The reliability of EUS for the diagnosis of chronic pancreatitis: Interobserver agreement among experienced endosonographers

Michael B. Wallace, Robert H. Hawes, Valerie Durkalski, Amitabh Chak, Shawn Mallery, Marc F. Catalano, Maurits J. Wiersema, Manoop S. Bhutani, Donato Ciaccia, Michael L. Kochman, Frank G. Gress, Annette Van Velse, Brenda J. Hoffman

Research output: Contribution to journalArticle

167 Citations (Scopus)

Abstract

Background: Endoscopic ultrasound (EUS) is a minimally invasive, low risk method of diagnosis for chronic pancreatitis (CP). The degree to which endosonographers agree on the features and diagnosis of CP is unknown. For EUS to be considered an accurate test for CP, there must be good interobserver agreement. Methods: Forty-five pancreatic EUS examinations were videotaped by 3 experienced endosonographers. Examinations from 33 patients with suspacted CP based on typical symptoms, as well as 12 control patients without suspected CP, were included. Eleven experienced endosonographers ("experts") who were blinded to clinical information independently evaluated all videotaped examinations for the presence of CP and the following 9 validatad features of CP: echogenic foci, strands, lobularity, cysts, stones, duct dilatation, duct irregularity, hyperechoic duct margins, and visible side branches. The experts also ranked (most to least) which features they believed to be the most indicative of CP. Interobserver agreement was expressed as the kappa (κ) statistic. Results: There was moderately good overall agreement for the final diagnosis of CP (κ = 0.45). Agreement was good for individual features of duct dilatation (κ = 0.6) and lobularity (κ = 0.51) but poor for the other 7 features (κ < 0.4). The expert panel had consensus or near consensus agreement (greater than 90%) on 206 of 450 (46%) individual EUS features including 22 of 45 diagnoses of CP. Agreement on the final diagnosis of CP was moderately good for those trained in third tier fellowships (κ = 0.42 ± 0.03) and those with more than 1100 lifetime pancreatic EUS examinations (κ = 0.46 ± 0.05). The presence of stones was regarded as the most predictive feature of CP by all endosonographers, followed by visible side branches, cysts, lobularity, irregular main pancreatic duct, hyperechoic foci, hyperechoic strands, main pancreatic duct dilatation, and main duct hyperechoic margins. The most common diagnostic criterion for the diagnosis of CP was the total number of features (median 4 or greater, range 3 or greater to 5 or greater). Conclusions: EUS is a reliable method for the diagnosis of chronic pancreatitis with good interobserver agreement among experienced endosonographers. Agreement on the EUS diagnosis of chronic pancreatitis is comparable to other commonly used endoscopic procedures such as bleeding ulcer stigmata and computed tomography of the brain for stroke localization and better than the physical diagnosis of heart sounds.

Original languageEnglish (US)
Pages (from-to)294-299
Number of pages6
JournalGastrointestinal Endoscopy
Volume53
Issue number3
StatePublished - 2001
Externally publishedYes

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Chronic Pancreatitis
Dilatation
Pancreatic Ducts
Cysts
Heart Sounds
Christianity
Ulcer

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Wallace, M. B., Hawes, R. H., Durkalski, V., Chak, A., Mallery, S., Catalano, M. F., ... Hoffman, B. J. (2001). The reliability of EUS for the diagnosis of chronic pancreatitis: Interobserver agreement among experienced endosonographers. Gastrointestinal Endoscopy, 53(3), 294-299.

The reliability of EUS for the diagnosis of chronic pancreatitis : Interobserver agreement among experienced endosonographers. / Wallace, Michael B.; Hawes, Robert H.; Durkalski, Valerie; Chak, Amitabh; Mallery, Shawn; Catalano, Marc F.; Wiersema, Maurits J.; Bhutani, Manoop S.; Ciaccia, Donato; Kochman, Michael L.; Gress, Frank G.; Van Velse, Annette; Hoffman, Brenda J.

In: Gastrointestinal Endoscopy, Vol. 53, No. 3, 2001, p. 294-299.

Research output: Contribution to journalArticle

Wallace, MB, Hawes, RH, Durkalski, V, Chak, A, Mallery, S, Catalano, MF, Wiersema, MJ, Bhutani, MS, Ciaccia, D, Kochman, ML, Gress, FG, Van Velse, A & Hoffman, BJ 2001, 'The reliability of EUS for the diagnosis of chronic pancreatitis: Interobserver agreement among experienced endosonographers', Gastrointestinal Endoscopy, vol. 53, no. 3, pp. 294-299.
Wallace, Michael B. ; Hawes, Robert H. ; Durkalski, Valerie ; Chak, Amitabh ; Mallery, Shawn ; Catalano, Marc F. ; Wiersema, Maurits J. ; Bhutani, Manoop S. ; Ciaccia, Donato ; Kochman, Michael L. ; Gress, Frank G. ; Van Velse, Annette ; Hoffman, Brenda J. / The reliability of EUS for the diagnosis of chronic pancreatitis : Interobserver agreement among experienced endosonographers. In: Gastrointestinal Endoscopy. 2001 ; Vol. 53, No. 3. pp. 294-299.
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T1 - The reliability of EUS for the diagnosis of chronic pancreatitis

T2 - Interobserver agreement among experienced endosonographers

AU - Wallace, Michael B.

