added size criteria and the anterior-posterior ratio compared with the initially modified classification. After a brief lecture on the modified categorization system prior to each quality control test, the eight radiologists independently categorized the lesions using the modified categorization. Interobserver agreement was measured using kappa statistics.
The overall kappa values for the modified categorizations indicated moderate to substantial degrees of agreement (initially modified categorization and re-modified categorization: κ=0.52 and κ=0.63, respectively). The kappa values for the subcategories of category 4 were 0.37 (95% confidence interval [CI], 0.24 to 0.52) and 0.39 (95% CI, 0.31 to 0.49), respectively. The overall kappa values for both the initially modified categorization and the re-modified categorization indicated a substantial degree of agreement when dichotomizing the interpretation as benign or suspicious.
The preliminary results demonstrated acceptable interobserver agreement for the modified categorization.
本研究旨在记录并评估观察者间的一致性，以此作为韩国乳腺癌筛查联盟（ABCS-K）为乳腺癌筛查效果的乳腺X线摄影和超声检查研究（MUST-BE）试验所开发的改良乳腺超声筛查分类的质量控制。
八位具有4至16年经验的乳腺放射科医生参与了MUST-BE试验的两轮质量控制测试。两名研究人员随机选取了125例和100例具有不同恶性和良性病变比例的乳腺病变病例。对两种版本的改良分类进行了测试。最初的改良分类是在第一次质量控制研讨会后制定的，重新改良的分类是在第二次研讨会后制定的。与最初的改良分类相比，ABCS-K建立的重新改良分类增加了尺寸标准和前后径比。在每次质量控制测试前，先就改良分类系统进行简短讲座，然后八位放射科医生使用改良分类对病变进行独立分类。使用kappa统计量来衡量观察者间的一致性。
改良分类的总体kappa值表明一致性程度为中等至高度（最初的改良分类和重新改良的分类：κ分别为0.52和0.63）。4类子类别的kappa值分别为0.37（95%置信区间[CI]，0.24至0.52）和0.39（95%CI，0.31至0.49）。当将解读分为良性或可疑时，最初改良分类和重新改良分类的总体kappa值均表明一致性程度较高。
初步结果表明改良分类的观察者间一致性可接受。
