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Background: The diagnostic accuracy of colon capsule endoscopy (CCE) depends on a well-cleansed bowel. Evaluating the cleansing quality can be difficult with a substantial interobserver variation. Objectives: Our primary aim was to establish a standard of agreement for bowel cleansing in CCE based on evaluations by expert readers. Then, we aimed to investigate the interobserver agreement on bowel cleansing. Design: We conducted an interobserver agreement study on bowel cleansing quality. Methods: Readers with different experience levels in CCE and colonoscopy evaluated bowel cleansing quality on the Leighton–Rex scale and Colon Capsule CLEansing Assessment and Report (CC-CLEAR), respectively. All evaluations were reported on an image level. A total of 24 readers rated 500 images on each scale. Results: An expert opinion-based agreement standard could be set for poor and excellent cleansing but not for the spectrum in between, as the experts agreed on only a limited number of images representing fair and good cleansing. The overall interobserver agreement on the Leighton–Rex full scale was good (intraclass correlation coefficient (ICC) 0.84, 95% CI (0.82–0.85)) and remained good when stratified by experience level. On the full CC-CLEAR scale, the overall agreement was moderate (ICC 0.62, 95% CI (0.59–0.65)) and remained so when stratified by experience level. Conclusion: The interobserver agreement was good for the Leighton–Rex scale and moderate for CC-CLEAR, irrespective of the reader's experience level. It was not possible to establish an expert-opinion standard of agreement for cleansing quality in CCE images. Dedicated training in using the scales may improve agreement and enable future algorithm calibration for artificial intelligence supported cleansing evaluation. Trial registration: All included images were derived from the CAREforCOLON 2015 trial (Registered with The Regional Health Research Ethics Committee (Registration number: S-20190100), the Danish data protection agency (Ref. 19/29858), and ClinicalTrials.gov (registration number: NCT04049357)). [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the impact of video sequences (cine-loops) on the interobserver agreement (IOA) using risk stratification systems (RSSs) for thyroid nodules (TNs). Methods: Twenty TNs were randomly selected from a large database and evaluated by twelve experienced observers using five different RSSs (Kwak-, ACR-, EU-, Korean-TIRADS, ATA Guidelines). In the first step, the evaluation was conducted based on static ultrasound (US) images in two planes ("static"). Six months later, these cases were reevaluated by the same observers using video sequences in two planes ("cine-loops"). Fleiss' kappa (κ) was calculated for the IOA analyses. Results: IOA on static was moderate with κ values of 0.46, 0.42, 0.40, 0.45, and 0.38 for the Kwak-, ACR-, EU-, Korean-TIRADS, and ATA Guidelines, respectively, while the IOA on cine-loops was fair with κ values of 0.41, 0.38, 0.37, 0.36, and 0.34 for the Kwak-, ACR-, EU-, Korean-TIRADS, and ATA Guidelines, respectively. The overall IOA was superior in static images versus cine-loops (p = 0.024). Among other findings, the subgroup analyses (related to age, gender, US certificates, number of thyroid US per week, and RSSs experience) particularly showed that the experience of the observers in using RSSs had a significant influence on the IOA. Conclusions: The overall IOA (all twelve observers and all five RSSs) was superior on static US images in comparison to cine-loops. Furthermore, the overall IOA of the five US features revealed superior κ values of the static images over cine-loops. However, this impact was significantly lower when the observers were highly experienced in the use of US RSSs of TNs. [ABSTRACT FROM AUTHOR]

Line-field confocal optical coherence tomography (LC-OCT) is a new technology for skin cancer diagnostics. However, the interobserver agreement (IOA) of known image markers of keratinocyte carcinomas (KC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), as well as precursors, SCC in situ (CIS) and actinic keratosis (AK), remains unexplored. This study determined IOA on the presence or absence of 10 key LC-OCT image markers of KC and precursors, among evaluators new to LC-OCT with different levels of dermatologic imaging experience. Secondly, the frequency and association between reported image markers and lesion types, was determined. Six evaluators blinded to histopathologic diagnoses, assessed 75 LC-OCT images of KC (21 SCC; 21 BCC), CIS (12), and AK (21). For each image, evaluators independently reported the presence or absence of 10 predefined key image markers of KCs and precursors described in an LC-OCT literature review. Evaluators were stratified by experience-level as experienced (3) or novices (3) based on previous OCT and reflectance confocal microscopy usage. IOA was tested for all groups, using Conger’s kappa coefficient (κ). The frequency of reported image marker and their association with lesion-types, were calculated as proportions and odds ratios (OR), respectively. Overall IOA was highest for the image markers lobules (κ = 0.68, 95% confidence interval (CI) 0.57;0.78) and clefting (κ = 0.63, CI 0.52;0.74), typically seen in BCC (94%;OR 143.2 and 158.7, respectively, p < 0.001), followed by severe dysplasia (κ = 0.42, CI 0.31;0.53), observed primarily in CIS (79%;OR 7.1, p < 0.001). The remaining seven image-markers had lower IOA (κ = 0.06–0.32) and were more evenly observed across lesion types. The lowest IOA was noted for a well-defined (κ = 0.07, CI 0;0.15) and interrupted dermal-epidermal junction (DEJ) (κ = 0.06, CI -0.002;0.13). IOA was higher for all image markers among experienced evaluators versus novices. This study shows varying IOA for 10 key image markers of KC and precursors in LC-OCT images among evaluators new to the technology. IOA was highest for the assessments of lobules, clefting, and severe dysplasia while lowest for the assessment of the DEJ integrity. [ABSTRACT FROM AUTHOR]

Objectives Few cytologically indeterminate thyroid fine-needle aspirations (FNAs) harbor BRAF V600E. Here, we assess interobserver agreement for The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) category III (atypia of undetermined significance [AUS]) FNAs harboring BRAF V600E and contrast their features with those harboring non- BRAF V600E alterations, with attention to cytopathology experience. Methods Seven reviewers evaluated 5 AUS thyroid FNAs harboring BRAF V600E. To blind reviewers, cases were intermixed with 19 FNAs falling within other TBSRTC categories and in which genetic alterations other than BRAF V600E had been identified (24 FNAs total). Interobserver agreement against both "index" and most popular ("mode") diagnoses was calculated. Four additional BRAF V600E cases were independently reviewed. Results Reviewers included 3 trainees and 3 American Board of Pathology (board)–certified cytopathologists. Board-certified cytopathologists, whose experience ranged from 2 to more than 15 subspecialty practice years, had known AUS rates. BRAF V600E was identified in 5 of 260 (2%) AUS FNAs. Interobserver agreement was higher among cytopathologists with more experience. Mode diagnosis differed from index diagnosis in 6 of 11 cases harboring RAS-like alterations; mode diagnosis was AUS in 4 of 5 BRAF V600E FNAs. Conclusions Atypia of undetermined significance of thyroid FNAs harboring BRAF V600E is uncommon yet relatively reproducible, particularly among pathologists with experience. It is advisable to sequence BRAF across V600 in such cases. [ABSTRACT FROM AUTHOR]

