Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions.
BACKGROUND
The aim of this study was to evaluate the degree of agreement among endosonographers for EUS diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions and the specific type of cystic lesion.


METHODS
Videotapes of EUS procedures from 31 consecutive cases of a range of histopathologically proven lesions, including mucinous cystic neoplasm, serous cystadenoma, neuroendocrine tumor, intraductal papillary mucinous tumor, and pseudocyst, were used to make a study videotape, which was reviewed by 8 experienced endosonographers. The reviewers, blinded to clinical and surgical histopathology results, reviewed each case for the presence or absence of the following features: abnormality of pancreatic duct and parenchyma, margins, solid component, debris, and septations. They were asked to identify each lesion as neoplastic or non-neoplastic and to give a specific diagnosis for each lesion.


RESULTS
There was fair agreement between endosonographers for diagnosis of neoplastic versus non-neoplastic lesions (kappa = 0.24). Agreement for individual types of lesions was moderately good for serous cystadenomas (kappa = 0.46) but fair for the remainder. Agreement was moderately good for presence or absence of solid component (kappa = 0.43); fair for presence or absence of abnormal pancreatic duct (kappa = 0.29), debris (kappa = 0.21), and septations (kappa = 0.30); and slight for presence or absence of margins (kappa = 0.01) and abnormal pancreatic parenchyma (kappa = 0.01). Accuracy rates of EUS for the diagnosis of neoplastic versus non-neoplastic lesions ranged from 40% to 93%.


CONCLUSIONS
There is little more than chance interobserver agreement among experienced endosonographers for diagnosis of neoplastic versus non-neoplastic, specific type, and EUS features of pancreatic cystic lesions.
Ahmad
Nuzhat A
NA
Gastroenterology Division, Department of Medicine, Hospital of University of Pennsylvania, Philadelphia VAMC, University of Pennsylvania School of Medicine, 19104-4283, USA.
Kochman
Michael L
ML
Brensinger
Colleen
C
Brugge
William R
WR
Faigel
Douglas O
DO
Gress
Frank G
FG
Kimmey
Michael B
MB
Nickl
Nicholas J
NJ
Savides
Thomas J
TJ
Wallace
Michael B
MB
Wiersema
Maurits J
MJ
Ginsberg
Gregory G
GG
D000368:Aged; D001707:Biopsy, Needle; D016009:Chi-Square Distribution; D002983:Clinical Competence; D016001:Confidence Intervals; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D005762:Gastroenterology / Q000592:standards / Q000639:trends; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010181:Pancreatic Cyst / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology*; D011336:Probability; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity