Degree Of Interobserver Agreement Research Articles

Determination of “borderline resectable” pancreatic cancer – A global assessment of 30 shades of grey

BackgroundPancreatic ductal adenocarcinoma (PDAC) is an aggressive cancer with a poor prognosis. Accurate preoperative assessment using computed tomography (CT) to determine resectability is crucial in ensuring patients are offered the most appropriate therapeutic strategy. Despite the use of classification guidelines, any interobserver variability between reviewing surgeons and radiologists may confound decisions influencing patient treatment pathways. MethodsIn this multicentre observational study, an international group of 96 clinicians (42 hepatopancreatobiliary surgeons and 54 radiologists) were surveyed and asked to report 30 pancreatic CT scans of pancreatic cancer deemed borderline at respective multidisciplinary meetings (MDM). The degree of interobserver agreement in resectability among radiologists and surgeons was assessed and subgroup regression analysis was performed. ResultsInterobserver variability between reviewers was high with no unanimous agreement. Overall interobserver agreement was fair with a kappa value of 0.32 with a higher rate of agreement among radiologists over surgeons. ConclusionInterobserver variability among radiologists and surgeons globally is high, calling into question the consistency of clinical decision making for patients with PDAC and suggesting that central review may be required for studies of neoadjuvant or adjuvant approaches in future as well as ongoing quality control initiatives, even amongst experts in the field.

The diagnostic performance of the Java-based software colorization tool in the diagnosis of dental caries: an in vitro study.

This in vitro study aimed to compare the diagnostic outcomes of caries detection in premolar and molar teeth on digital periapical radiographs viewed as grayscale images and in the Java-based software (JBS) pseudocolor spectrum. The study comprised 92 premolar or molar human teeth (n = 46 with caries and n = 46 without clinical caries). For each tooth, digital periapical radiographic images (DPRIs), JBS pseudocolor images, and stereomicroscope images were collected, and caries presence and depth were recorded. In JBS pseudocolor images, regions of interest (ROIs) were detected, and ROI values for caries area (ROI1), non-caries area (ROI2), mesial area (ROI3), and distal area (ROI4) were obtained. The degree of inter-observer agreement was determined using the kappa coefficient, and the sensitivity and specificity of the methods were assessed using ROC analysis. While neither method was consistent with stereomicroscopy in determining caries depth (P < .005), for both observers the kappa value of JBS pseudocolor images were slightly higher than those for DPRIs. ROI1 was found to be significantly lower than ROI2 (P < .001), whereas no difference was found between ROI3 and ROI4 (P = .877). For both observers, the sensitivity and specificity obtained from JBS pseudocolor were above 89%. JBS pseudocolor images can be used for caries detection and offer high sensitivity and specificity.

Diagnostic capacity and interobserver variability in FIGO, ACOG, NICE and Chandraharan cardiotocographic guidelines to predict neonatal acidemia

Objective Despite its routine use in intrapartum care, the technique of fetal cardiotocography has some limitations. The aim of this study is to analyze the predictive capacity and interobserver agreement in the latest versions of four international cardiotocography guidelines: Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG), the National Institute for Health and Care Excellence (NICE) and Chandraharan, used to predict neonatal acidemia. Study design The last 30 min of 150 cardiotocographic records were analyzed over all the pH ranges and were blindly evaluated by three independent reviewers. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated to assess the predictive capacity of each fetal cardiotocographic guideline. The degree of interobserver agreement was evaluated with the Fleiss Kappa coefficient. Results Observers found fetal cardiotocography guidelines to have a variable sensitivity and specificity. The Chandraharan classification reached the highest sensitivity (78.79%), while ACOG had the highest specificity (95.73%). On average for the three observers, Chandraharan had the highest discrimination capacity for neonatal acidemia, although this was only moderate (AUC 0.66; 95%CI, 0.55–0.77) and did not differ significantly from the remaining guidelines. The degree of agreement among the three observers, assessed according to the Fleiss Kappa coefficient, was generally acceptable or moderate for all items and classifications, being highest with the FIGO classification (ĸ = 0.35; 95%CI, 0.28–0.41) and lowest with the ACOG (ĸ = 0.23; 95%CI, 0.16–0.30). Conclusion Although all the guidelines have a moderate capacity to predict neonatal acidemia, the Chandraharan guideline has the highest capacity. This follows a different approach from the others in that it relies on interpretations of cardiotocographic traces based on fetal physiology. The degree of interobserver agreement is, in general, acceptable for the four guidelines, and is the highest for FIGO.