Objective: In the Netherlands, antenatal cardiotocography (aCTG) to assess fetal well‐being is performed in obstetrician‐led care. An innovative initiative was started to evaluate whether aCTG for specific indications—reduced fetal movements, external cephalic version, or postdate pregnancy—is feasible in non‐obstetrician‐led care settings by independent primary care midwives. Quality assessment is essential when reorganizing and shifting tasks and responsibilities. Therefore, we aimed to assess the inter‐ and intraobserver agreement for aCTG assessments between and within four professional groups involved in Dutch maternity care regarding the overall classification and assessment of the various components of aCTG. Method: This was a prospective study among 47 Dutch primary care midwives, hospital‐based midwives, residents, and obstetricians. Ten aCTG traces were assessed twice at a 1 month interval. To ensure a representative sample, we used two different sets of 10 aCTG traces each. We calculated the degree of agreement using the proportions of agreement. Results: The proportions of agreement for interobserver agreement on the classification of aCTG between and within the four professional groups varied from 0.82 to 0.94. The proportions of agreement for each professional group were slightly higher for intraobserver (0.86–0.94) than for interobserver agreement. For the various aCTG components, the proportions of agreement for interobserver agreement varied from 0.64 (presence of contractions) to 0.98 (baseline heart frequency). Conclusion: The proportion of agreement levels between and within the maternity care professionals in the classification of aCTG traces among healthy women were comparable. This means that these professional groups are equally well able to classify aCTGs in healthy pregnant women. Synopsis: The proportion of agreement levels between and within professionals in midwife‐led and obstetrician‐led care in the classification of antenatal cardiotocography traces among healthy women are comparable. [ABSTRACT FROM AUTHOR]

Objectives: Timely and accurate preoperative diagnosis of uterine sarcoma will increase patient survival. The primary aim of this study was to describe the ultrasound features of uterine sarcoma compared with those of uterine leiomyoma based on the terms and definitions of the Morphological Uterus Sonographic Assessment (MUSA) group. A secondary aim was to assess the interobserver agreement for reporting on ultrasound features according to MUSA terminology. Methods: This was a retrospective cohort study of patients with uterine sarcoma or uterine leiomyoma treated in a single tertiary center during the periods 1997–2019 and 2016–2019, respectively. Demographic characteristics, presenting symptoms and surgical outcomes were extracted from patients' files. Ultrasound images were re‐evaluated independently by two sonologists using MUSA terms and definitions. Descriptive statistics were calculated and interobserver agreement was assessed using Cohen's κ (with squared weights) or intraclass correlation coefficient, as appropriate. Results: A total of 107 patients were included, of whom 16 had a uterine sarcoma and 91 had a uterine leiomyoma. Abnormal uterine bleeding was the most frequent presenting symptom (69/107 (64%)). Compared with leiomyoma cases, patients with uterine sarcoma were older (median age, 65 (interquartile range (IQR), 60–70) years vs 48 (IQR, 43–52) years) and more likely to be postmenopausal (13/16 (81%) vs 15/91 (16%)). In the uterine sarcoma cohort, leiomyosarcoma was the most frequent histological type (6/16 (38%)), followed by adenosarcoma (4/16 (25%)). On ultrasound evaluation, according to Observers 1 and 2, the tumor border was irregular in most sarcomas (11/16 (69%) and 13/16 (81%) cases, respectively), but regular in most leiomyomas (65/91 (71%) and 82/91 (90%) cases, respectively). Lesion echogenicity was classified as non‐uniform in 68/91 (75%) and 51/91 (56%) leiomyomas by Observers 1 and 2, respectively, and 15/16 (94%) uterine sarcomas by both observers. More than 60% of the uterine sarcomas showed acoustic shadows (11/16 (69%) and 10/16 (63%) cases by Observers 1 and 2, respectively), whereas calcifications were reported in a small minority (0/16 (0%) and 2/16 (13%) cases by Observers 1 and 2, respectively). In uterine sarcomas, intralesional vascularity was reported as moderate to abundant in 13/16 (81%) cases by Observer 1 and 15/16 (94%) cases by Observer 2, while circumferential vascularity was scored as moderate to abundant in 6/16 (38%) by both observers. Interobserver agreement for the presence of cystic areas, calcifications, acoustic shadow, central necrosis, color score (overall, intralesional and circumferential) and maximum diameter of the lesion was moderate. The agreement for shape of lesion, tumor border and echogenicity was fair. Conclusions: A postmenopausal patient presenting with abnormal uterine bleeding and a new or growing mesenchymal mass with irregular tumor borders, moderate‐to‐abundant intralesional vascularity, cystic areas and an absence of calcifications on ultrasonography is at a higher risk of having a uterine sarcoma. Interobserver agreement for most MUSA terms and definitions is moderate. Future studies should validate the abovementioned clinical and ultrasound findings on uterine mesenchymal tumors in a prospective multicenter fashion. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objective: To compare the diagnostic performance for the detection of clinically significant prostate cancers and interobserver agreement between PI-RADS v2 and v2.1 Material and Method: The mpMRI images of 258 patients and 394 nodüles included in this retrospective study were obtained on 3T MR and evaluated by two radiologists according to PIRADS v2 and v2.1. Sensitivity and specificity between v2 and v2.1 were compared. Detection rates for clinically significant prostate cancers were evaluated. Interobserver agreement was evaluated using κ statistics. Results: PI-RADS v2.1 and v2 had higher sensitivity and lower specificity (100%, 52.38%) in the peripheral zone, and showed higher sensitivity and specificity (92.86%, 98.79%) in the transition zone for category ≥4 lesions to estimate csPCa, but no remarkable difference was found between the two versions. Interobserver agreement was statistically significant and very weak in the transition zone (κ=0.383, κ=0.279, respectively), very strong in the peripheral zone (κ=0.869) according to both classifications and they were similar. Conclusion: The diagnostic performance of PI-RADS v2 and v2.1 were found similar in the determination of clinically significant cancers and all cancers in both zones. The clinically significant cancer detection rate in category 2+1 lesions in the transition zone was higher than in category 2 lesions but it was not statistically significant. Interobserver agreement was low in the transition zone and very strong in the peripheral zone in both versions. [ABSTRACT FROM AUTHOR]