AU - Hawes, Robert H.

AU - Durkalski, Valerie

AU - Chak, Amitabh

AU - Mallery, Shawn

AU - Catalano, Marc F.

AU - Wiersema, Maurits J.

AU - Bhutani, Manoop S.

AU - Ciaccia, Donato

AU - Kochman, Michael L.

AU - Gress, Frank G.

AU - Van Velse, Annette

AU - Hoffman, Brenda J.

PY - 2001

Y1 - 2001

N2 - Background: Endoscopic ultrasound (EUS) is a minimally invasive, low risk method of diagnosis for chronic pancreatitis (CP). The degree to which endosonographers agree on the features and diagnosis of CP is unknown. For EUS to be considered an accurate test for CP, there must be good interobserver agreement. Methods: Forty-five pancreatic EUS examinations were videotaped by 3 experienced endosonographers. Examinations from 33 patients with suspacted CP based on typical symptoms, as well as 12 control patients without suspected CP, were included. Eleven experienced endosonographers ("experts") who were blinded to clinical information independently evaluated all videotaped examinations for the presence of CP and the following 9 validatad features of CP: echogenic foci, strands, lobularity, cysts, stones, duct dilatation, duct irregularity, hyperechoic duct margins, and visible side branches. The experts also ranked (most to least) which features they believed to be the most indicative of CP. Interobserver agreement was expressed as the kappa (κ) statistic. Results: There was moderately good overall agreement for the final diagnosis of CP (κ = 0.45). Agreement was good for individual features of duct dilatation (κ = 0.6) and lobularity (κ = 0.51) but poor for the other 7 features (κ < 0.4). The expert panel had consensus or near consensus agreement (greater than 90%) on 206 of 450 (46%) individual EUS features including 22 of 45 diagnoses of CP. Agreement on the final diagnosis of CP was moderately good for those trained in third tier fellowships (κ = 0.42 ± 0.03) and those with more than 1100 lifetime pancreatic EUS examinations (κ = 0.46 ± 0.05). The presence of stones was regarded as the most predictive feature of CP by all endosonographers, followed by visible side branches, cysts, lobularity, irregular main pancreatic duct, hyperechoic foci, hyperechoic strands, main pancreatic duct dilatation, and main duct hyperechoic margins. The most common diagnostic criterion for the diagnosis of CP was the total number of features (median 4 or greater, range 3 or greater to 5 or greater). Conclusions: EUS is a reliable method for the diagnosis of chronic pancreatitis with good interobserver agreement among experienced endosonographers. Agreement on the EUS diagnosis of chronic pancreatitis is comparable to other commonly used endoscopic procedures such as bleeding ulcer stigmata and computed tomography of the brain for stroke localization and better than the physical diagnosis of heart sounds.

AB - Background: Endoscopic ultrasound (EUS) is a minimally invasive, low risk method of diagnosis for chronic pancreatitis (CP). The degree to which endosonographers agree on the features and diagnosis of CP is unknown. For EUS to be considered an accurate test for CP, there must be good interobserver agreement. Methods: Forty-five pancreatic EUS examinations were videotaped by 3 experienced endosonographers. Examinations from 33 patients with suspacted CP based on typical symptoms, as well as 12 control patients without suspected CP, were included. Eleven experienced endosonographers ("experts") who were blinded to clinical information independently evaluated all videotaped examinations for the presence of CP and the following 9 validatad features of CP: echogenic foci, strands, lobularity, cysts, stones, duct dilatation, duct irregularity, hyperechoic duct margins, and visible side branches. The experts also ranked (most to least) which features they believed to be the most indicative of CP. Interobserver agreement was expressed as the kappa (κ) statistic. Results: There was moderately good overall agreement for the final diagnosis of CP (κ = 0.45). Agreement was good for individual features of duct dilatation (κ = 0.6) and lobularity (κ = 0.51) but poor for the other 7 features (κ < 0.4). The expert panel had consensus or near consensus agreement (greater than 90%) on 206 of 450 (46%) individual EUS features including 22 of 45 diagnoses of CP. Agreement on the final diagnosis of CP was moderately good for those trained in third tier fellowships (κ = 0.42 ± 0.03) and those with more than 1100 lifetime pancreatic EUS examinations (κ = 0.46 ± 0.05). The presence of stones was regarded as the most predictive feature of CP by all endosonographers, followed by visible side branches, cysts, lobularity, irregular main pancreatic duct, hyperechoic foci, hyperechoic strands, main pancreatic duct dilatation, and main duct hyperechoic margins. The most common diagnostic criterion for the diagnosis of CP was the total number of features (median 4 or greater, range 3 or greater to 5 or greater). Conclusions: EUS is a reliable method for the diagnosis of chronic pancreatitis with good interobserver agreement among experienced endosonographers. Agreement on the EUS diagnosis of chronic pancreatitis is comparable to other commonly used endoscopic procedures such as bleeding ulcer stigmata and computed tomography of the brain for stroke localization and better than the physical diagnosis of heart sounds.

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