IVFAustralia, PO Box 417, New Lambton, New South Wales, 2305, Australia.
University of New South Wales, Sydney, New South Wales, Australia.
Reprod Sci. 2023 Jun;30(6):1917-1926. doi: 10.1007/s43032-022-01151-2. Epub 2022 Dec 20.
To investigate inter- and intra-observer agreement in the assessment of cytoplasmic string (CS) by embryologists on day 5/6 human blastocysts using the EmbryoViewer software. This was a prospective study involving five embryologists working between 2019 and 2020. Inter-observer agreement was calculated using assessments performed on 104 day 5/6 blastocysts regarding the presence, number, and location of CS and CS vesicle activity using timelapse videos. Intra-observer agreement was calculated when the same embryologists repeated the observations after a month's break. Inter- and intra-observer agreement was assessed using Fleiss' kappa coefficient and the intra-class correlation coefficient (ICC). The inter-observer agreement on the presence of CS (kappa: 0.477, 95% CI: 0.301-0.639) and their vesicles (kappa: 0.494, 95% CI: 0.345-0.643) was moderate, while the specific characteristics of CS assessment ranged from fair to moderate (kappa scores between: 0.157 and 0.563). The intra-observer agreement indicated an improvement on the level of agreement (kappa scores between: 0.162 and 0.795) compared to the inter-observer agreement. This study has shown a moderate level of inter- and intra-observer agreement when assessing day 5/6 human blastocysts for the presence of CS and their vesicles. When the specific characteristics of CS assessment occurred (such as the number of CS/vesicles) a slight to moderate level of agreement was seen among the embryologists. Agreement of specific characteristics of CS was not optimal, suggesting the need for further training using specifically designed CS quality assurance programme (QAP) modules, to determine if inter- and intra-observer agreement can be improved.
研究胚胎学家使用胚胎观察仪软件在第 5/6 天人类囊胚上评估细胞质串（CS）时的观察者间和观察者内的一致性。这是一项前瞻性研究，涉及 2019 年至 2020 年间的五名胚胎学家。使用延时视频评估 104 个第 5/6 天的囊胚中 CS 的存在、数量和位置，以及 CS 囊泡活性，计算观察者间的一致性。在一个月的休息后，相同的胚胎学家重复观察时，计算观察者内的一致性。使用 Fleiss' kappa 系数和组内相关系数（ICC）评估观察者间和观察者内的一致性。CS 的存在（kappa：0.477，95%CI：0.301-0.639）和它们的囊泡（kappa：0.494，95%CI：0.345-0.643）的观察者间一致性为中度，而 CS 评估的具体特征从适度到中度不等（kappa 评分范围：0.157-0.563）。与观察者间的一致性相比，观察者内的一致性表明一致性水平有所提高（kappa 评分范围：0.162-0.795）。本研究表明，在评估第 5/6 天人类囊胚中 CS 的存在及其囊泡时，观察者间和观察者内的一致性为中度。当 CS 评估的具体特征（如 CS/囊泡的数量）发生时，胚胎学家之间存在轻微到中度的一致性。CS 具体特征的一致性不理想，表明需要使用专门设计的 CS 质量保证计划（QAP）模块进行进一步培训，以确定是否可以提高观察者间和观察者内的一致性。