Association between abdominal pain and fecal impaction grade assessed through radiography in constipated patients at a pediatric emergency service.

Abdominal pain in children is a frequent cause of emergency room consultation. An important group of those patients presents with chronic constipation and fecal impaction. Plain abdominal x-ray is widely used for making a diagnosis and ruling out the need for surgical treatment. The present study examined the association between pain intensity and fecal impaction grade. An analytic cross-sectional study was conducted that compared 2 radiographic scales to determine the association between the grade of fecal impaction observed and abdominal pain intensity in patients that sought medical attention at an emergency service within a 7-month period. The analysis was carried out by 2 different observers, utilizing 2 different radiographic scales to confirm their reproducibility. The degree of interobserver agreement was measured using the Kappa coefficient and the association between abdominal pain and fecal impaction grade was measured through the Spearman correlation coefficient. There was a significant association between pain intensity and the radiographic grade of fecal impaction (P<.05) for the radiographic scale by segments and its interobserver agreement was high, compared with the scale by percentage. Radiographic scales may be useful in the evaluation and treatment of patients with abdominal pain and constipation. The segmental scale showed less interobserver variability, suggesting its proposal as an alternative in the evaluation and follow-up of patients with chronic constipation.

Detecting and recording cardiac murmurs in clinically healthy puppies in first opinion veterinary practice at the first health check

BackgroundThe frequency that cardiac murmurs are identified and recorded in first opinion veterinary practices at the first health check in puppies is unknown. The aims of the study were to assess the agreement between first opinion veterinary practitioners, a veterinary student and a veterinary cardiology specialist on detecting murmurs, and to establish whether abnormal auscultation findings had been recorded in the health certificates of clinically healthy puppies. The study included prospective and retrospective investigations, where the prospectively collected auscultation findings from a veterinary cardiology specialist and a trained veterinary student were compared to auscultation findings recorded by first opinion veterinary practitioners.ResultsCardiac auscultation was performed on 331 client-owned, clinically healthy dogs at two time points: at age 34–69 days by a first opinion veterinary practitioner and at age 45–76 days, on average 9 days later, by a veterinary cardiology specialist and a trained veterinary student. Agreement among the three was compared for the presence of a murmur. The degree of inter-observer agreement was evaluated using Cohen’s kappa. Auscultation findings, as noted in the pets’ passports, from 331 puppies and 43 different first opinion veterinary practices, were retrospectively reviewed and prospectively compared with auscultation findings from a veterinary cardiology specialist. Agreement between the veterinary cardiology specialist and the first opinion veterinary practitioners was poor (ϰ = 0.01) and significantly different (P < 0.001). First opinion veterinary practitioners had recorded a cardiac murmur in only 1 of the 97 puppies in which the veterinary cardiology specialist detected a murmur. Two-hundred-and-fifty-two puppies were auscultated by both the veterinary cardiology specialist and the student. Their agreement was fair (ϰ = 0.40) and significantly different (P = 0.024). The agreement between the student and a first opinion veterinary practitioner on these 252 puppies was poor (ϰ = 0.03) and significantly different (P < 0.001).ConclusionsThis study shows that soft cardiac murmurs are rarely documented during the first veterinary health check in puppies by first opinion veterinary practitioners. Although soft murmurs may not be clinically relevant, finding and recording them is evidence of a carefully performed auscultation. Missing a non-pathological murmur is not of clinical importance; however, missing a pathological murmur could prove detrimental for the individual puppy.

