Diagnostic accuracy of preoperative magnetic resonance imaging for detecting subscapularis tendon tears: a diagnostic test study

ABSTRACT BACKGROUND: The accuracy of magnetic resonance imaging (MRI) for making the diagnosis of subscapularis tears presents wide variation in the literature and there are few prospective studies. OBJECTIVE: To compare the findings from MRI and arthroscopy for diagnosing subscapularis tears. DESIGN AND SETTING: Diagnostic test study performed in a tertiary care hospital. METHODS: We included patients who underwent arthroscopic rotator cuff repair and who had firstly undergone high magnetic field MRI without contrast. The images were independently evaluated by a shoulder surgeon and two musculoskeletal radiologists. Sensitivity, specificity, positive and negative predictive values, accuracy and inter and intra-observer agreement were calculated. RESULTS: MRIs on 200 shoulders were evaluated. The incidence of subscapularis tears was 69.5% (41.5% partial and 28.0% full-thickness). The inter and intra-observer agreement was moderate for detection of subscapularis tears. The shoulder surgeon presented sensitivity of 51.1% to 59.0% and specificity of 91.7% to 94.4%. The radiologists showed sensitivity of 83.5% to 87.1% and specificity of 41% to 45.9%. Accuracy ranged from 60.5% to 73.0%. CONCLUSION: The 1.5-T MRIs without contrast showed mean sensitivity of 70.2% and mean specificity of 61.9% for detection of subscapularis tears. Sensitivity was higher for the musculoskeletal radiologists, while specificity was higher for the shoulder surgeon. The mean accuracy was 67.6%, i.e. lower than that of rotator cuff tears overall.

Interobserver variability on hysteroscopic findings of patients with endometrial hyperplasia

Background@#Endometrial hyperplasia is a common gynecologic disorder seen in the clinics. Among patients with endometrial hyperplasia, an estimated 5-10% have underlying malignancy hence early diagnosis and management is important. Hysteroscopy, regarded as the gold standard for diagnosing intrauterine abnormalities, enables accurate study of the endometrial surface as well as target eye biopsy during the same procedure. These eye-directed biopsies have a high accuracy in the hands of experienced operators, but accuracy of this technique is dependent on recognition of suspected endometrial pathology.1@*Objective@#The objective of this study is to ascertain inter-observer agreement in describing hysteroscopic findings among patients with endometrial hyperplasia@*Methodology@#This is a prospective interobserver study of gynecologists from the Department of Obstetrics and Gynecology, St. Luke’s Medical Center. Three invited, consenting gynecologists reviewed 22 hysteroscopy recordings with histologic diagnosis of normal endometrium or endometrial hyperplasia from the files of the section of Minimally Invasive Gynecologic Surgery. Then, evaluation of the hysteroscopy recordings was conducted using an assessment form containing questions about the quality of the recording, characteristics of the endometrium, and their diagnoses. The final outcome of this study is the inter-observer agreement among hysteroscopists in describing hysteroscopic findings of patients with endometrial hyperplasia.@*Results@#There is a wide gap in the interobserver agreement between hysteroscopists in describing hysteroscopic findings of patients with endometrial hyperplasia. However, the interobserver agreement was found to be substantial among participants in identifying the correct diagnosis.@*Conclusion@#A clear, systematic and standard way of identifying and describing hysteroscopic findings should be developed and instituted for use among hysteroscopists and hysteroscopy training programs. This will help in precisely identifying the areas where adequate sampling should be done.

Training Effect on the Inter-observer Agreement in Endoscopic Diagnosis and Grading of Atrophic Gastritis according to Level of Endoscopic Experience

BACKGROUND: Endoscopic diagnosis of atrophic gastritis can contribute to risk stratification and thereby tailored screening for gastric cancer. We aimed to evaluate the effect of training on inter-observer agreement in diagnosis and grading of endoscopic atrophic gastritis (EAG) according to the level of endoscopists' experience. METHODS: Twelve endoscopists (six less-experienced and six experienced) participated in this prospective study. The training session consisted of 1) four interventions with two-week intervals, and 2) a follow-up period (two follow-up assessments without feedback). EAG was categorized as C1 to O3 according to the Kimura-Takemoto classification. Kappa statistics were used to calculate inter-observer agreement. RESULTS: At baseline, kappa indexes were 0.18 in the less-experienced group and 0.32 in the experienced group, respectively. After four interventions with feedback, the kappa index improved in both groups and was sustained during the follow-up period. Overall diagnostic yields of EAG were 43.1% ± 10.7% in pre-intervention and 46.8% ± 5.9% in post-intervention. Variability in the rate of diagnosis of EAG significantly decreased in the less-experienced group (r = 0.04, P = 0.003). CONCLUSION: Irrespective of experience level, inter-observer agreement for diagnosis and grading of EAG improved after training and remained stable after intervention.

Reproducibility Among Residents in Evaluating Cup-disc Ratio Using Computer-aided Planimetry

PURPOSE: To investigate the intra-observer agreement and inter-observer agreement among observers assessing optic disc cup-disc ratio of glaucoma patients. METHODS: Fifty stereoscopic optic disc photographs of patients with glaucoma were digitized and five ophthalmology residents drew optic disc and cup margin in a masked random fashion. It was performed twice on same photographs weekly under monoscopic and stereoscopic conditions. The agreement was estimated by Pearson correlation coefficient r. RESULTS: Intra-observer agreement for estimating linear cup-disc ratio (LCDR) under monoscopic (0.84) and stereoscopic conditions (0.86) were high and inter-observer agreement was also high under monoscopic (0.81) and stereoscopic conditions (0.83) showing more perfect agreement under stereoscopic condition. The observers estimated smaller cup-disc ratio when evaluating under stereoscopic condition than under monoscopic condition. CONCLUSIONS: Evaluating optic disc stereoscopically with computer-aided planimetry can be clinically useful when managing patients with glaucoma since it has a high reproducibility.