Interobserver Agreement for EUS in the Evaluation and Diagnosis of Pancreatic Cystic Lesinos

Abstract

Bacground/Aims: Endoscopic ultrasound (EUS) may provide detailed information regarding the morphology of cystic lesions and can be extremely helpful in ruling out a primary pancreatic lesion. However, the degree to which endosonographers agree on the diagnosis of pancreatic cystic lesions is reported rarely. We perfomed this study to evaluate the degree of agreement among endosonographers for EUS diagnosis of pancreatic cystic lesion and the variation in accuracy rates of endosonographers for diagnosis of pancreatic cystic lesion. Methods: Photograph series obtained from EUS examinations of 61 patients with cystic pancreatic lesions were reviewed by 3 experienced endosonographers. They were blinded to the clinical information and histopathologic results for each patient and reviewed each case solely for the presence or absence of previously defined features of cystic lesions of the pancreas. Interobserver agreement was expressed as the kappa ( ) statistic. Results: There were relatively poor overall agreement for the final diagnosis of pancreatic cystic mass (= 0.486). Agreement for individual types of lesion was good for IPMT (= 0.794) and serous cyst adenoma (= 0.666) but poor for the remainder. Agreement was good for individual features of septation (= 0.614), dilated pancreatic duct (= 0.574), and solid component (= 0.421) but poor for the other features. Accuracy rates of EUS for the diagnosis of pancreatic cystic mass ranged from 49% to 61%. EUS diagnosed IPMT and serous cystadenoma with high specificity but low sensitivity because that they were rule out easily without characteristic EUS features. Conclusions: Interobserver agreement is relatively poor for diagnosing pancreatic cystic mass by EUS. However, it appears to be better for some lesions than other. EUS morphology alone may not be adequate for discrimination between the various pancreatic cystic lesions. in addition studies assessing needle sampling, including the use histologic and biochemical markers of neoplasia are needed. Bacground/Aims: Endoscopic ultrasound (EUS) may provide detailed information regarding the morphology of cystic lesions and can be extremely helpful in ruling out a primary pancreatic lesion. However, the degree to which endosonographers agree on the diagnosis of pancreatic cystic lesions is reported rarely. We perfomed this study to evaluate the degree of agreement among endosonographers for EUS diagnosis of pancreatic cystic lesion and the variation in accuracy rates of endosonographers for diagnosis of pancreatic cystic lesion. Methods: Photograph series obtained from EUS examinations of 61 patients with cystic pancreatic lesions were reviewed by 3 experienced endosonographers. They were blinded to the clinical information and histopathologic results for each patient and reviewed each case solely for the presence or absence of previously defined features of cystic lesions of the pancreas. Interobserver agreement was expressed as the kappa ( ) statistic. Results: There were relatively poor overall agreement for the final diagnosis of pancreatic cystic mass (= 0.486). Agreement for individual types of lesion was good for IPMT (= 0.794) and serous cyst adenoma (= 0.666) but poor for the remainder. Agreement was good for individual features of septation (= 0.614), dilated pancreatic duct (= 0.574), and solid component (= 0.421) but poor for the other features. Accuracy rates of EUS for the diagnosis of pancreatic cystic mass ranged from 49% to 61%. EUS diagnosed IPMT and serous cystadenoma with high specificity but low sensitivity because that they were rule out easily without characteristic EUS features. Conclusions: Interobserver agreement is relatively poor for diagnosing pancreatic cystic mass by EUS. However, it appears to be better for some lesions than other. EUS morphology alone may not be adequate for discrimination between the various pancreatic cystic lesions. in addition studies assessing needle sampling, including the use histologic and biochemical markers of neoplasia are needed.