使用超声和腹腔镜视频集预测道格拉斯窝消失：一项观察者间和诊断准确性研究。
Predicting Pouch of Douglas Obliteration Using Ultrasound and Laparoscopic Video Sets: An Interobserver and Diagnostic Accuracy Study.
机构信息
Acute Gynecology, Early Pregnancy, and Advanced Endosurgery Surgery Unit, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Kingswood, New South Wales, Australia.
Department of Computer Sciences, Aberystwyth University, Aberystwyth, Wales.
出版信息
J Ultrasound Med. 2019 Dec;38(12):3155-3161. doi: 10.1002/jum.15015. Epub 2019 Apr 29.
OBJECTIVES
To investigate the diagnostic accuracy and interobserver agreement among sonologists when assessing offline ultrasound (US) video sets of the "sliding sign" and among gynecologic surgeons when assessing corresponding laparoscopic video sets to predict pouch of Douglas (POD) obliteration and to compare the performance of the groups.
METHODS
A diagnostic and reproducibility study was conducted, including 15 observers in 4 groups: (1) senior sonologists, (2) junior sonologists, (3) general gynecologists, and (4) advanced laparoscopists. The sonologists viewed 25 offline preoperative US video sets of the sliding sign, and the surgeons viewed the corresponding intraoperative laparoscopic videos of the same patients. Each observer was asked to classify POD obliteration in the video sets and was compared to the reference standard POD state determined at real-time laparoscopy by a single investigator (G.C.). The interobserver correlation and diagnostic accuracy were evaluated among the 15 observers and 4 groups. The Cohen κ coefficient and Fleiss κ coefficient were used for the analysis.
RESULTS
The overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for senior sonologists were 93.3%, 100%, 89.6%, 84.4%, and 100%, respectively; for junior sonologists, 70.0%, 88.9%, 59.4%, 55.2%, and 90.5%; for general gynecologists, 75.2%, 88.1%, 78.1%, 69.8%, and 91.9%; and for advanced laparoscopists, 82.4%, 91.9%, 90.8%, 82.9%, and 95.8%. The overall agreement between senior sonologists was almost perfect (Fleiss κ = 0.876); for junior sonologists and general gynecologists, it was moderate (Fleiss κ = 0.589 and 0.528); and for advanced laparoscopists, it was substantial (Fleiss κ = 0.652).
CONCLUSIONS
Interobserver agreement was superior among senior sonologists. Prediction of POD obliteration using offline US videos by senior sonologists is comparable to offline assessments of laparoscopic videos by advanced laparoscopists for prediction of POD obliteration.
目的
探究超声科医生评估离线超声（US）视频“滑动征”和妇科外科医生评估相应腹腔镜视频时对预测Douglas 陷凹（POD）消失的诊断准确性和观察者间一致性，并比较两组的表现。
方法
进行了一项诊断和再现性研究，包括 4 组的 15 名观察者：（1）资深超声科医生，（2）初级超声科医生，（3）普通妇科医生，和（4）高级腹腔镜医生。超声科医生观看了 25 例离线术前 US 视频的滑动征，外科医生观看了同一患者的相应术中腹腔镜视频。每位观察者均被要求对视频中的 POD 消失进行分类，并与实时腹腔镜检查中由单一研究者（G.C.）确定的参考 POD 状态进行比较。对 15 名观察者和 4 组的观察者间相关性和诊断准确性进行了评估。使用 Cohen κ 系数和 Fleiss κ 系数进行分析。
结果
资深超声科医生的整体准确性、敏感性、特异性、阳性预测值和阴性预测值分别为 93.3%、100%、89.6%、84.4%和 100%；初级超声科医生分别为 70.0%、88.9%、59.4%、55.2%和 90.5%；普通妇科医生分别为 75.2%、88.1%、78.1%、69.8%和 91.9%；高级腹腔镜医生分别为 82.4%、91.9%、90.8%、82.9%和 95.8%。资深超声科医生之间的总体一致性近乎完美（Fleiss κ = 0.876）；初级超声科医生和普通妇科医生之间的一致性为中度（Fleiss κ = 0.589 和 0.528）；高级腹腔镜医生之间的一致性为高度（Fleiss κ = 0.652）。
结论
资深超声科医生之间的观察者间一致性更高。资深超声科医生通过离线 US 视频预测 POD 消失的准确性与高级腹腔镜医生通过离线评估腹腔镜视频预测 POD 消失的准确性相当。
Zotero 插件