Abbasi Nimrah, Ryan Greg, Ruano Rodrigo, Sanz Cortes Magda, Ye Xiang Y, Shah Prakesh S, Filly Roy, Benachi Alexandra, Johnson Anthony
Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Mayo College of Medicine, Rochester, Minnesota, USA.
Prenat Diagn. 2022 Mar;42(3):348-356. doi: 10.1002/pd.5949. Epub 2021 Apr 24.
To evaluate inter-rater agreement for sonographic classification of stomach position (as a surrogate for liver herniation) in fetal left congenital diaphragmatic hernia (LCDH) among: (i) fetal medicine specialists from the North American Fetal Therapy Network (NAFTNet) centers within and without the fetal endoscopic tracheal occlusion (FETO) consortium and in comparison to an expert external reviewer (ER1); and (iii) among two expert ERs (ER1 and ER2).
Forty-eight physicians from 26 NAFTNet centers and 2 ERs were asked to assess 13 sonographic clips of isolated LCDH and classify stomach position as "intra-abdominal," "anterior left chest," "mid to posterior left chest," or "retro-cardiac" based on the classification published by Basta et al. Interrater agreement was assessed by determining proportion of stomach position ratings concordant amongst NAFTNet participants and ER1. Agreement for stomach position between ERs was calculated using kappa statistics.
Agreement for stomach position was 69% (39%-85%; n = 19) and 54% (23%-92%; n = 29) among FETO and non-FETO NAFTNet participants, respectively, when compared to ER1. Most disagreement in stomach position was related to a discrepancy of one position. ERs were in agreement for stomach position in 5 of 13 cases (38.5%) and inter-rater agreement was highest for "anterior" stomach position.
Interrater agreement for stomach position assessment in CDH was poor across NAFTNet and indeed amongst expert reviewers.
评估胎儿左先天性膈疝（LCDH）中胃位置的超声分类（作为肝脏疝出的替代指标）在以下人群中的评分者间一致性：（i）北美胎儿治疗网络（NAFTNet）中心内和外的胎儿医学专家，这些专家来自胎儿内镜气管阻塞（FETO）联盟和非FETO联盟，并与一名外部专家评审员（ER1）进行比较；（iii）两名专家评审员（ER1和ER2）之间。
邀请来自26个NAFTNet中心的48名医生和2名专家评审员评估13个孤立性LCDH的超声片段，并根据Basta等人发表的分类方法将胃位置分为“腹腔内”、“左前胸”、“左胸中部至后部”或“心后”。通过确定NAFTNet参与者和ER1之间胃位置评级一致的比例来评估评分者间一致性。使用kappa统计量计算评审员之间胃位置的一致性。
与ER1相比，FETO和非FETO的NAFTNet参与者中胃位置的一致性分别为69%（39%-85%；n = 19）和54%（23%-92%；n = 29）。胃位置的大多数分歧与相差一个位置有关。13例中有5例（38.5%）评审员对胃位置的判断一致，“前”胃位置的评分者间一致性最高。
在NAFTNet中，甚至在专家评审员之间，CDH中胃位置评估的评分者间一致性都很差。