Differentiation of simple renal parenchymal cyst and calyceal diverticulum.

Calyceal diverticulum is the cystic eventration of the upper urinary tract within the renal parenchyma, which gives the first impression of a simple renal cyst and therefore can easily be misdiagnosed. We conducted a study to assess the role of static-fluid magnetic resonance (MR) urography in the differentiation of renal parenchymal cysts and calyceal diverticulum in comparison with focused renal ultrasonography (US). Focused renal US, static-fluid, and excretory MR urography studies of 45 children who were admitted to our pediatric nephrology department with a diagnosis of renal cyst were reviewed retrospectively. Excretory MR urography was accepted as gold standard for the diagnosis of calyceal diverticulum. Sensitivity and specificity of focused renal US and static fluid MR urography in the diagnosis of renal calyceal diverticulum were assessed. Interobserver agreement between three radiologists in the diagnosis of calyceal diverticulum on MRI was also evaluated. The study included 29 patients (13 boys and 16 girls) aged between 6-18years (mean 11.5 ± 4.1). Five calyceal diverticula and 24 solitary renal parenchymal cysts were diagnosed. The sensitivity and the specificity of focused renal US were 40% and 100% in the diagnosis of calyceal diverticulum. The sensitivity and the specificity of static-fluid MR urography were 100% and 91.6%, respectively. The degree of interobserver agreement was excellent for the diagnosis of diverticulum for static-fluid MR urography (κ = 0.86, 95% CI: 0.71-1.00). Static-fluid MR urography can be successfully used in children for the differentiation of renal parenchymal cyst and calyceal diverticulum due to its high sensitivity and specificity, without exposing children to ionizing radiation or intravenous contrast agents.

Association between abdominal pain and fecal impaction grade assessed through radiography in constipated patients at a pediatric emergency service

Introduction and aimAbdominal pain in children is a frequent cause of emergency room consultation. An important group of those patients presents with chronic constipation and fecal impaction. Plain abdominal x-ray is widely used for making a diagnosis and ruling out the need for surgical treatment. The present study examined the association between pain intensity and fecal impaction grade. Materials and methodsAn analytic cross-sectional study was conducted that compared two radiographic scales to determine the association between the grade of fecal impaction observed and abdominal pain intensity in patients that sought medical attention at an emergency service within a 7-month period. The analysis was carried out by two different observers, utilizing two different radiographic scales to confirm their reproducibility. The degree of interobserver agreement was measured using the Kappa coefficient and the association between abdominal pain and fecal impaction grade was measured through the Spearman correlation coefficient. ResultsThere was a significant association between pain intensity and the radiographic grade of fecal impaction (p < 0.05) for the radiographic scale by segments and its interobserver agreement was high, compared with the scale by percentage. ConclusionsRadiographic scales may be useful in the evaluation and treatment of patients with abdominal pain and constipation. The segmental scale showed less interobserver variability, suggesting its proposal as an alternative in the evaluation and follow-up of patients with chronic constipation.

TL 18167 - Reproducibility assessment of the Lauge-Hansen, Danis-Weber and AO classifications of ankle fractures

Introduction: Although there are some studies on the reproducibility of various classifications of ankle fractures, they are controversial and lack consensus on which classification is the most appropriate. Thus, the objective of this study is to identify which of the 3 main ankle fracture classifications has the highest intra- and interobserver reproducibility and to assess whether the medical training stage of the participants affects the evaluation. Methods: Radiographs of 30 patients with ankle fracture in anteroposterior (AP), profile and true AP views were selected. All images were evaluated by 11 participants at different stages of their medical training (5 residents and 6 orthopedic surgeons) and at 2 different times. Intra- and interobserver agreement was analyzed using the weighted Cohen's kappa coefficient. Paired Student's t-tests were performed to assess whether the degree of interobserver agreement significantly differed between classification methods. Results: The results showed significant agreement in all classifications when analyzing intraobserver agreement alone. The Danis-Weber classification showed a highly significant (p&lt;0.0001) moderate-to-excellent interobserver agreement. The Danis-Weber classification had, on average, a significantly higher degree of agreement than the other classification methods (p&lt;0.0001). Conclusion: The Danis-Weber classification had the highest reproducibility among the classification methods evaluated in this study.

