title: Interobserver agreement among endosonographers for the diagnosis of neoplastic versus non-neoplastic pancreatic cystic lesions.
abstract: 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.
authors.affiliation: Gastroenterology Division, Department of Medicine, Hospital of University of Pennsylvania, Philadelphia VAMC, University of Pennsylvania School of Medicine, 19104-4283, USA.
authors.forename: Nuzhat A
authors.initials: NA
authors.lastname: Ahmad
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kochman
authors.forename: Colleen
authors.initials: C
authors.lastname: Brensinger
authors.forename: William R
authors.initials: WR
authors.lastname: Brugge
authors.forename: Douglas O
authors.initials: DO
authors.lastname: Faigel
authors.forename: Frank G
authors.initials: FG
authors.lastname: Gress
authors.forename: Michael B
authors.initials: MB
authors.lastname: Kimmey
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Nickl
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Savides
authors.forename: Michael B
authors.initials: MB
authors.lastname: Wallace
authors.forename: Maurits J
authors.initials: MJ
authors.lastname: Wiersema
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Ginsberg
mesh_terms: 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