Background: While the effectiveness of cardiotocography in reducing neonatal morbidity is still debated, it remains the primary method for assessing fetal well-being during labor. Evaluating how accurately professionals interpret cardiotocography signals is essential for its effective use. The objective was to evaluate the accuracy of fetal hypoxia prediction by practitioners through the interpretation of cardiotocography signals and clinical variables during labor. Material and methods: We conducted a cross-sectional online survey, involving 120 obstetric healthcare providers from several countries. One hundred cases, including fifty cases of fetal hypoxia, were randomly assigned to participants who were invited to predict the fetal outcome (binary criterion of pH with a threshold of 7.15) based on the cardiotocography signals and clinical variables. After describing the participants, we calculated (with a 95% confidence interval) the success rate, sensitivity and specificity to predict the fetal outcome for the whole population and according to pH ranges, professional groups and number of years of experience. Interobserver agreement and reliability were evaluated using the proportion of agreement and Cohen's kappa respectively. Results: The overall ability to predict a pH level below 7.15 yielded a success rate of 0.58 (95% CI 0.56-0.60), a sensitivity of 0.58 (95% CI 0.56-0.60) and a specificity of 0.63 (95% CI 0.61-0.65). No significant difference in the success rates was observed with respect to profession and number of years of experience. The success rate was higher for the cases with a pH level below 7.05 (0.69) and above 7.20 (0.66) compared to those falling between 7.05 and 7.20 (0.48). The proportion of agreement between participants was good (0.82), with an overall kappa coefficient indicating substantial reliability (0.63). Conclusions: The use of an online tool enabled us to collect a large amount of data to analyze how practitioners interpret cardiotocography data during labor. Despite a good level of agreement and reliability among practitioners, the overall accuracy is poor, particularly for cases with a neonatal pH between 7.05 and 7.20. Factors such as profession and experience level do not present notable impact on the accuracy of the annotations. The implementation and use of a computerized cardiotocography analysis software has the potential to enhance the accuracy to detect fetal hypoxia, especially for ambiguous cardiotocography tracings. [ABSTRACT FROM AUTHOR]

Background: Several classification systems have been developed to support orthopedic surgeons regarding diagnostic, treatment, or prognostic outcomes of distal radius fracture (DRF). However, the best classification system for this fracture remains controversial. We aimed to identify the reliability of three different DRF classifications among orthopedists in training (medical residents).Methods: Orthopedic residents (n = 22) evaluated thirty cases of DRF in anteroposterior and lateral projections in three different periods (0, 6, 12 months). Each radiography was sorted with three different classifications: Frykman, AO/OTA, and Jupiter-Fernandez. All assessments were blinded to the investigators. The inter- and intra-observer reliability was evaluated using the Cohen's kappa coefficient. An additional analysis was performed for a simpler sub-classification of the AO/OTA (27, 9, or 3 groups).Results: Inter-observer agreement for AO/OTA, Frykman, and Jupiter-Fernandez classifications was slight (k = 0.15), fair (k = 0.31), and fair (k = 0.30), respectively. Intra-observer agreement showed similar results: AO/OTA, k = 0.14; Frykman, k = 0.28; and Jupiter-Fernandez, k = 0.28. When the AO/OTA classification was simplified (9 or 3 descriptions), the inter-observer agreement improved from slight (k = 0.16) to fair (k = 0.21 and k = 0.30, respectively). A similar improvement from slight (k = 0.14) to fair (k = 0.32 and k = 0.21) was detected for intra-observer agreement.Conclusions: The more complex the DRF classification system, the more complex is to reach reliable inter- and intra-observer agreements between orthopedic trainees. Senior residents did not necessarily show greater kappa values in DRF classifications. [ABSTRACT FROM AUTHOR]

Introduction: It is a shortcoming of traditional cardiotocography (CTG) classification table formats that CTG traces are frequently classified differently by different users, resulting in poor interobserver agreements. A fast‐and‐frugal tree (FFTree) flow chart may help provide better concordance because it is straightforward and has clearly structured binary questions with understandable "yes" or "no" responses. The initial triage to determine whether a fetus is suitable for labor when utilizing fetal ECG ST analysis (STAN) is very important, since a fetus with restricted capacity to respond to hypoxic stress may not generate STAN events and therefore may become falsely negative. This study aimed to compare physiology‐focused FFTree CTG interpretation with FIGO classification for assessing the suitability for STAN monitoring. Material and methods: A retrospective study of 36 CTG traces with a high proportion of adverse outcomes (17/36) selected from a European multicenter study database. Eight experienced European obstetricians evaluated the initial 40 minutes of the CTG recordings and judged whether STAN was a suitable fetal surveillance method and whether intervention was indicated. The experts rated the CTGs using the FFTree and FIGO classifications at least 6 weeks apart. Interobserver agreements were calculated using proportions of agreement and Fleiss' kappa (κ). Results: The proportions of agreement for "not suitable for STAN" were for FIGO 47% (95% confidence interval [CI] 42%–52%) and for FFTree 60% (95% CI 56–64), ie a significant difference; the corresponding figures for "yes, suitable" were 74% (95% CI 71–77) and 70% (95% CI 67–74). For "intervention needed" the figures were 52% (95% CI 47–56) vs 58% (95% CI 54–62) and for "expectant management" 74% (95% CI 71–77) vs 72% (95% CI 69–75). Fleiss' κ agreement on "suitability for STAN" was 0.50 (95% CI 0.44–0.56) for the FIGO classification and 0.57 (95% CI 0.51–0.63) for the FFTree classification; the corresponding figures for "intervention or expectancy" were 0.53 (95% CI 0.47–0.59) and 0.57 (95% CI 0.51–0.63). Conclusions: The proportion of agreement among expert obstetricians using the FFTree physiological approach was significantly higher compared with the traditional FIGO classification system in rejecting cases not suitable for STAN monitoring. That might be of importance to avoid false negative STAN recordings. Other agreement figures were similar. It remains to be shown whether the FFTree simplicity will benefit less experienced users and how it will work in real‐world clinical scenarios. [ABSTRACT FROM AUTHOR]

Background: Primary sclerosing cholangitis (PSC) is a cholestatic liver disease that progresses to cirrhosis and liver failure. The Anali and Amsterdam scores are based upon imaging features on MRI and ERCP, respectively. Aims: We aimed to compare the interobserver variability and performances of these scores. Methods: Patients with PSC with at least 1 MRCP were included. Images were independently scored by 2 experts. Agreement and prognostic performance with a primary end point of hepatic decompensation was assessed. Results: Fifty-nine patients were included (67.8% male, 86.4% IBD). Interobserver agreement for the Anali and Amsterdam scores were moderate (k = 0.49; 95% CI 0.35–0.64 and k = 0.43; 95% CI 0.30–0.56, respectively). Among the Anali components, dysmorphy (caudate/right lobe ratio > 0.9) had fair agreement (k = 0.37; 95% CI 0.14–0.60) and portal hypertension (k = 0.64, 95% CI 0.32–0.89) and intrahepatic dilation (k = 0.70; 95% CI 0.53–0.87) had substantial agreement. The Amsterdam extrahepatic and intrahepatic scores had fair agreement (k = 0.38; 95% CI 0.23–0.52) and moderate agreement (k = 0.50; 95% CI 0.34–0.67), respectively. Anali score (HR 5.90, 95% CI 1.64–21.21), total bilirubin (HR = 3.23; 95% Cl 1.06–9.91), and age (HR = 1.05; 95% CI 1.00–1.11) were independent predictors of hepatic decompensation. Mayo risk score and Anali score had good discriminative ability with c-statistics of 0.78 (CI 0.59–0.96) and 0.76 (CI 0.56–0.91). Anali score remained an independent predictor after adjusting for Mayo risk score. Conclusion: Anali score adds additional predictive value for hepatic decompensation in patients with PSC. [ABSTRACT FROM AUTHOR]

