Department of Nephrology and Medical Intensive Care, Charite University Hospital Berlin, Berlin, Germany.
Department of Radiology, Charite University Hospital Berlin, Berlin, Germany.
Ultraschall Med. 2024 Feb;45(1):47-53. doi: 10.1055/a-2048-6383. Epub 2023 Apr 18.
To investigate the inter- and intraobserver variability in comparison to an expert gold standard of the new and modified renal cyst Bosniak classification proposed for contrast-enhanced ultrasound findings (CEUS) by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) in 2020.
84 CEUS examinations for the evaluation of renal cysts were evaluated retrospectively by six readers with different levels of ultrasound expertise using the modified Bosniak classification proposed for CEUS. All cases were anonymized, and each case was rated twice in randomized order. The consensus reading of two experts served as the gold standard, to which all other readers were compared. Statistical analysis was performed using Cohen's weighted kappa tests, where appropriate.
Intraobserver variability showed substantial to almost perfect agreement (lowest kappa κ=0.74; highest kappa κ=0.94), with expert level observers achieving the best results. Comparison to the gold standard was almost perfect for experts (highest kappa κ=0.95) and lower for beginner and intermediate level readers still achieving mostly substantial agreement (lowest kappa κ=0.59). Confidence of rating was highest for Bosniak classes I and IV and lowest for classes IIF and III.
Categorization of cystic renal lesions based on the Bosniak classification proposed by the EFSUMB in 2020 showed very good reproducibility. While even less experienced observers achieved mostly substantial agreement, training remains a major factor for better diagnostic performance.
为了与专家金标准进行比较，以调查 2020 年欧洲超声医学和生物学联合会（EFSUMB）提出的对比增强超声（CEUS）新的和修改后的肾囊肿 Bosniak 分类的观察者内和观察者间的可变性。
回顾性评估了 84 例 CEUS 检查，用于评估肾囊肿，由具有不同超声专业知识水平的六位读者使用为 CEUS 提出的修改后的 Bosniak 分类进行评估。所有病例均匿名，并以随机顺序两次评分。两名专家的共识阅读作为金标准，与其他所有读者进行比较。使用 Cohen 的加权 Kappa 检验进行统计分析，在适当的情况下。
观察者内的可变性显示出实质性到几乎完美的一致性（最低 Kappa κ=0.74；最高 Kappa κ=0.94），具有专家水平的观察者取得了最佳结果。与金标准相比，专家的结果几乎是完美的（最高 Kappa κ=0.95），而初学者和中级水平的读者的结果仍然是实质性的（最低 Kappa κ=0.59）。评分的信心最高的是 Bosniak Ⅰ级和Ⅳ级，最低的是Ⅱ F级和Ⅲ级。
基于 EFSUMB 2020 年提出的 Bosniak 分类对囊性肾病变进行分类显示出非常好的可重复性。尽管经验较少的观察者也能达到主要实质性一致，但培训仍然是提高诊断性能的主要因素。
