Diagnostic Discrepancies in Retinopathy of Prematurity Classification
Diagnostic Discrepancies in Retinopathy of Prematurity Classification
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DOI：
10.1016/j.ophtha.2016.04.035
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发表时间：
2016-08-01
期刊：
影响因子：
13.7
通讯作者：
Chiang, Michael F.
中科院分区：
文献类型：
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作者：
Campbell, J. Peter;Ryan, Michael C.;Chiang, Michael F.
目的：确定专家之间在早产儿视网膜病变(ROP)分类中最常见的差异区域。设计：前瞻性队列研究。参与者：来自7个参与中心的281名婴儿被确认为多中心前瞻性ROP队列研究的一部分。每个地点都有参与的眼科医生，他们在使用双目间接眼底镜(BIO)进行常规检查后提供临床分类，并获得广角视网膜图像，由2名研究专家独立分类。方法：从研究对象获得广角视网膜图像(Retcam；Clarity Medical Systems，Pleasanton，CA)，2名专家使用安全的网络模块对每张图像进行评估。将两位专家基于图像的分区、分期和疾病分类(无ROP、轻度ROP、II型或前增型和I型)与BIO获得的临床分类进行比较。主要观察指标：专家间基于图像的一致性，以及基于图像的与眼底镜诊断的一致性，使用绝对一致性和加权kappa统计。结果：共有281名婴儿的1553项眼科检查纳入研究。在1553次比较中，有620次(40%)的分期分类(40%)、1553次比较中的287次(18%)加上疾病分类(包括预加)、1553次比较中的117次(8%)以及1553次比较中的618次(40%)存在不同的ROP分类。然而，有无1型疾病的符合率为95%。结论：ROP分类中最常见的差异区域是分期，尽管专家间对临床上重要疾病的一致性很高，例如是否存在1型和2型疾病。在发现临床重大疾病的能力方面，基于图像的分级与临床检查没有差异。这项研究提供了更多的证据表明，与临床检查相比，基于图像的ROP分类可以可靠地检测到临床上有意义的ROP水平。(C)2016年由美国眼科学会颁发。
Purpose: To identify the most common areas for discrepancy in retinopathy of prematurity (ROP) classification between experts.Design: Prospective cohort study.Participants: A total of 281 infants were identified as part of a multicenter, prospective, ROP cohort study from 7 participating centers. Each site had participating ophthalmologists who provided the clinical classification after routine examination using binocular indirect ophthalmoscopy (BIO) and obtained wide-angle retinal images, which were independently classified by 2 study experts.Methods: Wide-angle retinal images (RetCam; Clarity Medical Systems, Pleasanton, CA) were obtained from study subjects, and 2 experts evaluated each image using a secure web-based module. Image-based classifications for zone, stage, plus disease, and overall disease category (no ROP, mild ROP, type II or pre-plus, and type I) were compared between the 2 experts and with the clinical classification obtained by BIO.Main Outcome Measures: Inter-expert image-based agreement and image-based versus ophthalmoscopic diagnostic agreement using absolute agreement and weighted kappa statistic.Results: A total of 1553 study eye examinations from 281 infants were included in the study. Experts disagreed on the stage classification in 620 of 1553 comparisons (40%), plus disease classification (including pre-plus) in 287 of 1553 comparisons (18%), zone in 117 of 1553 comparisons (8%), and overall ROP category in 618 of 1553 comparisons (40%). However, agreement for presence versus absence of type 1 disease was >95%. There were no differences between image-based and clinical classification except for zone III disease.Conclusions: The most common area of discrepancy in ROP classification is stage, although inter-expert agreement for clinically significant disease, such as presence versus absence of type 1 and type 2 disease, is high. There were no differences between image-based grading and clinical examination in the ability to detect clinically significant disease. This study provides additional evidence that image-based classification of ROP reliably detects clinically significant levels of ROP with high accuracy compared with the clinical examination. (C) 2016 by the American Academy of Ophthalmology.