Simple Summary: Thyroiditis is one of the most common immune toxicities in patients treated with combination immune checkpoint inhibition. Increased metabolic activity in the thyroid can be observed on FDG-PET/CT performed for the purposes of response assessment. The aim of our retrospective study was to assess the association and temporal profile of FDG-PET/CT findings suggesting thyroiditis with the natural history of clinical and biochemical thyroid dysfunction. Our findings demonstrated that an increased metabolic activity of the thyroid seen on routine FDG-PET/CT correlates with a biochemical diagnosis of thyroiditis and persists well after the initial biochemical diagnosis. We demonstrated that patients with FDG-PET/CT changes were more likely to develop overt clinical hypothyroidism. Background: FDG-PET/CT used for immune checkpoint inhibitor (ICI) response assessment can incidentally identify immune-related adverse events (irAEs), including thyroiditis. This study aimed to correlate the time course of FDG-PET/CT evidence of thyroiditis with clinical and biochemical evolution of thyroid dysfunction. Methods: A retrospective review was performed by two independent blinded nuclear medicine physicians (NMPs) of thyroidal FDG uptake in 127 patients who underwent PET/CT between January 2016 and January 2019 at baseline and during treatment monitoring of combination ICI therapy for advanced melanoma. Interobserver agreement was assessed and FDG-PET/CT performance defined by a receiver-operating characteristic (ROC) curve using thyroid function tests (TFTs) as the standard of truth. Thyroid maximum standardized uptake value (SUVmax) and its temporal changes with respect to the longitudinal biochemistry were serially recorded. Results: At a median of 3 weeks after commencing ICI, 43/127 (34%) had a diagnosis of thyroiditis established by abnormal TFTs. FDG-PET/CT was performed at baseline and at a median of 11 weeks (range 3–32) following the start of therapy. ROC analysis showed an area under the curve of 0.87 (95% CI 0.80, 0.94) for FDG-PET/CT for detection of thyroiditis with a positive predictive value of 93%. Among patients with biochemical evidence of thyroiditis, those with a positive FDG-PET/CT were more likely to develop overt hypothyroidism (77% versus 35%, p < 0.01). In the evaluation of the index test, there was an almost perfect interobserver agreement between NMPs of 93.7% (95% CI 89.4–98.0), kappa 0.83. Conclusion: Increased metabolic activity of the thyroid on routine FDG-PET/CT performed for tumoral response of patients undergoing ICI therapy is generally detected well after routine biochemical diagnosis. Elevation of FDG uptake in the thyroid is predictive of overt clinical hypothyroidism and suggests that an ongoing robust inflammatory response beyond the initial thyrotoxic phase may be indicative of thyroid destruction. [ABSTRACT FROM AUTHOR]

We aimed to compare the performance and interobserver agreement of radiologists manually segmenting images or those assisted by automatic segmentation. We further aimed to reduce interobserver variability and improve the consistency of radiomics features. This retrospective study included 327 patients diagnosed with prostate cancer from September 2016 to June 2018; images from 228 patients were used for automatic segmentation construction, and images from the remaining 99 were used for testing. First, four radiologists with varying experience levels retrospectively segmented 99 axial prostate images manually using T2-weighted fat-suppressed magnetic resonance imaging. Automatic segmentation was performed after 2 weeks. The Pyradiomics software package v3.1.0 was used to extract the texture features. The Dice coefficient and intraclass correlation coefficient (ICC) were used to evaluate segmentation performance and the interobserver consistency of prostate radiomics. The Wilcoxon rank sum test was used to compare the paired samples, with the significance level set at p < 0.05. The Dice coefficient was used to accurately measure the spatial overlap of manually delineated images. In all the 99 prostate segmentation result columns, the manual and automatic segmentation results of the senior group were significantly better than those of the junior group (p < 0.05). Automatic segmentation was more consistent than manual segmentation (p < 0.05), and the average ICC reached >0.85. The automatic segmentation annotation performance of junior radiologists was similar to that of senior radiologists performing manual segmentation. The ICC of radiomics features increased to excellent consistency (0.925 [0.888~0.950]). Automatic segmentation annotation provided better results than manual segmentation by radiologists. Our findings indicate that automatic segmentation annotation helps reduce variability in the perception and interpretation between radiologists with different experience levels and ensures the stability of radiomics features. [ABSTRACT FROM AUTHOR]

Purpose: When an optical colonoscopy is carried out, Scope Guide can assist the endoscopist in determining the localization. In colon capsule endoscopy (CCE), this support is not available. To our knowledge, the interobserver agreement on landmark identification has never been studied. This study aims to investigate the interobserver agreement on landmark identification in CCE. Methods: An interobserver study was carried out comparing the landmark identification (the ileocecal valve, hepatic flexure, splenic flexure, and anus) in CCE investigations between an external private contractor and three in-house CCE readers with different levels of experience. All CCE investigations analyzed in this study were carried out as a part of the Danish screening program for colorectal cancer. Patients were between 50 and 74 years old with a positive fecal immunochemical test (FIT). A random sample of 20 CCE investigations was taken from the total sample of more than 800 videos. Results: Overall interobserver agreement on all landmarks was 51%. Interobserver agreement on the first cecal image (ileocecal valve), hepatic flexure, splenic flexure, and last rectal image (anus) was 72%, 29%, 22%, and 83%, respectively. The overall interobserver agreement, including only examinations with adequate bowel preparation (n = 16), was 54%, and for individual landmarks, 73%, 32%, 24%, and 85%. Conclusion: Overall interobserver agreement on all four landmarks from CCE was poor. Measures are needed to improve landmark identification in CCE investigations. Artificial intelligence could be a possible solution to this problem. [ABSTRACT FROM AUTHOR]