Comparison of interobserver agreement between the evaluation of bicipital and the patellar tendon reflex in healthy dogs

The reliability of reflex-assessment is currently debatable, with current literature regarding the patellar tendon reflex (PTR) as highly reliable, while the biceps tendon reflex (BTR) is regarded to be of low reliability in the dog. Such statements are, however, based on subjective observations rather than on an empirical study. The goals of this study were three-fold: (1) the quantification of the interobserver agreement (IA) on the evaluation of the canine bicipital (BTR) and patellar tendon (PTR) reflex in healthy dogs, (2) to compare the IA of the BTR and PTR evaluation and (3) the identification of intrinsic (sex, age, fur length, weight) and extrinsic (observer´s expertise, body side) risk factors on the IA of both reflexes. The observers were subdivided into three groups based on their expected level of expertise (neurologists = highest -, practitioners = middle–and veterinary students = lowest level of expertise). For the BTR, 54 thoracic limbs were analyzed and compared to the evaluation of the PTR on 64 pelvic limbs. Each observer had to evaluate the reflex presence (RP) (present or absent) and the reflex activity (RA) using a 5-point ordinal scale. Multiple reliability coefficients were calculated. The influence of the risk factors has been calculated using a mixed regression-model. The Odds Ratio for each factor was presented. The higher the level of expertise the higher was the IA of the BTR. For RP(BTR), IA was highest for neurologists and for RA(BTR) the IA was lowest for students. The level of expertise had a significant impact on the degree of the IA in the evaluation of the bicipital tendon reflex: for the RA(BTR), practitioners had a 3.4-times (p = 0.003) and students a 7.0-times (p < 0.001) higher chance of discordance. In longhaired dogs the chance of disagreement was 2.6-times higher compared to shorthaired dogs in the evaluation of RA(BTR) (p = 0.003). Likewise, the IA of the RP(PTR) was the higher the higher the observers´ expertise was with neurologists having significantly highest values (p < 0.001). The RA(PTR) has been evaluated more consistent by practitioners and students than the RA(BTR). For practitioners this difference was significant (< 0.01). Our data suggests that neurologists assess the bicipital and patellar tendon reflex in dogs most reliably. None of the examined risk factors had a significant impact on the degree of IA in the evaluation of RP(PTR), while students had a 4.4-times higher chance of discordance when evaluating the RA(PTR) compared to the other groups. This effect was significant (p < 0.001). Neurologists can reliably assess the bicipital and patellar tendon reflex in healthy dogs. Observer´s level of expertise and the fur length of the dog affect the degree of IA of RA(BTR). The influence of the observer´s expertise is higher on the evaluation of the BTR than on the PTR.

48. Does it exist an interobserver variability in the interpretation of SSEPs in comatose patients after cardiac arrest? An answer from the Italian Multicentric study ProNeCA

Evaluate inter-observer variability reading of SSEPs in post-anoxic comatose patients included in ProNeCa. 3 readers and a “Gold Standard”, central coordinatior of Italian study, decided to interpretate independently 13 SSEPs. SEPs evaluation was splited into “Absent” (A), “Present” (P) and Not Valutable (NV). The degree of interobserver agreement was calculated using Overall Agreement, Kappa Coefficients and Intraclass Correlation Coefficient (ICC). Overal Agreement between raters (69.2%; 95%CI 38.6–90.9) and agreement of each rater vs. GS was good (from Rater1 = 84.6% to Rater3 = 92.3%). Interrater Agreement was substantial, Exact kappa = 0.64. For category A was 0.58 (moderete agreement), NV 0.62 (substantial agreement) and Present 0.77 (good). Single raters were in good agreement vs. GS (two had a weighted κ⩾0.800), higher than K for bivariate comparison among raters (weighted κ from 0.68 to 0.87). ICC yielded a good 0.747 [0.49–0.91] P = 0.0287. Interobserver agreement for A in accord with lecterature was moderate, with quite wide confidence intervals. Each rater is from fair to good agreement with the GS. To reach a more reliable agreement and reduce CI we decided to increse the sample size: 32 SSEP have been reed but not yet included in this analysis.

