Department of Upper Gastrointestinal Surgery, St Vincent's Hospital Melbourne, Melbourne, Australia; Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Australia.
Cancer Research Program, School of Public Health & Preventive Medicine Monash University, Melbourne, Australia.
HPB (Oxford). 2023 Nov;25(11):1393-1401. doi: 10.1016/j.hpb.2023.07.883. Epub 2023 Jul 22.
Pancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variability between reviewing surgeons and radiologists may confound decisions influencing patient treatment pathways.
In this multicentre observational study, an international group of 96 clinicians (42 hepatopancreatobiliary surgeons and 54 radiologists) were surveyed and asked to report 30 pancreatic CT scans of pancreatic cancer deemed borderline at respective multidisciplinary meetings (MDM). The degree of interobserver agreement in resectability among radiologists and surgeons was assessed and subgroup regression analysis was performed.
Interobserver variability between reviewers was high with no unanimous agreement. Overall interobserver agreement was fair with a kappa value of 0.32 with a higher rate of agreement among radiologists over surgeons.
Interobserver variability among radiologists and surgeons globally is high, calling into question the consistency of clinical decision making for patients with PDAC and suggesting that central review may be required for studies of neoadjuvant or adjuvant approaches in future as well as ongoing quality control initiatives, even amongst experts in the field.
胰腺导管腺癌（PDAC）是一种侵袭性癌症，预后不良。使用计算机断层扫描（CT）进行准确的术前评估以确定可切除性对于确保为患者提供最合适的治疗策略至关重要。尽管使用了分类指南，但审查外科医生和放射科医生之间的任何观察者间差异都可能使影响患者治疗途径的决策复杂化。
在这项多中心观察性研究中，一组 96 名国际临床医生（42 名肝胆胰外科医生和 54 名放射科医生）接受了调查，并被要求报告在各自的多学科会议（MDM）上被认为是边缘性的 30 例胰腺 CT 扫描胰腺癌。评估了放射科医生和外科医生之间在可切除性方面的观察者间一致性，并进行了亚组回归分析。
审稿人之间的观察者间差异很大，没有一致意见。总体观察者间一致性为中等，kappa 值为 0.32，放射科医生之间的一致性高于外科医生。
全球范围内放射科医生和外科医生之间的观察者间差异很大，这使得对 PDAC 患者的临床决策的一致性受到质疑，并表明即使在该领域的专家中，未来也可能需要对新辅助或辅助方法进行研究以及正在进行的质量控制计划，需要进行中央审查。
