Evaluating diagnostic consistency: intra and interobserver agreement in rotator cuff tear classification using...

Ultrasound (US) is a more accessible alternative to MRI for rotator cuff tear (RCT) assessment. Rapid US can identify RCTs, but accurate US interpretation remains challenging, even for experts. We performed a retrospective cross-sectional study to evaluate intraobserver and interobserver agreement and accuracy in RCT detection with US between expert and non-expert readers.

Long-axis cine sweeps of supraspinatus tendon from 138 patients with suspected RCTs were analyzed and compared to corresponding MRI results (reference standard). Three non-experts (graduate student, medical student, radiology resident) and three experts (fellowship-trained musculoskeletal (MSK) radiologist, MSK sonographer, and radiology fellow) independently classified tendons as normal, full-thickness tear, or partial-thickness tear by predefined criteria.

For all-tear detection (ATD), expert accuracy (%) ranged from 68.8 (95% CI, 61.1-76.5) to 84.8% (78.8-90.9), and non-expert accuracy from 63.0 (54.9-71.1) to 79.7% (73.0-86.4). For full-thickness tear detection (FTTD), expert accuracy ranged from 75.4 (68.2-82.6) to 87.0% (81.4-92.6), and non-expert accuracy from 73.9 (66.6-81.2) to 79.0% (72.2-85.8). Interobserver agreement for ATD was moderate among experts (Light's kappa ( $\kappa$ ) = 0.42 (95% CI, 0.30-0.58)) and fair among non-experts ( $\kappa$ = 0.38 (0.32-0.50)). Intraobserver agreement was fair ( $\kappa$ = 0.35 (0.29-0.43)). Our experts achieved higher sensitivity, resulting in improved overall accuracy.

Ultrasound readers of all experience levels accurately identified over 80% of RCTs when compared with MRI. Expert readers achieved higher accuracy, sensitivity, and reliability than non-experts. Ultrasound reliably detects RCTs and remains the preferred imaging modality for its accessibility and patient comfort, underscoring the need for standardization, training, and technological improvements.