MTE11.01 The Clinical Impact of the 2015 WHO Classification of Lung Tumors

MTE11.01 The Clinical Impact of the 2015 WHO Classification of Lung Tumors

Interobserver Agreement on Pathologic Features of Liver Biopsy Tissue in Patients with Nonalcoholic Fatty Liver Disease.

Background:The histomorphologic criteria for the pathological features of liver tissue from patients with non-alcoholic fatty liver disease (NAFLD) remain subjective, causing confusion among pathologists and clinicians. In this report, we studied interobserver agreement of NAFLD pathologic features and analyzed causes of disagreement. Methods:Thirty-one cases of clinicopathologically diagnosed NAFLD from 10 hospitals were selected. One hematoxylin and eosin and one Masson’s trichrome-stained virtual slide from each case were blindly reviewed with regard to 12 histological parameters by 13 pathologists in a gastrointestinal study group of the Korean Society of Pathologists. After the first review, we analyzed the causes of disagreement and defined detailed morphological criteria. The glass slides from each case were reviewed a second time after a consensus meeting. The degree of interobserver agreement was determined by multi-rater kappa statistics. Results:Kappa values of the first review ranged from 0.0091–0.7618. Acidophilic bodies (k = 0.7618) and portal inflammation (k = 0.5914) showed high levels of agreement, whereas microgranuloma (k = 0.0984) and microvesicular fatty change (k = 0.0091) showed low levels of agreement. After the second review, the kappa values of the four major pathological features increased from 0.3830 to 0.5638 for steatosis grade, from 0.1398 to 0.2815 for lobular inflammation, from 0.1923 to 0.3362 for ballooning degeneration, and from 0.3303 to 0.4664 for fibrosis.Conclusions:More detailed histomorphological criteria must be defined for correct diagnosis and high interobserver agreement of NAFLD.

What middle phalanx base fracture characteristics are most reliable and useful for surgical decision-making?

