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Interobserver variability in endoscopic ultrasonography: a prospective evaluation

L D Roubein¹, P Lynch, G Glober

¹Department of Gastrointestinal Oncology and Digestive Diseases, M.D. Andersen Cancer Center, Houston, Texas, USA.

Gastrointestinal Endoscopy

|November 1, 1996

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Endoscopic ultrasonography (EUS) shows fair agreement for rectal cancer lymph node staging. While T stage agreement was high, kappa statistics indicated a need for broader validation in diverse patient populations.

Area of Science:

Gastroenterology
Oncology
Medical Imaging

Background:

Endoscopic ultrasonography (EUS) is crucial for staging gastrointestinal cancers.
Limited research exists on interobserver variability in EUS interpretation for rectal carcinoma staging.

Purpose of the Study:

To prospectively evaluate interobserver variation in staging rectal carcinoma using EUS.
To establish a protocol minimizing observer bias in EUS interpretation.

Main Methods:

Three endoscopists prospectively evaluated 26 rectal carcinoma patients.
One performed sigmoidoscopy; a primary EUS operator had full patient data; a secondary EUS operator was blinded.
EUS findings were compared between operators.

Main Results:

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T stage agreement reached 88% between endosonographers, but kappa statistics showed no significant agreement for T1-T4.
Inter-rater agreement for N stage was 73% with a kappa of 0.42.
The study protocol effectively reduced observer bias.

Conclusions:

Fair agreement exists for lymph node staging via EUS in rectal cancer.
While overall agreement is high, kappa analysis suggests limitations due to a specific lesion distribution.
Further validation in diverse settings is necessary to confirm findings.