Division of Gastroenterology, Mater Dei Hospital, Malta.
Division of Gastroenterology, Mater Dei Hospital, Malta.
Dig Liver Dis. 2022 Oct;54(10):1403-1409. doi: 10.1016/j.dld.2022.06.027. Epub 2022 Aug 5.
The primary aim of this study was to assess the reliability, intra- and inter-observer variation of the SPICE, Mucosal protrusion angle (MPA) and SHYUNG scores in differentiating a subepithelial mass (SEM) from a bulge.
This retrospective multicentre study analysed the 3 scores, radiological studies, enteroscopy and/or surgical findings.
100 patients with a potential SEM (mean age 57.6years) were recruited with 75 patients having pathology. In patients with a SEM the mean SPICE score was 2.04 (95% CI 1.82-2.26) as compared to 1.16 (95% CI 0.81-1.51) without any pathology (AUC 0.74, p<0.001), with a fair intra-observer agreement (Kappa 0.3, p<0.001) and slight inter-observer agreement (Kappa 0.14, p<0.05). SPICE had a 37.3% sensitivity and 92.0% specificity in distinguishing between a SEM and bulge, whereas MPA<90˚ had 58.7% and 76.0% respectively, with poor intra-observer(p = 0.05) and interobserver agreement (p = 0.64). The SHYUNG demonstrated a moderate intra-observer (Kappa 0.44, p<0.001) and slight inter-observer reliability (Kappa 0.18, p<0.001). The sensitivity of an elevated SHYUNG score (≥4) in identifying a SEM was 18.7% with a specificity of 92.0% (AUC 0.71, p = 0.002).
Though these scores are easy to use, they have, at best, slight to moderate intra and inter-observer agreement. Their overall diagnostic performances are limited.
本研究的主要目的是评估 SPICE、黏膜突起角（MPA）和 SHYUNG 评分在区分黏膜下肿块（SEM）与隆起之间的可靠性、观察者内和观察者间的变异性。
这项回顾性多中心研究分析了这 3 个评分、影像学研究、内镜检查和/或手术结果。
共纳入 100 例有 SEM 潜在可能的患者（平均年龄 57.6 岁），其中 75 例患者有病理学结果。在 SEM 患者中，SPICE 评分的平均值为 2.04（95%CI 1.82-2.26），而无任何病理学表现的患者为 1.16（95%CI 0.81-1.51）（AUC 0.74，p<0.001），观察者内的一致性为中等（Kappa 0.3，p<0.001），观察者间的一致性为轻微（Kappa 0.14，p<0.05）。SPICE 在区分 SEM 和隆起方面的敏感性为 37.3%，特异性为 92.0%，而 MPA<90˚的敏感性分别为 58.7%和 76.0%，观察者内的一致性较差（p=0.05），观察者间的一致性也较差（p=0.64）。SHYUNG 评分显示出中等的观察者内一致性（Kappa 0.44，p<0.001）和轻微的观察者间可靠性（Kappa 0.18，p<0.001）。升高的 SHYUNG 评分（≥4）在识别 SEM 时的敏感性为 18.7%，特异性为 92.0%（AUC 0.71，p=0.002）。
尽管这些评分易于使用，但它们的观察者内和观察者间一致性最好也只是轻微到中等。它们的整体诊断性能有限。