Fracture-dislocations of the proximal interphalangeal joint are vexing because subluxation and articular damage can lead to arthrosis and the treatments are imperfect. Ideally, a surgeon could advise a patient, based on radiographs, when the risk of problems merits operative intervention, but it is unclear if middle phalanx base fracture characteristics are sufficiently reliable to be useful for surgical decision making. We evaluated (1) the degree of interobserver agreement as a function of fracture characteristics, (2) the differences in interobserver agreement between experienced and less-experienced hand surgeons, and (3) what fracture characteristics and surgeon characteristics were associated with the decision for operative treatment. Ninety-nine (33%) of 296 hand surgeons evaluated 21 intraarticular middle phalanx base fractures on lateral radiographs. Eighty-one surgeons (82%) were in academic practice and 57 (58%) had less than 10 years experience. Participants assessed six fracture characteristics and recommended treatment (nonoperative or operative: extension block pinning, external fixation, open reduction and internal fixation, volar plate arthroplasty, or hemihamate autograft arthroplasty) for all cases. With all surgeons pooled together, the interobserver agreement for fracture characteristics was substantial for assessment of a 2-mm articular step or gap (kappa, 0.73; 95% CI, 0.60-0.86; p < 0.001), subluxation or dislocation (kappa, 0.72; 95% CI, 0.58-0.86; p < 0.001), and percentage of articular surface involved (intraclass correlation coefficient [ICC], 0.67; 95% CI, 0.54-0.81; p < 0.001); moderate for comminution (kappa, 0.55; 95% CI, 0.39-0.70; p < 0.001) and stability (kappa, 0.54; 95% CI, 0.39-0.69; p < 0.001); and fair for the number of fracture fragments (ICC, 0.39; 95% CI, 0.27-0.57; p < 0.001). When recommending treatment, interobserver agreement was substantial (kappa, 0.69; 95% CI, 0.50-0.88; p < 0.001) for the recommendation to operate or not to operate, but only fair (kappa, 0.34; 95% CI, 0.21-0.47; p < 0.001) for the specific type of treatment, indicating variation in operative techniques. There were no differences in agreement for any of the fracture characteristics or treatment preference between less-experienced and more-experienced surgeons, although statistical power on this comparison was low. None of the surgeon characteristics was associated with the decision for operative treatment, whereas all fracture characteristics were, except for stable and uncertain joint stability. Articular step or gap (β, 0.90; R-squared, 0.89; 95% CI, 0.75-1.05; p < 0.001), likelihood of subluxation or dislocation (β, 0.80; R-squared, 0.76; 95% CI, 0.59-1.02; p < 0.001), and unstable fractures (β, 0.88; R-squared, 0.81; 95% CI, 0.67-1.1; p < 0.001), are most strongly associated with the decision for operative treatment. We found that assessment of a step or gap and likelihood of subluxation were most reliable and are strongly associated with the decision for operative treatment. Surgeons largely agree on which fractures might benefit from surgery, and the variation seems to be with the operative technique. Efforts at improving the care of these fractures should focus on the comparative effectiveness of the various operative treatment options. Level III, diagnostic study.

The utility of atlas-assisted segmentation in the male pelvis is dependent on the interobserver agreement of the structures segmented.

To investigate the relationship between the ability of atlas-based autosegmentation to reduce outlining time in the male pelvis (body, bladder, rectum, femoral heads, prostate and seminal vesicles) and the interobserver agreement in the delineation of these structures. To examine any increase of the interobserver agreement with the use of an autosegmentation tool. We created atlases in the ABAS™ system v. 2.0 (Elekta, Crawley, UK) and recorded the time to delineate the above structures on eight patients with and without its aid. We also measured the interobserver agreement in the structure definitions using several metrics [Dice's similarity coefficient (DSC), mean distance to conformity, percentage volume difference] with and without the aid of ABAS. There is a high degree of correlation between the time saving with the use of ABAS and the degree of interobserver agreement (r = 0.90 for DSC). This indicates that for structures where the interobserver agreement is low (DSC < 0.65), the ABAS does not reduce outlining time. We found that the interobserver agreement is increased with ABAS only for the prostate. Outlining time saved in the male pelvis is highly correlated with the interobserver agreement of the structures. Only for the prostate does the use of ABAS significantly reduce the amount of interobserver variation in contouring. The use of autosegmentation software increases the outlining time for structures where the interobserver agreement is low. Any increase in the interobserver agreement in contouring with the aid of such software may be limited to those structures where there is currently mid-range agreement between observers.

Focused Renal Sonography Performed and Interpreted by Internal Medicine Residents

Intensivist-performed focused sonography, including renal sonography, is becoming accepted practice. Whether internal medicine residents can be trained to accurately rule out renal obstruction and identify sonographic findings of chronic kidney disease is unknown. The purpose of this study was to test the ability of residents to evaluate for this specific constellation of findings. Internal medicine residents were trained in a 5-hour module on focused renal sonography evaluating renal length, echogenicity, hydronephrosis, and cysts on a convenience sample of medical ward, intermediate care, and medical intensive care unit patients. All patients underwent comprehensive sonography within 24 hours. The primary outcome was represented by the Fleiss κ statistic, which indicated the degree of interobserver agreement between residents and radiologists. Sensitivity, specificity, and positive and negative predictive values were calculated using the comprehensive radiologist-read examination as the reference. Seventeen internal medicine residents imaged 125 kidneys on 66 patients. The average number of studies performed was 7.3 (SD, 6.6). Residents demonstrated excellent agreement with radiologists for hydronephrosis (κ = 0.73; P < .001; SE, 0.15; sensitivity, 94%; specificity, 93%), moderate agreement for echogenic kidneys (κ = 0.43; P < .001; SE, 0.13; sensitivity, 40%; specificity, 98%), and substantial agreement for renal cysts (κ = 0.61; P < .001; SE, 0.12; sensitivity, 60%; specificity, 96%). Residents showed sensitivity of 100% and specificity of 88% for identification of atrophic kidneys, defined as length less than 8 cm. After a 5-hour training course, medical residents accurately identified hydronephrosis and key sonographic findings of chronic kidney disease in a cohort of medical patients. Screening for hydronephrosis and renal atrophy can be performed by medical residents after adequate training.