Aim: Liver biopsy is the gold standard for demonstrating hepatic damage in patients with chronic hepatitis. In this study, the reproducibility of the Modified Ishak Histological Activity Index (MHAI), used in the histopathological evaluation of chronic hepatitis, between observers trained in different centers was investigated. Patients and Methods: A total of 64 liver needle biopsies were included in the study between 2020 and 2023. Sections of the cases stained with hematoxylin-eosin, silver and trichrome were re-evaluated under a light microscope by the investigator (İÇ) and re-scored according to MHAI. In statistical evaluation, Cohen's kappa statistics were applied using the SPSS 21.0 progr am. Results: When all cases are taken into consideration in statistical evaluation, kappa value is; MAI was found to be 0.02 (slight) for degree and 0.38 (fair) for stage. When the researcher's compatibility with other pathologists was evaluated, the kappa values in the grading were quite low and found to be incompatible. Although there were higher values (0.12-0.49) in the stage than in the degree, the fit was poor and moderate. However, pathologists with a long-term history of collaboration showed higher levels of compliance, highlighting the importance of ongoing exchange of information. Conclusion: This study highlights the need for a standardized approach to interpretation and application of MHAI scoring to increase reproducibility. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate interobserver agreement on the findings of baseline contrast-enhanced multidetector computed tomography (CE-MDCT) performed at the postoperative third month in patients who underwent surgery due to ductal adenocarcinoma of the pancreatic head and investigate the value of these findings in predicting locoregional recurrence. Material and methods: The baseline CE-MDCT images of 198 patients who underwent the Whipple procedure due to pancreatic head tumors were evaluated independently by three radiologists at the postoperative third month. The radiologists were asked to note suspicious findings in terms of locoregional recurrence, including postoperative fat stranding, the presence of perivascular contrast-enhanced solid tissue, short diameter of solid tissue if present, the shape of solid tissue (convex/concave), presence of peritoneal implants, diameter (mm) of pancreatic duct dilatation if present, the presence of lymph nodes larger than 5 mm, portal vein stenosis (≥50 and <50%), the presence of ascites, and the presence of distant metastases, as specified by the Society of Abdominal Radiology in October 2022. The agreement between the radiologists and the value of these parameters in predicting locoregional recurrence were investigated. Results: Among the CE-MDCT findings evaluated, the radiologists had a moderate-to-high level of agreement concerning the presence of perivascular contrast-enhanced solid tissue. However, there was a poor interobserver agreement on the shape of solid tissue. A very high level of agreement was found among the radiologists in the evaluation of pancreatic duct dilatation, peritoneal implants, ascites, and the presence of distant metastases. According to the univariate analysis, the rates of portal vein stenosis had a 1.419 -fold effect [odds ratio (OR)=1.419, [95% confidence interval (CI)= 0.548–3.679, p=0.041], lymph node presence had a 2.337 -fold effect [odds ratio (OR)=2.337, [95% confidence interval (CI)= 1.165–4.686, p=0.015], perivascular contrast-enhanced solid tissue had 2.241 -fold effect [odds ratio (OR)=2.241, [95% confidence interval (CI)= 1.072–4.684, p=0.005]. In the multivariate analysis, perivascular contrast-enhanced solid tissue had 2.241 -fold effect [odds ratio (OR)=2.519, [95% confidence interval (CI)= 1.132–5.605, p=0.024]. Conclusion: In the postoperative baseline CE-MDCT examination, the presence of solid tissue, lymph node presence, and portal vein stenosis in the surgical bed are among the findings that may indicate early locoregional recurrence in patients with pancreatic ductal adenocarcinoma. [ABSTRACT FROM AUTHOR]

Monitoring the fidelity with which implementers implement behavioral procedures is important, but individuals tasked with monitoring fidelity may have received little training. As a result, their data may be affected by variations in implementers' performance, such as the frequency of fidelity errors. To determine the extent to which the frequency of fidelity errors affected data accuracy, we used a multielement design in which novice observers collected fidelity data from video models with three levels of programmed fidelity (40%, 80%, and 100%) of a procedure based on differential reinforcement of other behavior (DRO). Participants collected fidelity data with lower accuracy, as indexed by interobserver agreement scores, when errors were more frequent. These findings suggest that individuals collecting fidelity data may need additional supports to detect and record all errors when procedural fidelity is low. [ABSTRACT FROM AUTHOR]

Background and aim: To evaluate and compare magnetic resonance imaging (MRI) sequences that could potentially be used in the diagnosis of coronavirus disease 2019 (COVID-19). Materials and methods: Included in the study were 42 patient who underwent thorax computed tomography (CT) for COVID-19 pneumonia and thorax MRI for any reason within 24 h after CT. The T2-weighted fast spin echo periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) (T2W-FSE-P), fast imaging employing steady-state acquisition, T2 fat-saturated FSE, axial T1 liver acquisition with volume acceleration (LAVA) and single-shot FSE images were compared in terms of their ability to show COVID-19 findings. Results: The mean age of the patients was 47.2 ± 24 years. Of the patients, 22 were male (52.4%) and 20 (47.6%) were female. The interobserver intraclass coefficient (ICC) for the image quality score was the highest in the T2W-FSE-P sequence and lowest in the T1 LAVA sequence. All of the lesion-based evaluations of the interobserver agreement were statistically significant, with the kappa value varying between 0.798 and 0.998. Conclusion: All 5 sequences evaluated in the study were successful in showing the parenchymal findings of COVID-19. Since the T2WFSE-P sequence had the best scores in both interobserver agreement and ICC for the image quality score, it was considered that it can be included in thorax MRI examinations to assist the diagnosis of COVID-19. [ABSTRACT FROM AUTHOR]

Objective: Distal clavicle fracture classification directly affects the treatment decisions. It is unclear whether the classification systems implemented differ depending on surgeons' backgrounds. This study aimed to compare the interobserver agreement of four classification systems used for lateral clavicle fractures by shoulder specialists and general trauma surgeons. Methods: Radiographs of 20 lateral clavicle fractures representing a full spectrum of adult fracture patterns were analyzed by eight experienced shoulder specialists and eight general trauma surgeons from 10 different hospitals. All cases were graded according to the Orthopedic Trauma Association (OTA), Neer, Jäger/Breitner, and Gongji classification systems. To measure observer agreement, Fleiss' kappa coefficient (κ) was applied and assessed. Results: When only X‐ray films were presented, both groups achieved fair agreement. However, when the 3D‐CT scan images were provided, improved interobserver agreement was found in the specialist group when the OTA, Jäger/Breitner, and Gongji classification systems were used. In the generalist groups, improved agreement was found when using the Gongji classification system. In terms of interobserver reliability, the OTA, Neer, and Jäger/Breitner classification systems showed better agreement among shoulder specialists, while a slightly lower level of agreement was found using the Gongji classification system. For the OTA classification system, interobserver agreement had a mean kappa value of 0.418, ranging from 0.446 (specialist group) to 0.402 (generalist group). For the Neer classification system, interobserver agreement had a mean kappa value of 0.368, ranging from 0.402 (specialist group) to 0.390 (generalist group). For the Jäger/Breitner classification system, the inter‐observer agreement had a mean kappa value of 0.380, ranging from 0.413 (specialist group) to 0.404 (generalist group). For the Gongji classification system, interobserver agreement had a mean kappa value of 0.455, ranging from 0.480 (specialist group) to 0.485 (generalist group). Conclusion: Generally speaking, 3D‐CT scans provide a richer experience that can lead to better results in most classification systems of lateral clavicle fractures, highlighting the value of digitization and specialization in diagnosis and treatment. Competitive interobserver agreement was exhibited in the generalist group using the Gongji classification system, suggesting that the Gongji classification is suitable for general trauma surgeons who are not highly experienced in the shoulder field. [ABSTRACT FROM AUTHOR]

