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ORIGINAL ARTICLE
Year : 2015  |  Volume : 4  |  Issue : 3  |  Page : 244-249

Interobserver agreement of EUS elastography in the evaluation of solid pancreatic lesions


1 Department of Gastroenterology, Hospital of Braga, Braga, Portugal
2 Department of Gastroenterology, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña; Foundation for Research in Digestive Diseases, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
3 Department of Gastroenterology, Sahlgrenska University Hospital, Gothenburg; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
4 Department of Gastroenterology, Hospital of Braga, Braga; Surgical Sciences Research Domain, Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga, Portugal
5 Department of Gastroenterology, Portuguese Oncology Institute, Oporto; Department of Physiology, Cardiovascular Research and Development Unit, Oporto Faculty of Medicine, Porto, Portugal
6 Surgical Sciences Research Domain, Life and Health Sciences Research Institute, School of Health Sciences, University of Minho, Braga; 9Department of Gastroenterology, Hospital Center of Alto Minho, Viana do Castelo, Portugal
7 Department of Gastroenterology, Hospital Center of Alto Ave, Guimarães, Portugal

Correspondence Address:
Dr. João-Bruno Soares
Department of Gastroenterology, Hospital of Braga, Braga
Portugal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2303-9027.163016

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Background and Objectives: Previous reports assessing the reproducibility of endoscopic ultrasound elastography (EUS-E) in evaluation of solid pancreatic lesions (SPL) involved only experienced endosonographers. We aimed to assess the interobserver agreement (IOA) of EUS-E in the evaluation of SPL by endoscopists with different levels of experience in EUS and EUS-E. Materials and Methods: A cross-sectional observational multicenter study was designed and included 11 endoscopists who were divided into four groups: Group A (long experience in EUS and EUS-E); Group B (short experience in EUS and EUS-E); Group C (long experience in EUS and no experience in EUS-E); and Group D (no experience in EUS or EUS-E). The observers independently classified the patterns of 60 video sequences of EUS-E, after a 20-min training session. For each group, we calculated IOA (kappa statistic, k) of EUS-E and the diagnostic accuracy of EUS-E for pancreatic malignancy, by comparing the pattern of EUS-E indicative of malignancy (heterogeneous or homogenous blue) with the final diagnosis. Results: The overall IOA was moderate (k = 0.42; 95% confidence interval (CI) 0.33-0.52). The IOA of Group A (k = 0.80; 95% CI 0.65-1.00) was significantly higher than that of Groups B (k = 0.54; 95%CI 0.40-0.71), C (k = 0.54; 95%CI 0.39-0.68), and D (k = 0.28; 95%CI 0.14-0.40). IOA of Groups B and C was not significantly different, but it was significantly higher than that of Group D. The diagnostic accuracy of Group A (area under the curve under summary receiver operating characteristic (AUROC) = 0.83; 95%CI 0.75-0.90) was not significantly different from that of Group B (AUROC = 0.77; 95%CI 0.71-0.83), but it was significantly higher than that of Groups C (AUROC = 0.74; 95%CI 0.67-0.81) and D (AUROC = 0.74; 95%CI 0.67-0.81). No significant difference was seen between Groups B, C, and D for diagnostic accuracy. Conclusion: EUS-E is reproducible in the evaluation of SPL, even between endoscopists with no or limited experience in EUS and/or EUS-E. Reproducibility and diagnostic accuracy increase with experience in EUS and EUS-E.


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