一项针对经验丰富的内镜超声检查医师对胰腺囊肿“串珠征”观察者间变异性的国际研究。
An international study of interobserver variability of "string sign" of pancreatic cysts among experienced endosonographers.
作者信息
Hakim Seifeldin, Coronel Emmanuel, González Graciela M Nogueras, Ge Philip S, Chari Suresh T, Thosani Nirav, Ramireddy Srinivas, Badillo Ricardo, DaVee Tomas, Catalano Marc F, Sealock Robert J, Parupudi Sreeram, Hernandez Lyndon V, Joshi Virendra, Irisawa Atsushi, Rana Surinder, Lakhtakia Sundeep, Vilmann Peter, Saftoiu Adrian, Sun Siyu, Giovannini Marc, Katz Matthew H, Kim Michael P, Bhutani Manoop S
机构信息
Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center, Houston, TX, USA.
Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
出版信息
Endosc Ultrasound. 2021 Jan-Feb;10(1):39-50. doi: 10.4103/eus.eus_73_20.
BACKGROUND AND OBJECTIVES
No single optimal test reliably determines the pancreatic cyst subtype. Following EUS-FNA, the "string sign" test can differentiate mucinous from nonmucinous cysts. However, the interobserver variability of string sign results has not been studied.
METHODS
An experienced endosonographer performed EUS-FNA of pancreatic cysts on different patients and was recorded on video performing the string sign test for each. The videos were shared internationally with 14 experienced endosonographers, with a survey for each video: "Is the string sign positive?" and "If the string sign is positive, what is the length of the formed string?" Also asked "What is the cutoff length for string sign to be considered positive?" Interobserver variability was assessed using the kappa statistic (κ).
RESULTS
A total of 112 observations were collected from 14 endosonographers. Regarding string sign test positivity, κ was 0.6 among 14 observers indicating good interrater agreement (P < 0.001) while κ was 0.38 when observers were compared to the index endosonographer demonstrating marginal agreement (P < 0.001). Among observations of the length of the string in positive samples, 89.8% showed >5 mm of variability (P < 0.001), indicating marked variability. There was poor agreement on the cutoff length for a string to be considered positive.
CONCLUSION
String sign of pancreatic cysts has a good interobserver agreement regarding its positivity that can help in differentiating mucinous from nonmucinous pancreatic cysts. However, the agreement is poor on the measured length of the string and the cutoff length of the formed string to be considered a positive string sign.
背景与目的
没有单一的最佳检测方法能够可靠地确定胰腺囊肿的亚型。在超声内镜引导下细针穿刺活检（EUS-FNA）后，“线征”检测可区分黏液性囊肿和非黏液性囊肿。然而，线征结果的观察者间变异性尚未得到研究。
方法
一位经验丰富的内镜超声医师对不同患者的胰腺囊肿进行EUS-FNA，并对每次操作进行线征检测的过程进行视频记录。这些视频在国际上分享给14位经验丰富的内镜超声医师，并针对每个视频进行调查：“线征是否为阳性？”以及“如果线征为阳性，形成的线的长度是多少？”同时询问“线征被认为阳性的截断长度是多少？”使用kappa统计量（κ）评估观察者间变异性。
结果
共收集到14位内镜超声医师的112份观察结果。关于线征检测的阳性率，14位观察者之间的κ为0.6，表明观察者间一致性良好（P < 0.001），而将观察者与索引内镜超声医师进行比较时，κ为0.38，表明一致性一般（P < 0.001）。在阳性样本中线的长度观察结果中，89.8%显示变异性>5 mm（P < 0.001），表明变异性显著。对于线被认为阳性的截断长度，一致性较差。
结论
胰腺囊肿的线征在其阳性方面具有良好的观察者间一致性，这有助于区分黏液性和非黏液性胰腺囊肿。然而，在测量的线的长度以及形成的线被认为是阳性线征的截断长度方面，一致性较差。
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