Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Division of Pelvic Cancer, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden.
Ultrasound Obstet Gynecol. 2021 Nov;58(5):773-779. doi: 10.1002/uog.23662.
To evaluate interobserver agreement for the assessment of local tumor extension in women with cervical cancer, among experienced and less experienced observers, using transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI).
The TVS observers were all gynecologists and consultant ultrasound specialists, six with and seven without previous experience in cervical cancer imaging. The MRI observers were five radiologists experienced in pelvic MRI and four less experienced radiology residents without previous experience in MRI of the pelvis. The less experienced TVS observers and all MRI observers underwent a short basic training session in the assessment of cervical tumor extension, while the experienced TVS observers received only a written directive. All observers were assigned the same images from cervical cancer patients at all stages (n = 60) and performed offline evaluation to answer the following three questions: (1) Is there a visible primary tumor? (2) Does the tumor infiltrate > ⅓ of the cervical stroma? and (3) Is there parametrial invasion? Interobserver agreement within the four groups of observers was assessed using Fleiss kappa (κ) with 95% CI.
Experienced and less experienced TVS observers, respectively, had moderate interobserver agreement with respect to tumor detection (κ (95% CI), 0.46 (0.40-0.53) and 0.46 (0.41-0.52)), stromal invasion > ⅓ (κ (95% CI), 0.45 (0.38-0.51) and 0.53 (0.40-0.58)) and parametrial invasion (κ (95% CI), 0.57 (0.51-0.64) and 0.44 (0.39-0.50)). Experienced MRI observers had good interobserver agreement with respect to tumor detection (κ (95% CI), 0.70 (0.62-0.78)), while less experienced MRI observers had moderate agreement (κ (95% CI), 0.51 (0.41-0.62)), and both experienced and less experienced MRI observers, respectively, had good interobserver agreement regarding stromal invasion (κ (95% CI), 0.80 (0.72-0.88) and 0.71 (0.61-0.81)) and parametrial invasion (κ (95% CI), 0.69 (0.61-0.77) and 0.71 (0.61-0.81)).
We found interobserver agreement for the assessment of local tumor extension in patients with cervical cancer to be moderate for TVS and moderate-to-good for MRI. The level of interobserver agreement was associated with experience among TVS observers only for parametrial invasion. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
评估在宫颈癌患者中，经验丰富和经验较少的观察者使用经阴道超声（TVS）和磁共振成像（MRI）评估局部肿瘤扩展的观察者间一致性。
TVS 观察者均为妇科医生和顾问超声专家，其中 6 名具有，7 名不具有宫颈癌成像经验。MRI 观察者均为 5 名经验丰富的盆腔 MRI 放射科医生和 4 名无盆腔 MRI 经验的经验较少的放射科住院医师。经验较少的 TVS 观察者和所有 MRI 观察者均接受了关于评估宫颈癌肿瘤扩展的简短基础培训课程，而经验丰富的 TVS 观察者仅收到了书面指示。所有观察者均对所有阶段的宫颈癌患者（n = 60）的相同图像进行离线评估，并回答以下三个问题：（1）是否有可见的原发性肿瘤？（2）肿瘤是否浸润> ⅓ 的宫颈基质？以及（3）是否存在宫旁侵犯？使用 Fleiss kappa（κ）评估 4 组观察者内的观察者间一致性，并带有 95%置信区间（CI）。
分别为经验丰富和经验较少的 TVS 观察者对肿瘤检测的观察者间一致性具有中等程度（κ（95%CI），0.46（0.40-0.53）和 0.46（0.41-0.52））、基质浸润> ⅓（κ（95%CI），0.45（0.38-0.51）和 0.53（0.40-0.58））和宫旁侵犯（κ（95%CI），0.57（0.51-0.64）和 0.44（0.39-0.50））。经验丰富的 MRI 观察者对肿瘤检测的观察者间一致性具有良好程度（κ（95%CI），0.70（0.62-0.78）），而经验较少的 MRI 观察者具有中度一致性（κ（95%CI），0.51（0.41-0.62）），经验丰富和经验较少的 MRI 观察者分别对基质浸润（κ（95%CI），0.80（0.72-0.88）和 0.71（0.61-0.81））和宫旁侵犯（κ（95%CI），0.69（0.61-0.77）和 0.71（0.61-0.81））具有良好的观察者间一致性。
我们发现，在宫颈癌患者中，TVS 评估局部肿瘤扩展的观察者间一致性为中等，MRI 为中等至良好。观察者间一致性的水平仅与 TVS 观察者的经验有关，与宫旁侵犯有关。 © 2021 作者。国际妇产科超声学会（ISUOG）在约翰威立父子公司的支持下出版《超声妇产科杂志》。
