Inter-rater reliability for diagnosis of geographic atrophy using spectral domain OCT in age-related macular degeneration
Inter-rater reliability for diagnosis of geographic atrophy using spectral domain OCT in age-related macular degeneration
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DOI：
10.1038/s41433-021-01490-5
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发表时间：
2021-03-08
期刊：
影响因子：
3.9
通讯作者：
Sivaprasad, Sobha
中科院分区：
文献类型：
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作者：
Chandra, Shruti;Rasheed, Rajna;Sivaprasad, Sobha
目的评价SD-OCT图像鉴别完全性视网膜色素上皮和视网膜外萎缩(CRORA)的评分者间可靠性。方法选择50例AMD所致cRORA患者的SD-OCT行匿名扫描图像。每个.tiff图像都以白底黑(BW)和黑底白(WB)格式保存。五名接受过视网膜培训的临床医生根据CAM组的定义对这两组图像进行了两次分级，以诊断cRORA。Fleiss kappa统计量用于评分者之间的信度，Cohen‘s kappa统计量用于评分者之间的内部信度和年级间信度。结果WB图像和BW图像的等级间信度分别为0.28~0.92和0.34~0.86。然而，对于习惯于CAM标准的评分员，年级间和年级内的一致性分别为WB 0.92；BW 0.86和0.92。WB图像的Fleiss kappa为0.49p值和0.0001；BW图像的Fleiss kappa为0.34p值和0.0001。总体而言，使用WB图像对除RPE衰减/损耗之外的所有参数的一致性更好。结论真实世界受过视网膜训练的眼科医生在SD-OCT上对CRRA的诊断存在显著差异。这项研究强调，在临床实践中实施cRORA之前，需要进行培训以识别cRORA的不同特征。
Purpose To evaluate the inter-rater reliability for identification of complete retinal pigment epithelium and outer retinal atrophy (cRORA) on SD-OCT images as defined by the Classification of Atrophy Meetings (CAM) group. Methods Fifty images of anonymized SD-OCT line scans of eyes with cRORA due to AMD were selected. Each .tiff image was saved in both black-on-white (BW) and white-on-black (WB) format. Five retina-trained clinicians graded both sets of images twice for the diagnosis of cRORA based on the CAM group definition. Fleiss kappa statistic was calculated for inter-rater reliability and Cohen's kappa statistic for intra-grader and inter-grader reliability between any two graders. Results The inter-grader reliability varied from as low as 0.28 to 0.92 for WB images and 0.34 to 0.86 for BW images. However, the inter-grader and intra-grader agreement was WB 0.92; BW 0.86 and 0.92 respectively, for graders accustomed to the CAM criteria. Fleiss kappa was 0.49 (p value < 0.0001) for WB images and 0.34 (p value < 0.0001 for BW images. Overall, the agreement was better using WB images for all parameters except RPE attenuation/loss. Conclusion There is significant variability in diagnosis of cRORA on SD-OCT by retina-trained ophthalmologists in the real world. The study highlights the need for training to recognise the different features of cRORA prior to its implementation in clinical practice.