Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.
Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven, Belgium.
J Ultrasound Med. 2019 Oct;38(10):2673-2683. doi: 10.1002/jum.14971. Epub 2019 Feb 23.
To evaluate the intra- and inter-rater agreement for myometrial lesions using Morphologic Uterus Sonographic Assessment terminology.
Thirteen raters with high (n = 6) or medium experience (n = 7) assessed 30 3-dimensional ultrasound clips with (n = 20) and without (n = 10) benign myometrial lesions. Myometrial lesions were reported as poorly or well defined and then systematically evaluated for the presence of individual features. The clips were blindly assessed twice (at a 2-month interval). Intra- and inter-rater agreements were calculated with κ statistics.
The reporting of poorly defined lesions reached moderate intra-rater agreement (κ = 0.49 [high experience] and 0.47 [medium experience]) and poor inter-rater agreement (κ = 0.39 [high experience] and 0.25 [medium experience]). The reporting of well-defined lesions reached good to very good intra-rater agreement (κ = 0.73 [high experience] and 0.82 [medium experience]) and good inter-rater agreement (κ = 0.75 [high experience] and 0.63 [medium experience]). Most individual features associated with ill-defined lesions reached moderate intra- and inter-rater agreement among highly experienced raters (κ = 0.41-0.60). The least reproducible features were myometrial cysts, hyperechoic islands, subendometrial lines and buds, and translesional flow (κ = 0.11-0.34). Most individual features associated with well-defined lesions reached moderate to good intra- and inter-rater agreement among all observers (κ = 0.41-0.80). The least reproducible features were a serosal contour, asymmetry, a hyperechoic rim, and fan-shaped shadows (κ = 0.00-0.35).
The reporting of well-defined lesions showed excellent agreement, whereas the agreement for poorly defined lesions was low, even among highly experienced raters. The agreement on identifying individual features varied, especially for features associated with ill-defined lesions. Guidelines on minimum requirements for features associated with ill-defined lesions to be interpreted as poorly defined lesions may improve agreement.
使用形态学子宫超声评估术语评估子宫肌层病变的组内和组间一致性。
13 名具有高（n=6）或中等经验（n=7）的评估者评估了 30 个 3 维超声剪辑，其中 20 个剪辑有良性子宫肌层病变，10 个剪辑没有。子宫肌层病变的报告为定义不清或定义明确，然后对个别特征进行系统评估。这些剪辑被盲法评估两次（间隔 2 个月）。采用κ 统计法计算组内和组间的一致性。
报告定义不清的病变，高经验评估者（κ=0.49）和中经验评估者（κ=0.47）的组内一致性为中度，高经验评估者（κ=0.39）和中经验评估者（κ=0.25）的组间一致性为较差。报告定义明确的病变，高经验评估者（κ=0.73）和中经验评估者（κ=0.82）的组内一致性为好到非常好，高经验评估者（κ=0.75）和中经验评估者（κ=0.63）的组间一致性为好。与定义不清的病变相关的大多数个别特征在高经验评估者中具有中度的组内和组间一致性（κ=0.41-0.60）。最不可复制的特征是子宫肌层囊肿、高回声岛、子宫内膜下线条和芽、以及跨病变血流（κ=0.11-0.34）。与定义明确的病变相关的大多数个别特征在所有观察者中具有中度到良好的组内和组间一致性（κ=0.41-0.80）。最不可复制的特征是浆膜轮廓、不对称、高回声边缘和扇形阴影（κ=0.00-0.35）。
定义明确的病变的报告具有极好的一致性，而定义不清的病变的一致性较低，即使在高经验评估者中也是如此。对个别特征的识别一致性各不相同，尤其是与定义不清的病变相关的特征。关于将与定义不清的病变相关的特征解释为定义不清的病变所需的最低要求的指南可能会提高一致性。
