Medline ® Abstract for Reference 16
Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions.
Ahmad NA, Kochman ML, Brensinger C, Brugge WR, Faigel DO, Gress FG, Kimmey MB, Nickl NJ, Savides TJ, Wallace MB, Wiersema MJ, Ginsberg GG
Gastrointest Endosc. 2003;58(1):59.
BACKGROUND: The aim of this study was to evaluate the degree of agreement among endosonographers for EUS diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions and the specific type of cystic lesion.
METHODS: Videotapes of EUS procedures from 31 consecutive cases of a range of histopathologically proven lesions, including mucinous cystic neoplasm, serous cystadenoma, neuroendocrine tumor, intraductal papillary mucinous tumor, and pseudocyst, were used to make a study videotape, which was reviewed by 8 experienced endosonographers. The reviewers, blinded to clinical and surgical histopathology results, reviewed each case for the presence or absence of the following features: abnormality of pancreatic duct and parenchyma, margins, solid component, debris, and septations. They were asked to identify each lesion as neoplastic or non-neoplastic and to give a specific diagnosis for each lesion.
RESULTS: There was fairagreement between endosonographers for diagnosis of neoplastic versus non-neoplastic lesions (kappa = 0.24). Agreement for individual types of lesions was moderately good for serous cystadenomas (kappa = 0.46) but fair for the remainder. Agreement was moderately good for presence or absence of solid component (kappa = 0.43); fair for presence or absence of abnormal pancreatic duct (kappa = 0.29), debris (kappa = 0.21), and septations (kappa = 0.30); and slight for presence or absence of margins (kappa = 0.01) and abnormal pancreatic parenchyma (kappa = 0.01). Accuracy rates of EUS for the diagnosis of neoplastic versus non-neoplastic lesions ranged from 40% to 93%.
CONCLUSIONS: There is little more than chance interobserver agreement among experienced endosonographers for diagnosis of neoplastic versus non-neoplastic, specific type, and EUS features of pancreatic cystic lesions.
Gastroenterology Division, Department of Medicine, Hospital of University of Pennsylvania, Philadelphia VAMC, University of Pennsylvania School of Medicine, 19104-4283, USA.