Introduction: Grey Scale Inversion Imaging (GSII), a radiology reading software, has been utilized to improve anatomical and pathological delineation and consequently increase the diagnostic accuracy in a variety of trauma and Orthopaedic conditions. Objective/aim: The objective of this study was to assess whether Grey Scale Inversion Imaging (GSII) has any impact on the diagnostic accuracy and inter-observer reliability in diagnosing neck of femur fractures. Method: We performed a retrospective, single-centre study, to identify 50 consecutive anteroposterior (AP) pelvis radiographs of patients who presented to our unit with suspected neck of femur fractures between 2020 and 2021. The images included a combination of normal pelvic radiographs and others with features suggestive either intracapsular or extracapsular neck of femur fractures, which had been confirmed on computed tomography (CT), magnetic resonance imaging (MRI) and/or subsequent surgery. Four independent observers (two Trauma and Orthopaedics (T&O) consultants, one T&O Trainee Registrar (ST3 level) and one Trainee Senior House Officer (SHO in T&O) reviewed the images and graded each radiograph image using the Likert scale in response to the statement "there is a fracture". Following this, the same radiographs were inverted to Grey Scale Inversion Imaging (GSII) grey scale images and reassessed. RAND correlation was used for statistical analysis. Results: Overall, observers appeared to have similar accuracy with normal radiographic imaging and with GSI sequences. Conclusion: Grey Scale Inversion Imaging (GSII) of digital radiographs did not affect the diagnostic accuracy of detecting neck of femur fractures in our study. [ABSTRACT FROM AUTHOR]

The New Coimbra Method is the most recently proposed standardized method to assess entheseal changes (EC). However, the method's developers acknowledge the inadequacy of their guidelines and state that those who will use the method need in‐person training from them. This study aims to determine the applicability of the method's guideline by testing the interobserver agreement (IOA) with observers who were not trained by the developers. The second objective of this study is to apply the New Coimbra Method to a relatively small archeological sample, in this case a Bronze Age population from Kültepe‐Kanesh, Türkiye. Four observers (the authors) scored EC in three entheses of the right upper limb of 52 adults. IOA was analyzed via Fleiss' kappa (FK) and percentage of agreement (PA) tests. FK test results indicate moderate overall agreement (0.458), while PA implies significantly high agreement (95%). The results of the FK and PA tests contradict each other due to the known limitations of the latter. However, FK values among features vary broadly; some of the features indicate substantial agreement and surpass the required benchmark, while the rest remains moderate or lower. The features that revealed substantial agreement indicate the sufficiency of the method's guidelines. However, the guidelines for the other features appear to be inadequate. Further revision of the guidelines could make the method more applicable for all researchers with no requirement of in‐person training. [ABSTRACT FROM AUTHOR]

With the increasing longevity of cystic fibrosis (CF), there is a growing need to minimise exposure to ionising radiation in patients who undergo regular imaging tests while monitoring the course of the lung disease. This study aimed to define the role of lung ultrasounds (LUS) in the evaluation of lung disease severity in children with clinically stable CF. LUS was performed on 131 patients aged 5 weeks to 18 years (study group) and in 32 healthy children of an equivalent age range (control group). Additionally, an interobserver study was performed on 38 patients from the study group. In CF patients, the following ultrasound signs were identified: I-lines; Z-lines; single, numerous and confluent B-lines; Am-lines; small and major consolidations; pleural line abnormalities and small amounts of pleural fluid. The obtained results were evaluated against an original ultrasound score. LUS results were correlated with the results of chest X-ray (CXR) [very high], pulmonary function tests (PFTs) [high] and microbiological status [significant]. The interobserver study showed very good agreement between investigators. We conclude that LUS is a useful test in the evaluation of CF lung disease severity compared to routinely used methods. With appropriate standardisation, LUS is highly reproducible. [ABSTRACT FROM AUTHOR]

Procedural fidelity is the extent to which independent variables are implemented as designed. Despite 40 years of discussion about the importance of procedural fidelity for behavioral research, reporting of fidelity data remains an uncommon practice in behavior‐analytic journals. Researchers have speculated about reasons for underreporting, but the perspectives of scholars about when reporting is warranted or necessary have not yet been explored. Thus, the purpose of this study was to evaluate possible reasons for infrequent reporting of fidelity data in behavior‐analytic studies. To address this purpose, we conducted focus groups with scholars in applied behavior analysis. Five themes emerged regarding why procedural fidelity data are not typically reported. We provide a discussion about how these themes are interrelated and offer suggestions and recommendations to assist with the collection and reporting of fidelity data. [ABSTRACT FROM AUTHOR]

