Transvaginal ultrasound assessment of myometrial and cervical stromal invasion in women with endometrial cancer: interobserver reproducibility among ultrasound experts and gynecologists
Transvaginal ultrasound assessment of myometrial and cervical stromal invasion in women with endometrial cancer: interobserver reproducibility among ultrasound experts and gynecologists
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DOI：
10.1002/uog.14645
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发表时间：
2015-04-01
影响因子：
7.1
通讯作者：
Epstein, E.
中科院分区：
文献类型：
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作者：
Eriksson, L. S. E.;Lindqvist, P. G.;Epstein, E.
目的评估超声专家和妇科医生在预测子宫内膜癌妇女子宫深部肌层和宫颈间质浸润的经阴道超声中的观察者间可重复性。方法将53例子宫内膜癌妇女的子宫体和宫颈的超声视频剪辑，术前由同一超声专家检查，整合为数字化调查。9名超声专家和9名妇科医生评估了子宫深部肌层和宫颈间质浸润的存在或不存在。结果与妇科医生相比，超声专家对子宫颈间质浸润的判断具有更高的敏感性、特异性，且与病理组织学检查结果一致（42%（95% CI，31-53%）vs 57%）（95% CI，45-68%），P < 0.01; 83%（95% CI，78-86%）vs 87%（95% CI，83-90%），P = 0.02; Kappa值为0.45（95% CI，0.40-0.49）vs 0.58（95%CI，0.53-0.62），P< 0.001），但与深肌层浸润无关（73%（95% CI，66-79%）vs 73%（95% CI，66-79%），P = 1.0; 70%（95% CI，65-75%）vs 69%（95% CI，63-74%），P = 0.68; kappa，0.48（95% CI，0.44-0.53）vs 0.52（95% CI，0.48-0.57），P = 0.11）。虽然观察者间的再现性（根据Kappa的测试比例为“好”和“非常好”）关于子宫深肌层浸润，两组之间没有差异（专家组34%，妇科医生组22%，P = 0.13），超声专家评估宫颈间质浸润的观察者间重复性显著高于妇科医生结论术前超声评估子宫内膜癌深肌层和宫颈间质浸润的准确率最高，与妇科医生相比，超声专家评估子宫内膜癌深肌层和宫颈间质浸润的准确率更高，重复性更好。版权所有（C）2014 ISUOG.由John Wiley & Sons有限公司出版
Objectives To assess interobserver reproducibility among ultrasound experts and gynecologists in the prediction by transvaginal ultrasound of deep myometrial and cervical stromal invasion in women with endometrial cancer.Methods Sonographic videoclips of the uterine corpus and cervix of 53 women with endometrial cancer, examined preoperatively by the same ultrasound expert, were integrated into a digitalized survey. Nine ultrasound experts and nine gynecologists evaluated presence or absence of deep myometrial and cervical stromal invasion. Histopathology from hysterectomy specimens was used as the gold standard.Results Compared with gynecologists, ultrasound experts showed higher sensitivity, specificity and agreement with histopathology in the assessment of cervical stromal invasion (42% (95% CI, 31-53%) vs 57% (95% CI, 45-68%), P < 0.01; 83% (95% CI, 78-86%) vs 87% (95% CI, 83-90%), P = 0.02; and kappa, 0.45 (95% CI, 0.40-0.49) vs 0.58 (95% CI, 0.53-0.62), P< 0.001, respectively) but not of deep myometrial invasion (73% (95% CI, 66-79%) vs 73% (95% CI, 66-79%), P = 1.0; 70% (95% CI, 65-75%) vs 69% (95% CI, 63-74%), P = 0.68; and kappa, 0.48 (95% CI, 0.44-0.53) vs 0.52 (95% CI, 0.48-0.57), P = 0.11, respectively). Though interobserver reproducibility (in the context of test proportions 'good' and 'very good', according to kappa) regarding deep myometrial invasion did not differ between the groups (experts, 34% vs gynecologists, 22%, P = 0.13), ultrasound experts assessed cervical stromal invasion with significantly greater interobserver reproducibility than did gynecologists (53% vs 14%, P< 0.001).Conclusion Preoperative ultrasound assessment of deep myometrial and cervical stromal invasion in endometrial cancer is best performed by ultrasound experts, as, compared with gynecologists, they showed a greater degree of agreement with histopathology and greater interobserver reproducibility in the assessment of cervical stromal invasion. Copyright (C) 2014 ISUOG. Published by John Wiley & Sons Ltd.