PCR vs “PCAren’t”

Clostridium difficile remains the most common nosocomial cause of diarrhea and is becoming an increasingly important community-acquired infection.1,2 Antibiotic resistance, as well as the recently identified BI/NAP1/027 strain, is responsible for more cases of severe C difficile –associated diarrhea worldwide.3 The diagnosis of C difficile infection is usually based on a combination of history of antibiotic use, the presence of pseudomembranes on colonoscopy, appropriate histology on biopsy, and confirmatory laboratory stool tests for either the C difficile toxin or bacterial toxin genes. Most clinical laboratories employ a C difficile –associated toxin enzyme immunoassay (EIA). These assays are technically easy to perform and have a rapid turnaround time. Although they have specificities ranging from 65% to 100%, the sensitivities are limited, ranging from 31% to 99%.4 Recently, US Food and Drug Administration–approved, polymerase chain reaction (PCR)–based molecular assays performed on stool lysates have been increasingly recognized as the most sensitive and specific methods of diagnosing C difficile . These assays target C difficile toxin genes rather than the toxins themselves, with a sensitivity from 77% to 100% and a specificity from 93% to 99%.5–7 The tissue diagnosis of C difficile in a gastrointestinal mucosal biopsy specimen is generally straightforward, although some infections (eg, enterohemorrhagic Escherichia coli , Shigella , and toxin-producing Clostridium perfringens ) may produce similar features both macroscopically and morphologically. Ischemia is frequently in the histologic differential diagnosis as well, and the distinction between the two is extremely important because the treatments are different. In their article in this issue of the American Journal of Clinical Pathology , Wiland and colleagues8 examine the degree of interobserver agreement in the histologic diagnosis of C difficile colitis and correlate the histologic findings with clinical data. They also …

Concordancia interobservador en la detección de bocio por palpación en población escolar

ObjectiveTo estimate the agreement between observers on the detection of goitre by physical exploration in a school population. MethodologyWe performed a cross-sectional study to detect goitre in a representative sample of 1134 schoolchildren aged 6 to 12 years from 20 schools in the health area of La Mancha Centro. The examination was performed blinded by two observers. Five grades in thyroid size were established (0, Ia, Ib, II and III). Above grade Ia was considered as goitre. The agreement was assessed in relation to variables such as age, sex, body mass index, height, and day of examination. The weighted kappa was used to measure the agreement. ResultsIn the 1097 schoolchildren with a dual examination, 96 (8.8%) cases of goitre were detected by observer 1, and 102 (9.3%) cases by observer 2, (P=.58). The degree of interobserver agreement in the identification and grading of goitre was moderate (kappa 0,55, 95%CI: 0,46 to 0,64) for the first, and substantial (weighted kappa 0,61; 95%CI: 0,51 to 0,71) for the second. The degree of agreement was somewhat higher in girls, older schoolchildren, increased weight, height, and body mass index. The interobserver agreement was relatively stable throughout the study. ConclusionsThe interobserver agreement in detecting goitre by palpation in our study is moderate, but is lower in younger children and stable for the duration of study.

