Henderickx Michaël M E L, Stoots Simone J M, De Bruin Daniel M, Wijkstra Hessel, Freund Jan Erik, Wiseman Oliver J, Ploumidis Achilles, Skolarikos Andreas, Somani Bhaskar K, Şener Tarik Emre, Emiliani Esteban, Dragos Laurian B, Villa Luca, Talso Michele, Daudon Michel, Traxer Olivier, Kronenberg Peter, Doizi Steeve, Tailly Thomas, Tefik Tzevat, Hendriks Nora, Beerlage Harrie P, Baard Joyce, Kamphuis Guido M
Department of Urology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.
Biomedical Diagnostics Lab, Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
J Endourol. 2022 Oct;36(10):1362-1370. doi: 10.1089/end.2022.0217. Epub 2022 Jul 13.
To assess the diagnostic accuracy and intra-observer agreement of endoscopic stone recognition (ESR) compared with formal stone analysis. Stone analysis is a corner stone in the prevention of stone recurrence. Although X-ray diffraction (XRD) and infrared spectroscopy are the recommended techniques for reliable formal stone analysis, this is not always possible, and the process takes time and is costly. ESR could be an alternative, as it would give immediate information on stone composition. Fifteen endourologists predicted stone composition based on 100 videos from ureterorenoscopy. Diagnostic accuracy was evaluated by comparing the prediction from visual assessment with stone analysis by XRD. After 30 days, the videos were reviewed again in a random order to assess intra-observer agreement. The median diagnostic accuracy for calcium oxalate monohydrate was 54% in questionnaire 1 (Q1) and 59% in questionnaire 2 (Q2), whereas calcium oxalate dihydrate had a median diagnostic accuracy of 75% in Q1 and 50% in Q2. The diagnostic accuracy for calcium hydroxyphosphate was 10% in Q1 and 13% in Q2. The median diagnostic accuracy for calcium hydrogen phosphate dihydrate and calcium magnesium phosphate was 0% in both questionnaires. The median diagnostic accuracy for magnesium ammonium phosphate was 20% in Q1 and 40% in Q2. The median diagnostic accuracy for uric acid was 22% in both questionnaires. Finally, there was a diagnostic accuracy of 60% in Q1 and 80% in Q2 for cystine. The intra-observer agreement ranged between 45% and 72%. Diagnostic accuracy of ESR is limited and intra-observer agreement is below the threshold of acceptable agreement.
评估内镜下结石识别（ESR）与传统结石分析相比的诊断准确性及观察者内一致性。结石分析是预防结石复发的基石。虽然X射线衍射（XRD）和红外光谱是推荐用于可靠的传统结石分析的技术，但这并非总是可行，且该过程耗时且成本高。ESR可能是一种替代方法，因为它能立即提供结石成分信息。15位泌尿外科内镜医师根据100段输尿管镜检查视频预测结石成分。通过将视觉评估的预测结果与XRD结石分析结果进行比较来评估诊断准确性。30天后，以随机顺序再次查看这些视频，以评估观察者内一致性。一水草酸钙在问卷1（Q1）中的诊断准确性中位数为54%，在问卷2（Q2）中为59%，而二水草酸钙在Q1中的诊断准确性中位数为75%，在Q2中为50%。磷酸氢钙在Q1中的诊断准确性为10%，在Q2中为13%。磷酸二氢钙和磷酸钙镁在两份问卷中的诊断准确性中位数均为0%。磷酸镁铵在Q1中的诊断准确性中位数为20%，在Q2中为40%。尿酸在两份问卷中的诊断准确性中位数均为22%。最后，胱氨酸在Q1中的诊断准确性为60%，在Q2中为80%。观察者内一致性在45%至72%之间。ESR的诊断准确性有限，观察者内一致性低于可接受一致性的阈值。
