An international study of interobserver variability of "string sign" of pancreatic cysts among experienced endosonographers
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An international study of interobserver variability of "string sign" of pancreatic cysts among experienced endosonographers. / Hakim, Seifeldin; Coronel, Emmanuel; González, Graciela M. Nogueras; Ge, Philip S.; Chari, Suresh T; Thosani, Nirav; Ramireddy, Srinivas; Badillo, Ricardo; Davee, Tomas; Catalano, Marc F.; Sealock, Robert J.; Parupudi, Sreeram; Hernandez, Lyndon V.; Joshi, Virendra; Irisawa, Atsushi; Rana, Surinder; Lakhtakia, Sundeep; Vilmann, Peter; Saftoiu, Adrian; Sun, Siyu; Giovannini, Marc; Katz, Matthew H; Kim, Michael P.; Bhutani, Manoop S.
I: Endoscopic Ultrasound, Bind 10, Nr. 1, 2021, s. 39-50.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - An international study of interobserver variability of "string sign" of pancreatic cysts among experienced endosonographers
AU - Hakim, Seifeldin
AU - Coronel, Emmanuel
AU - González, Graciela M. Nogueras
AU - Ge, Philip S.
AU - Chari, Suresh T
AU - Thosani, Nirav
AU - Ramireddy, Srinivas
AU - Badillo, Ricardo
AU - Davee, Tomas
AU - Catalano, Marc F.
AU - Sealock, Robert J.
AU - Parupudi, Sreeram
AU - Hernandez, Lyndon V.
AU - Joshi, Virendra
AU - Irisawa, Atsushi
AU - Rana, Surinder
AU - Lakhtakia, Sundeep
AU - Vilmann, Peter
AU - Saftoiu, Adrian
AU - Sun, Siyu
AU - Giovannini, Marc
AU - Katz, Matthew H
AU - Kim, Michael P.
AU - Bhutani, Manoop S
N1 - Publisher Copyright: © 2021 Spring Media. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Background and Objectives: No single optimal test reliably determines the pancreatic cyst subtype. Following EUS-FNA, the 'string sign' test can differentiate mucinous from nonmucinous cysts. However, the interobserver variability of string sign results has not been studied. Methods: An experienced endosonographer performed EUS-FNA of pancreatic cysts on different patients and was recorded on video performing the string sign test for each. The videos were shared internationally with 14 experienced endosonographers, with a survey for each video: 'Is the string sign positive?' and 'If the string sign is positive, what is the length of the formed string?' Also asked 'What is the cutoff length for string sign to be considered positive?' Interobserver variability was assessed using the kappa statistic (κ). Results: A total of 112 observations were collected from 14 endosonographers. Regarding string sign test positivity, κ was 0.6 among 14 observers indicating good interrater agreement (P < 0.001) while κ was 0.38 when observers were compared to the index endosonographer demonstrating marginal agreement (P < 0.001). Among observations of the length of the string in positive samples, 89.8% showed >5 mm of variability (P < 0.001), indicating marked variability. There was poor agreement on the cutoff length for a string to be considered positive. Conclusion: String sign of pancreatic cysts has a good interobserver agreement regarding its positivity that can help in differentiating mucinous from nonmucinous pancreatic cysts. However, the agreement is poor on the measured length of the string and the cutoff length of the formed string to be considered a positive string sign.
AB - Background and Objectives: No single optimal test reliably determines the pancreatic cyst subtype. Following EUS-FNA, the 'string sign' test can differentiate mucinous from nonmucinous cysts. However, the interobserver variability of string sign results has not been studied. Methods: An experienced endosonographer performed EUS-FNA of pancreatic cysts on different patients and was recorded on video performing the string sign test for each. The videos were shared internationally with 14 experienced endosonographers, with a survey for each video: 'Is the string sign positive?' and 'If the string sign is positive, what is the length of the formed string?' Also asked 'What is the cutoff length for string sign to be considered positive?' Interobserver variability was assessed using the kappa statistic (κ). Results: A total of 112 observations were collected from 14 endosonographers. Regarding string sign test positivity, κ was 0.6 among 14 observers indicating good interrater agreement (P < 0.001) while κ was 0.38 when observers were compared to the index endosonographer demonstrating marginal agreement (P < 0.001). Among observations of the length of the string in positive samples, 89.8% showed >5 mm of variability (P < 0.001), indicating marked variability. There was poor agreement on the cutoff length for a string to be considered positive. Conclusion: String sign of pancreatic cysts has a good interobserver agreement regarding its positivity that can help in differentiating mucinous from nonmucinous pancreatic cysts. However, the agreement is poor on the measured length of the string and the cutoff length of the formed string to be considered a positive string sign.
KW - mucinous pancreatic cyst
KW - mucous
KW - pancreatic cyst
KW - string sign
KW - surface tension
KW - viscosity
U2 - 10.4103/eus.eus_73_20
DO - 10.4103/eus.eus_73_20
M3 - Journal article
C2 - 33473044
AN - SCOPUS:85101410107
VL - 10
SP - 39
EP - 50
JO - Endoscopic Ultrasound
JF - Endoscopic Ultrasound
SN - 2226-7190
IS - 1
ER -
ID: 301454510