Flexible Spectral Imaging Color Enhancement (FICE) Is Useful to Discriminate Among Non-neoplastic Lesion, Adenoma, and Cancer of Stomach

Studies regarding the discrimination of non-neoplastic lesion, adenoma, and cancer of the stomach using magnifying endoscopy with flexible spectral imaging color enhancement system (FIME) in each different channel of that system have not yet been reported. To ascertain the usefulness of FIME discriminating among the three kinds of gastric lesions. When finding a lesion to be a possible neoplasm using conventional endoscopy, the examiner discriminated among the three kinds of gastric lesions by observing the pit pattern on the lesion using magnifying endoscopy with white light (WLME) and then recorded the image. The procedure was repeated three more times with FIME with channel 0, 2, and 4. The four recorded images per lesion were then given to four raters for discriminating among the three kinds of gastric lesions. The proportion of agreement and the degree of agreement between endoscopic and pathological diagnosis (AEP) by WLME were 0.85 and 0.76, respectively, and those by FIME were 0.91 and 0.86, respectively. All AEPs from discriminations with FIME was higher than that with WLME. AEPs from the discriminations with FIME with channel 4 were higher than those with FIME with channel 0 or 2. The degree of interobserver agreement among the results of the four raters was 0.42 for WLME and 0.50-0.59 for FIME with each of the three different channels. FICE is useful in discriminating among non-neoplastic lesions, adenoma, and cancer of the stomach, and channel 4 of the FICE is better than channel 0 and 2 for the discriminations.

Reliability and agreement of two smear reading scales for classification and monitoring of multidrug therapy in leprosy patients

After the clinical diagnosis of leprosy, classification methods are necessary to define a treatment and prognosis of patients consistent with bacterial load. Bacteria are detected in skin smear, and bacterial load typically is established by the internationally used Ridley's logarithmic scale, However, in Colombia an alternative semiquantitative scale is used. The interobserver reproducibility was established for the Ridley and Colombia scales, and the level of correlation-matching was identified between the bacillary indices obtained in order to assess the degree of interchangeability. Standardization was attained by a reading of the smears by 2 readers with subsequent, blinded evaluation of inter-observer agreement. Each reader quantified the bacterial load of for each sample (n=325) using the Colombian and the Ridley scales. The degree of interobserver agreement was assessed with weighted kappa coefficient. The level of correlation and agreement between the measurements of the bacillary index was established with coefficient of Lin. The interobserver weighted kappa coefficient was 0.83 for the Colombia scale and 0.85 for the Ridley scale. The Lin coefficient was 0.96 for the correlation-matching of bacillary indexes. Interobserver agreement obtained for both scales was excellent as the correlation-matching bacillary indices determined with both methods. With the cut-off points yielded a good level of agreement, ensuring interchangeability between the scales defining the high or low bacterial load.

Non-computer-assisted liquid-based cytology for diagnosis of oral squamous cell carcinoma

The development of oral squamous cell carcinoma (OSCC) occasionally follows the neoplastic progression of other premalignant lesions. Although biopsy is the definitive diagnostic method, liquid-based cytology is an adequate method for screening suspicious lesions. We compared liquid-based cytology to histology for diagnosis of OSCC in patients with oral lesions that raised clinical suspicion of malignancy. Our sample consisted of 48 patients. Cytological samples were obtained by scraping the lesion superficially using Cytobrush®. We conducted cytological and histopathological evaluation of all preparations. We estimated sensitivity and specificity levels as well as positive and negative predictive values. The degree of inter-observer agreement for both methods was assessed using the kappa index. Twenty-eight (58.3%) of the cases finally were diagnosed with OSCC and 20 (41.7%) were determined to be premalignant lesions. We observed eight false negatives and no false positives; OSCC prevalence was 56.5%. The values for diagnostic indices were: sensitivity, 69% (CI 95%, prevalence 51.87); specificity, 100%; positive predictive value, 100%; negative predictive value, 71% (CI 95% 54.82). A kappa index of 0.622 (CI 95% 0.93, 0.39) was observed.