术前 CT 对胰腺癌可切除性的分类：观察者间一致性。
Preoperative CT Classification of the Resectability of Pancreatic Cancer: Interobserver Agreement.
机构信息
From the Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (I.J., J.M.L., D.H.L., H.J.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, Korea (I.J., J.M.L., D.H.L., H.J.K.); Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (J.M.L.); Department of Radiology, Chung-Ang University Hospital, Seoul, Korea (E.S.L.); Department of Radiology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea (J.Y.S.); Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea (S.J.A.); Department of Radiology, Seoul National University Bundang Hospital, Seoul, Korea (W.C.); Department of Radiology, Hallym University Sacred Heart Hospital, Anyang, Korea (S.M.L.); and Department of Medical Imaging, University of Toronto, Toronto, Canada (H.K.Y.).
出版信息
Radiology. 2019 Nov;293(2):343-349. doi: 10.1148/radiol.2019190422. Epub 2019 Sep 10.
Background Accurate assessment of local resectability of pancreatic cancer at initial workup is critical to determine the most appropriate management strategy among up-front operation, neoadjuvant treatment, or palliative treatment. Purpose To investigate the interobserver agreement of the preoperative CT classification of the local resectability of pancreatic cancer and to determine if radiologist experience level impacts evaluation, and to evaluate the reader performance in assessing resectability at CT in a subset of patients with a reference standard for local resectability. Materials and Methods This retrospective study was composed of patients with pathologic-analysis-confirmed pancreatic cancers between January 2013 and December 2014 who underwent baseline multiphasic contrast agent-enhanced CT. Eight board-certified radiologists with different levels of experience (more experienced, ≥6 years, = 4; less experienced, 1st- or 2nd-year fellows, = 4) reviewed the CT images and classified cancers as resectable, borderline resectable, or unresectable. Interobserver agreements were determined for all reviewers and subgroups of reviewers stratified according to experience (more vs less) by using Fleiss κ statistics. In patients with reference standards for local resectability, diagnostic performances of each reviewer were assessed by using receiver operating characteristic curve analysis. Results There were 110 patients (mean age, 61 years ± 11; 60 men) who were evaluated. Overall interobserver agreements were moderate for resectability classification (κ = 0.48; 95% confidence interval: 0.45, 0.50). Only 30.0% of patients (33 of 110) were given the same resectability classification from all reviewers. More experienced reviewers demonstrated higher agreement in category assignments than less experienced reviewers (κ = 0.55 [95% confidence interval: 0.50, 0.60] vs 0.43 [95% confidence interval: 0.38, 0.49], respectively). For prediction at CT of margin-negative (ie, R0) resections ( = 82), areas under the receiver operating characteristic curve of all reviewers were greater than 0.80 (range, 0.83-0.96). However, borderline resectable cancers showed diverse R0 rates ranging from 0% to 74% depending on the reviewers. Conclusion Considerable interobserver variability exists in the assignment at CT of the local resectability of pancreatic cancer, even among experienced radiologists. © RSNA, 2019
背景 准确评估胰腺癌初始检查时的局部可切除性对于确定最适当的治疗策略至关重要，这些策略包括直接手术、新辅助治疗或姑息治疗。目的 研究术前 CT 对胰腺癌局部可切除性的分类的观察者间一致性，并确定放射科医生的经验水平是否会影响评估结果，并评估在一组有局部可切除性参考标准的患者中，CT 评估可切除性的读者性能。材料与方法 本回顾性研究纳入了 2013 年 1 月至 2014 年 12 月期间接受基线多期对比增强 CT 检查并经病理分析证实为胰腺癌的患者。8 名具有不同经验水平（更有经验，≥6 年，n = 4；较有经验，第 1 年或第 2 年住院医师，n = 4）的经过认证的放射科医生回顾了 CT 图像，并将癌症分为可切除、边界可切除或不可切除。使用 Fleiss κ 统计量确定了所有观察者和根据经验分层的观察者亚组（更有经验与较有经验）的观察者间一致性。在有局部可切除性参考标准的患者中，使用接收者操作特征曲线分析评估了每位观察者的诊断性能。结果 共评估了 110 例患者（平均年龄，61 岁±11 岁；60 例男性）。整体而言，可切除性分类的观察者间一致性为中度（κ=0.48；95%置信区间：0.45，0.50）。只有 30.0%（33/110）的患者得到了所有观察者相同的可切除性分类。更有经验的观察者在类别分配上的一致性高于经验较少的观察者（κ=0.55[95%置信区间：0.50，0.60]与 0.43[95%置信区间：0.38，0.49]）。对于预测 CT 下无边缘阳性（即 R0）切除（n = 82），所有观察者的受试者工作特征曲线下面积均大于 0.80（范围，0.83-0.96）。然而，边界可切除性的癌症的 R0 率差异较大，范围为 0%至 74%，具体取决于观察者。结论 即使在有经验的放射科医生中，在 CT 评估胰腺癌的局部可切除性时，也存在相当大的观察者间差异。
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