Reliability of the Spinal Instability Neoplastic Score (SINS) among radiation oncologists: an assessment of instability secondary to spinal metastases.
Reliability of the Spinal Instability Neoplastic Score (SINS) among radiation oncologists: an assessment of instability secondary to spinal metastases.
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DOI：
10.1186/1748-717x-9-69
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发表时间：
2014-03-04
期刊：
影响因子：
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通讯作者：
Gokaslan ZL
中科院分区：
文献类型：
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作者：
Fisher CG;Schouten R;Versteeg AL;Boriani S;Varga PP;Rhines LD;Kawahara N;Fourney D;Weir L;Reynolds JJ;Sahgal A;Fehlings MG;Gokaslan ZL
脊柱不稳定肿瘤评分（Spinal Instability Neoplastic Score，简称SEP）对肿瘤相关脊柱不稳定进行分类。它有可能简化已确定或潜在脊柱不稳患者向脊柱外科医生的转诊。本研究的目的是确定放射肿瘤学家之间和观察员内的可靠性和有效性的评价。来自10个国际研究中心的33名放射肿瘤学家对30例肿瘤性脊柱疾病病例进行了评分。对于每例病例，记录了总评分（0-18分）、三个临床分类（稳定：0-6分，潜在不稳定：7-12分，不稳定：13-18分）和二元量表（“稳定”：0-6分和“当前或可能不稳定”;建议手术咨询：7-18分）。6-8周后重复评估。通过kappa统计量计算观察者间一致性和观察者内重现性，并转换为一致性水平（轻度、一般、中度、实质性和极好）。有效性通过与脊柱外科医生的共识标准进行比较来确定。放射肿瘤学家在使用“稳定”与“当前或可能不稳定"二元量表时表现出显著（κ = 0.76）观察者间和极好（κ = 0.80）观察者内可靠性。与金标准相比，二元量表的有效性也非常好（κ = 0.85）。放射肿瘤学家没有将不稳定病例评定为稳定，确保所有病例均适当推荐进行手术咨询。在放射肿瘤学家中，MRI是一种高度可靠、可重复和有效的评估工具，可以解决肿瘤相关脊柱疾病的一个关键问题：脊柱是否“稳定”或是否存在“当前或可能的不稳定”，需要手术评估？
The Spinal Instability Neoplastic Score (SINS) categorizes tumor related spinal instability. It has the potential to streamline the referral of patients with established or potential spinal instability to a spine surgeon. This study aims to define the inter- and intra-observer reliability and validity of SINS among radiation oncologists. Thirty-three radiation oncologists, across ten international sites, rated 30 neoplastic spinal disease cases. For each case, the total SINS (0-18 points), three clinical categories (stable: 0-6 points, potentially unstable: 7-12 points, and unstable: 13-18 points), and a binary scale (‘stable’: 0-6 points and ‘current or possible instability’; surgical consultation recommended: 7-18 points) were recorded. Evaluation was repeated 6-8 weeks later. Inter-observer agreement and intra-observer reproducibility were calculated by means of the kappa statistic and translated into levels of agreement (slight, fair, moderate, substantial, and excellent). Validity was determined by comparing the ratings against a spinal surgeon’s consensus standard. Radiation oncologists demonstrated substantial (κ = 0.76) inter-observer and excellent (κ = 0.80) intra-observer reliability when using the SINS binary scale (‘stable’ versus ‘current or possible instability’). Validity of the binary scale was also excellent (κ = 0.85) compared with the gold standard. None of the unstable cases was rated as stable by the radiation oncologists ensuring all were appropriately recommended for surgical consultation. Among radiation oncologists SINS is a highly reliable, reproducible, and valid assessment tool to address a key question in tumor related spinal disease: Is the spine ‘stable’ or is there ‘current or possible instability’ that warrants surgical assessment?