The goal of a medico‐legal autopsy is primarily to determine the cause and manner of death. To this end, the pathologist often uses auxiliary analyses, including histology. However, the utility of routine histology in all medico‐legal autopsies is unknown. Earlier studies on the utility of routine histology have shown inconsistent effects, with some studies recommending it and others rejecting it. To study the degree to which histology informs on the underlying cause of death, we sent autopsy reports from suspension‐, immersion‐, fire‐, and traffic‐related deaths to senior board‐certified forensic pathologists and had them assess the cause of death, first without knowledge of the histological findings and then with knowledge thereof. Fifty cases were identified in each of four subgroups: fire‐, immersion‐, suspension‐, and traffic‐related deaths. The autopsy reports were anonymized, and the histological findings and conclusions were removed. Two board‐certified forensic pathologists independently reviewed the reports in each subgroup and assessed the manner and underlying cause of death (including their certainty of this assessment on a five‐level scale) with and without access to histological findings. The probability of changing the underlying cause of death posthistology was low in all study groups. There was a slight increase in the degree of certainty posthistology in cases where the underlying cause of death was not changed, but only when the antehistology certainty was low. Our results suggest that histology does not meaningfully inform on the underlying cause of death in suspension‐, immersion‐, fire‐, and traffic‐related deaths except when antehistology certainty is low. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the reproducibility of lower uterine segment (LUS) thickness measurement before induction of labor (IOL), and to assess the relationship between LUS thickness and IOL outcomes. Methods: This was a prospective cohort study of pregnant women undergoing IOL at term, conducted in a single tertiary hospital between July 2014 and February 2017. Women with a singleton pregnancy at ≥ 37 weeks' gestation, with a live fetus in cephalic presentation and a Bishop score of ≤ 6, were eligible for inclusion. Both nulliparous and parous women, and those with a previous Cesarean section (CS), were eligible. All women underwent transvaginal ultrasound assessment before IOL admission, and cervical length and LUS thickness were measured offline after delivery. Maternal and obstetric characteristics and Bishop score were recorded. The main outcome was the overall rate of CS after IOL, and secondary outcomes were CS for either failure to progress in the active phase of labor or failed IOL, and CS for failed IOL only. Interobserver agreement for measurement of LUS thickness between two operators was assessed using the intraclass correlation coefficient (ICC) and Bland–Altman analysis with the ANOVA test to evaluate systematic bias. Univariable and multivariable analysis were employed to evaluate the relationship between clinical and sonographic characteristics and IOL outcomes. Results: Of 265 women included in the analysis, 195 (73.6%) had a vaginal delivery and 70 (26.4%) required a CS after IOL. Reproducibility analysis showed excellent interobserver agreement for the measurement of LUS thickness (ICC, 0.96 (95% CI, 0.93–0.98)). On Bland–Altman analysis, the mean difference in LUS thickness between the two operators was 0.15 mm (95% limits of agreement, –1.84 to 2.14 mm), and there was no evidence of systematic bias (ANOVA test, P = 0.46). Univariable analysis showed that LUS thickness was associated significantly with overall CS (P = 0.002), CS for failure to progress in the active phase of labor or failed IOL (P = 0.03) and CS for failed IOL (P = 0.037). On multivariable logistic regression analysis, LUS thickness was an independent predictive factor for overall CS (odds ratio (OR), 1.149 (95% CI, 1.031–1.281)) and CS for failure to progress in the active phase of labor or failed IOL (OR, 1.226 (95% CI, 1.039–1.445)). Conclusions: In women undergoing IOL at term, measurement of LUS thickness is feasible and reproducible, and is associated significantly with IOL outcome. © 2022 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Simple Summary: Hip laxity is one of the most frequent orthopedic disorders in dogs, and it is one of the main underlying reasons for canine hip dysplasia. Canine hip dysplasia is a progressive disease influenced by inheritance. Veterinarians can take timely preventive/therapeutic measures when hip laxity is diagnosed early, and prevent the participation of dysplastic dogs in breeding programs to reduce the prevalence of the disease. Effective treatment strategies can increase the welfare of dogs by reducing the severity of the disease at older ages. In this study, we aimed to assess the reproducibility of the protocols reported for the radiographic assessment of canine hip dysplasia in 8- and 12-month-old Rottweilers. Five observers investigated eight radiographic parameters at each examination time. According to the results, there were high interobserver agreements at both ages for the measurable parameters, such as the center edge angle (CEA), dorsal acetabular rim slope (DARS), distraction index (DI), and Norberg angle (NA), whereas the observers recorded poor to moderate agreements for the subjective values, such as the grading of the dorsal acetabular rim (GDAR), grading of the degenerative joint disease (GDJD), location of the center of the femoral head (LCFH), and sclerosis of the cranial acetabular rim (SCAR). Hip laxity is one of the predisposing factors of canine hip dysplasia. The early diagnosis of hip laxity allows veterinarians to prevent the participation of dysplastic dogs in breeding programs, which could lower the disease's prevalence due to its genetic background. Furthermore, it allows them to plan preventive/therapeutic procedures for mild/near-normal hips to reduce the symptoms of the disease at older ages. A reliable screening program must be repeatable and reproducible, and intra- and inter-observer studies can help us to determine the best methods. In this study, we aimed to evaluate the radiographic parameters used for the early diagnosis of hip dysplasia in Rottweilers at 8 and 12 months of age with five observers to assess the interobserver agreements. According to our findings, there were high interobserver agreements at both ages for the quantitative values, such as the center edge angle (CEA), dorsal acetabular rim slope (DARS), distraction index (DI), and Norberg angle (NA), whereas we recorded from poor to moderate agreements for the qualitative values, such as the grading of the dorsal acetabular rim (GDAR), grading of the degenerative joint disease (GDJD), location of the center of the femoral head (LCFH), and sclerosis of the cranial acetabular rim (SCAR). [ABSTRACT FROM AUTHOR]

We examined articles with experiments published in the Journal of Applied Behavior Analysis and in Behavior Analysis in Practice from 2017 through 2021 to determine how frequently procedural fidelity was assessed. When procedural fidelity was assessed, we determined how often a measure of interobserver agreement for those fidelity data was provided. We also determined how often a measure of interobserver agreement for participants' behavior was provided. Across both journals and all years, 54.7% of relevant articles provided a measure of procedural fidelity. Of them, 17.7% provided a measure of interobserver agreement for procedural fidelity. In marked contrast, 96.4% provided interobserver agreement data for participants' behavior. It is unfortunate that applied behavior analysts frequently fail to provide procedural fidelity data and, when they do, often fail to provide interobserver agreement data for the fidelity data. Reviewers for, and editors of, behavior‐analytic journals are encouraged to strongly consider the relative value of procedural fidelity and agreement on procedural fidelity measures when rendering recommendations on the suitability of a given submission. [ABSTRACT FROM AUTHOR]

Objective Despite its routine use in intrapartum care, the technique of fetal cardiotocography has some limitations. The aim of this study is to analyze the predictive capacity and interobserver agreement in the latest versions of four international cardiotocography guidelines: Federation of Gynecology and Obstetrics (FIGO), American College of Obstetrics and Gynecology (ACOG), the National Institute for Health and Care Excellence (NICE) and Chandraharan, used to predict neonatal acidemia. Study design The last 30 min of 150 cardiotocographic records were analyzed over all the pH ranges and were blindly evaluated by three independent reviewers. The sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated to assess the predictive capacity of each fetal cardiotocographic guideline. The degree of interobserver agreement was evaluated with the Fleiss Kappa coefficient. Results Observers found fetal cardiotocography guidelines to have a variable sensitivity and specificity. The Chandraharan classification reached the highest sensitivity (78.79%), while ACOG had the highest specificity (95.73%). On average for the three observers, Chandraharan had the highest discrimination capacity for neonatal acidemia, although this was only moderate (AUC 0.66; 95%CI, 0.55–0.77) and did not differ significantly from the remaining guidelines. The degree of agreement among the three observers, assessed according to the Fleiss Kappa coefficient, was generally acceptable or moderate for all items and classifications, being highest with the FIGO classification (ĸ = 0.35; 95%CI, 0.28–0.41) and lowest with the ACOG (ĸ = 0.23; 95%CI, 0.16–0.30). Conclusion Although all the guidelines have a moderate capacity to predict neonatal acidemia, the Chandraharan guideline has the highest capacity. This follows a different approach from the others in that it relies on interpretations of cardiotocographic traces based on fetal physiology. The degree of interobserver agreement is, in general, acceptable for the four guidelines, and is the highest for FIGO. [ABSTRACT FROM AUTHOR]

