Reuben A, Johnson A L, Cotton P B
Br J Radiol. 1978 Dec;51(612):956-62. doi: 10.1259/0007-1285-51-612-956.
Observer variation in the interpretation of endoscopic pancreatograms has been examined by asking four experienced observers to assess 40 sets of well-documented radiographs (from 20 patients with cancer and 20 with pancreatitis), both without ("blind") and with clinical details, each on three occasions. Individual consistency for "blind" diagnoses ranged from 61% to 78%, increasing significantly with clinical information. Overall diagnostic accuracy with clinical information varied from 52% to 83% for cancer, and from 87% to 95% for pancreatitis. However, unanimous and correct opinions were given by the four observers for only 53% of all cases, even when clinical details were provided. Clinical information changed the radiographic diagnosis in 43% of assessments, 83% of these changes leading to improved accuracy. ERCP gives direct information about the major pancreatic and biliary duct systems and often provides an accurate diagnosis. Caution must be exercised in relying upon radiological appearances alone.
通过让四名经验丰富的观察者评估40组记录完备的X光片（来自20名癌症患者和20名胰腺炎患者）来研究内镜胰腺造影解读中的观察者差异，评估分三次进行，一次不提供临床细节（“盲法”），另两次提供临床细节。“盲法”诊断的个体一致性在61%至78%之间，随着临床信息的提供显著提高。对于癌症，有临床信息时总体诊断准确率在52%至83%之间，对于胰腺炎则在87%至95%之间。然而，即使提供了临床细节，四名观察者对所有病例中只有53%给出了一致且正确的意见。临床信息在43%的评估中改变了X光片诊断，其中83%的改变提高了准确性。内镜逆行胰胆管造影（ERCP）可提供有关主要胰胆管系统的直接信息，且常常能做出准确诊断。仅依靠放射学表现时必须谨慎。
