title: Detection of early gastric cancer using hydro-stomach CT: blinded vs unblinded analysis.
abstract: OBJECTIVE
  To evaluate the difference in diagnostic performance of hydro-stomach computed tomography (CT) to detect early gastric cancer (EGC) between blinded and unblinded analysis and to assess independent factors affecting visibility of cancer foci.
  
  
  METHODS
  Two radiologists initially blinded and then unblinded to gastroscopic and surgical-histological findings independently reviewed hydro-stomach CT images of 110 patients with single EGC. They graded the visibility of cancer foci for each of three gastric segments (upper, middle and lower thirds) using a 4-point scale (1: definitely absent, 2: probably absent, 3: probably present, and 4: definitely present). The sensitivity and specificity for detecting an EGC were calculated. Intraobserver and interobserver agreements were analyzed. The visibility of an EGC was evaluated with regard to tumor size, invasion depth, gastric segments, histological type and gross morphology using univariate and multivariate analysis.
  
  
  RESULTS
  The respective sensitivities and specificities [reviewer 1: blinded, 20% (22/110) and 98% (215/220); unblinded, 27% (30/110) and 100% (219/220)/reviewer 2: blinded, 19% (21/110) and 98% (216/220); unblinded, 25% (27/110) and 98% (215/220)] were not significantly different. Although intraobserver agreements were good (weighted κ = 0.677 and 0.666), interobserver agreements were fair (blinded, 0.371) or moderate (unblinded, 0.558). For both univariate and multivariate analyses, the tumor size and invasion depth were statistically significant factors affecting visibility.
  
  
  CONCLUSIONS
  The diagnostic performance of hydro-stomach CT to detect an EGC was not significantly different between blinded and unblinded analysis. The tumor size and invasion depth were independent factors for visibility.
authors: Department of Radiology, Center for Imaging Science, Sungkyunkwan University School of Medicine, Ilwon-Dong, Kangnam-Ku, Seoul, South Korea.
authors: Ki Jeong
authors: KJ
authors: Park
authors: Min Woo
authors: MW
authors: Lee
authors: Ji Hyun
authors: JH
authors: Koo
authors: Yulri
authors: Y
authors: Park
authors: Heejung
authors: H
authors: Kim
authors: Dongil
authors: D
authors: Choi
authors: Soon Jin
authors: SJ
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000473:pathology*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult