Department of Gastroenterology, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan.
Department of Gastroenterology, Juntendo University, Tokyo, Japan.
PLoS One. 2019 Feb 22;14(2):e0212427. doi: 10.1371/journal.pone.0212427. eCollection 2019.
Various studies have been previously conducted on the diagnosis of lymphadenopathy as benign or malignant, but the results vary. These studies did not describe the inter-rater agreement on the EUS features of lymphadenopathy. In this study, we evaluate the inter-rater agreement on EUS features and propose EUS diagnostic norms for lymphadenopathy based on inter-rater agreement.
A total of 68 lymph nodes subjected to EUS-fine needle aspiration (FNA) were reviewed by five endoscopic experts. The EUS features evaluated lymph node size, shape, border, margin, echogenicity, homogeneity, and the hilum of the lymph node. Inter-rater agreement (multi-rater kappa statics) was performed. We established new criteria using results with a high degree of inter-rater agreement from EUS features and compared them with the former criteria.
There was a moderate agreement on shape, kappa (K) = 0.44 (95% confidence interval [CI]: 0.34-0.54), and fair agreement on echogenicity, homogeneity, border, and hilum of the lymph node, K (95% CI) = 0.33 (0.17-0.38), 0.34 (0.26-0.35), 0.22 (0.21-0.31), and 0.22 (0.11-0.26), respectively. This resulted in the establishment of new EUS diagnostic criteria using shape, long axis > 20 mm and short axis > 10 mm. New criteria were superior to old criteria (area under the curve 0.82 vs 0.52, P < 0.001).
EUS diagnostic criteria for lymphadenopathy based on inter-rater agreement were more accurate than old criteria. This result will be useful for the diagnosis of lymphadenopathy.
先前已经有多项研究针对淋巴结病的良性或恶性诊断进行了研究，但结果各异。这些研究并未描述超声内镜（EUS）特征对淋巴结病的观察者间一致性。在本研究中，我们评估了 EUS 特征的观察者间一致性，并基于观察者间一致性提出了用于诊断淋巴结病的 EUS 诊断标准。
由五位内镜专家对 68 个接受 EUS 细针穿刺（FNA）的淋巴结进行了回顾性分析。评估的 EUS 特征包括淋巴结大小、形状、边界、边缘、回声、均匀性和淋巴结门。进行了观察者间一致性（多观察者 Kappa 统计学）评估。我们使用具有高度观察者间一致性的 EUS 特征结果建立了新的标准，并将其与先前的标准进行了比较。
在形状上具有中度一致性，Kappa（K）= 0.44（95%置信区间 [CI]：0.34-0.54），在回声、均匀性、边界和淋巴结门方面具有适度一致性，K（95% CI）= 0.33（0.17-0.38）、0.34（0.26-0.35）、0.22（0.21-0.31）和 0.22（0.11-0.26）。这导致使用形状、长轴>20mm 和短轴>10mm 建立了新的 EUS 诊断标准。新标准优于旧标准（曲线下面积 0.82 对 0.52，P<0.001）。
基于观察者间一致性的 EUS 诊断淋巴结病的标准比旧标准更准确。该结果将有助于淋巴结病的诊断。
