Abstract
BackgroundWe recently reported poor inter-observer agreement in identifying and quantifying individual ultrasonographic features of polycystic ovaries. Our objective was to determine the effect of a training workshop on reducing inter-observer variation in the ultrasonographic evaluation of polycystic ovaries.MethodsTransvaginal ultrasound recordings from thirty women with polycystic ovary syndrome (PCOS) were evaluated by three radiologists and three reproductive endocrinologists both before and after an ultrasound workshop. The following endpoints were assessed: 1) follicle number per ovary (FNPO), 2) follicle number per single cross-section (FNPS), 3) largest follicle diameter, 4) ovarian volume, 5) follicle distribution pattern and 6) presence of a corpus luteum (CL). Lin's concordance correlation coefficients (rho) and kappa statistics for multiple raters (kappa) were used to assess level of inter-observer agreement (>0.80 good, 0.60 – 0.80 moderate/fair, <0.60 poor).ResultsFollowing the workshop, inter-observer agreement improved for the evaluation of FNPS (rho = 0.70, delta rho = +0.11), largest follicle diameter (rho = 0.77, delta rho = +0.10), ovarian volume (rho = 0.84, delta rho = +0.12), follicle distribution pattern (kappa = 0.80, delta kappa = +0.21) and presence of a CL (kappa = 0.87, delta kappa = +0.05). No improvement was evident for FNPO (rho = 0.54, delta rho = -0.01). Both radiologists and reproductive endocrinologists demonstrated improvement in scores (p < 0.001).ConclusionReliability in evaluating ultrasonographic features of polycystic ovaries can be significantly improved following participation in a training workshop. If ultrasonographic evidence of polycystic ovaries is to be used as an objective measure in the diagnosis of PCOS, then standardized training modules should be implemented to unify the approach to evaluating polycystic ovarian morphology.
Highlights
We recently reported poor inter-observer agreement in identifying and quantifying individual ultrasonographic features of polycystic ovaries
While these criteria were heralded as a legitimate first step toward characterizing the clinical spectrum of polycystic ovary syndrome (PCOS), they did override standards and practices employed in the UK and most of Europe where the diagnosis had long been based on ultrasonography [3]
Revisions to the consensus criteria were intended to broaden the clinical spectrum of PCOS and allowed for a diagnosis based on identification of two of three criteria: 1) oligo- or chronic anovulation, 2) clinical and/or biochemical hyperandrogenism and 3) polycystic ovaries on ultrasonography
Summary
We recently reported poor inter-observer agreement in identifying and quantifying individual ultrasonographic features of polycystic ovaries. In 1990, the first attempt by experts to generate international consensus criteria for PCOS resulted in exclusion of polycystic ovaries as a potential marker of the syndrome [4]. While these criteria were heralded as a legitimate first step toward characterizing the clinical spectrum of PCOS, they did override standards and practices employed in the UK and most of Europe where the diagnosis had long been based on ultrasonography [3]. Revisions to the consensus criteria were intended to broaden the clinical spectrum of PCOS and allowed for a diagnosis based on identification of two of three criteria: 1) oligo- or chronic anovulation, 2) clinical and/or biochemical hyperandrogenism and 3) polycystic ovaries on ultrasonography. While there is concern that these criteria are too expansive [2], they do reflect majority opinion that polycystic ovaries are a significant component of PCOS
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