1851 Diagnostic Accuracy and Interrater Agreement of Gynecological Sonographers in Evaluating the Pouch of Douglas for Obliteration Using the Sliding Sign Technique

Abstract

Study Objective Evaluate the accuracy of sonographers in classifying pouch of Douglas (POD) obliteration state and their interrater agreement with the reference standard senior sonologist. Design Prospective diagnostic accuracy and interrater agreement study. Setting Gynecology-focused ultrasound practice. Patients or Participants Seven sonographers of varying experience. Interventions Sonographer were provided with a short educational program on POD obliteration and the sliding sign technique. None were routinely utilizing the sliding sign in practice prior to study initiation. Over two months, the sonographers prospectively and consecutively performed, recorded, and interpreted the state of the POD as positive, negative or indeterminate. Senior sonologist was blinded to the sonographers’ classification when the reference standard classification was made. Measurements and Main Results Diagnostic accuracy and interrater agreement using Cohen's kappa were calculated (Table). 819 patients underwent basic TVS. The reference standard prevalence of a negative sliding sign was 43/819 (5.3%). Conclusion With a low prevalence of a negative sliding sign, it is difficult to evaluate a sonographers’ ability to correctly classify this abnormal state. However, sonographers were uniformly highly specific in their classification of the POD state. As the awareness of the sliding sign technique spreads, it will be essential to understand how to educate, credential, and monitor performance and interpretation by sonographers, who perform the majority of gynecological scans internationally.