Background: Studies systematically documenting US findings in children with acute pancreatitis are limited. Pancreas duct dilation is described as the most reliable finding of acute pancreatitis but this has not been rigorously examined in children. Objective: To systematically document US findings in children with acute pancreatitis and to define interobserver agreement on those findings. Materials and methods: In this cross-sectional study we retrospectively reviewed images for all pediatric patients <18 years of age who had been prospectively enrolled in a registry of patients with index admissions for acute pancreatitis between March 2013 and July 2020. Two blinded observers (R1, R2) reviewed the first transabdominal US examination performed within 2 weeks of the pancreatitis attack for each patient. Results: In 141 children, US was performed at a median of 1 day (interquartile range [IQR]: 0, 1) following acute attack. Thirty-three (23%, R1) and 38 (27%, R2) children had no abnormal findings on US. Peripancreatic edema was the most frequent finding documented by both reviewers (63% R1, 54% R2). The pancreatic duct was visible in only 35% of the children and was dilated in only 12% (R1) and 14% (R2). There was substantial to almost-perfect agreement between reviewers on findings of acute pancreatitis (κ=0.62–1), including duct visibility. Conclusion: Peripancreatic edema was the most frequently identified finding in children with acute pancreatitis, present in up to 63%, with almost perfect interobserver agreement. Duct dilation, cited in the literature as a reliable finding of acute pancreatitis, was rarely identified in our sample. [ABSTRACT FROM AUTHOR]

Context: The Indian Academy of Cytologists published Guidelines and categories for Reporting Serous Effusions (IACGRSE) in 2020 to improve consistency and reproducibility of fluid cytology reporting and to guide patient management. Aims: To evaluate category-wise agreement while using IACGRSE 2020 categories. To analyze interobserver agreement among participants with different level of training and years of experience. Settings and Design: A retrospective interobserver variability study. Methods and Material: Study was done with four participants: an expert cytopathologist and three cytopathology fellows with varying experience. Fluid smears from 60 cases with clinical and/or radiological evidence of malignancy were categorized into one of the five IACGRSE 2020 categories. The interpretations of expert cytopathologist were taken as standard. Statistical Analysis Used: Interobserver agreement was analyzed using Kappa statistics. Results: Previous cases without definitive category got classified into "Atypical cells NOS" (3.33%) and "Atypical cells, Suspicious of Malignancy" (15%). Agreement analysis for IACGRSE 2020 categories showed better concordance for inadequate (I), malignant (V), and benign (II) categories. The range of Kappa for interobserver agreement of fellows was fair to substantial (range 0.1692--0.7249). The participant with substantial diagnostic agreement with expert ( = 0.729, 88.3%) had the most experience. Causes of major discordance were pertaining to paucity and distribution of cells, and to misinterpretation of reactive mesothelial cells. Conclusions: IACGRSE 2020 categories and participants' experience were important determinants in classifying the effusion fluid cytology smears and interobserver agreement; emphasizing the need to use IACGRSE2020, and sufficient time and training required for accurate diagnosis of fluid specimens. [ABSTRACT FROM AUTHOR]

Objective: Histopathological examination of the liver is the gold standard in the follow-up and treatment of chronic hepatit B vius (HBV) disease. Ishak's Modified histological activity index (HAI) and fibrosis staging system are usually used in Turkey. Although a common scoring system is used, the same sample can be interpreted differently between different pathologists due to various variables. In this study, the evaluation of liver histopathologies of chronic HBV patients by pathologists in different hospitals and the correlation of the results with each other and the effect on the treatment decision were investigated. Methods: Pathology slides of liver biopsy materials of 10 patients were evaluated by pathologists in 5 different tertiary care hospitals. Using non-parametric statistical methods, the coefficient of agreement between pathologists was determined. Also, descriptive statistics were used to determine the percentage of receiving treatment. Results: Agreement between pathologists was calculated the most in total HAI and Fibrosis score (k=0.8186, k=0.8217). The Kuder-Richardson reliability coefficient among centres was found to be high in the treatment decision (k=0.8207). Although all patients were indicated for treatment according to The European Association for the Study of the Liver 2017 guideline, it was calculated that an average of 58% of the patients could receive treatment according to liver histopathology. Conclusion: Differences in the pathological diagnosis between pathologists in centres may cause delays in chronic hepatitis B patients' access to treatment. [ABSTRACT FROM AUTHOR]

To validate a vascular severity score as an appropriate output for artificial intelligence (AI) Software as a Medical Device (SaMD) for retinopathy of prematurity (ROP) through comparison with ordinal disease severity labels for stage and plus disease assigned by the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), committee. Validation study of an AI-based ROP vascular severity score. A total of 34 ROP experts from the ICROP3 committee. Two separate datasets of 30 fundus photographs each for stage (0–5) and plus disease (plus, preplus, neither) were labeled by members of the ICROP3 committee using an open-source platform. Averaging these results produced a continuous label for plus (1–9) and stage (1–3) for each image. Experts were also asked to compare each image to each other in terms of relative severity for plus disease. Each image was also labeled with a vascular severity score from the Imaging and Informatics in ROP deep learning system, which was compared with each grader's diagnostic labels for correlation, as well as the ophthalmoscopic diagnosis of stage. Weighted kappa and Pearson correlation coefficients (CCs) were calculated between each pair of grader classification labels for stage and plus disease. The Elo algorithm was also used to convert pairwise comparisons for each expert into an ordered set of images from least to most severe. The mean weighted kappa and CC for all interobserver pairs for plus disease image comparison were 0.67 and 0.88, respectively. The vascular severity score was found to be highly correlated with both the average plus disease classification (CC = 0.90, P < 0.001) and the ophthalmoscopic diagnosis of stage (P < 0.001 by analysis of variance) among all experts. The ROP vascular severity score correlates well with the International Classification of Retinopathy of Prematurity committee member's labels for plus disease and stage, which had significant intergrader variability. Generation of a consensus for a validated scoring system for ROP SaMD can facilitate global innovation and regulatory authorization of these technologies. [ABSTRACT FROM AUTHOR]

Purpose: Meniscal allograft transplantation (MAT) has shown good promise in restoring normal knee joint biomechanics in a meniscal deficient patient. However, MRI appearance of the meniscal allograft is often questioned and raises concerns of its viability and function. This paper aims to introduce and validate a new scoring system for MAT MRI appearance at 12 months [MRI appearance in Meniscal Transplant Score (MIMS)], using key changes such as extrusion, meniscal signal change, loss of shape, synovitis and bone marrow oedema. Methods: A retrospective analysis of 10 patients from a single surgeon series was conducted. All MAT were performed with soft tissue fixation technique. MRI was performed at 12 months post-transplant with two independent consultant musculoskeletal radiologists and one experienced meniscal transplant surgeon scoring the images obtained. Interobserver agreement and intraclass correlation were measured. Results: Interobserver agreement between examiners on individual features of the MIMS was superior for tibial bone oedema, substantial for meniscal extrusion and femoral bone oedema, moderate for meniscal shape and synovitis, and fair for meniscal signal changes. Absolute agreement between raters found good reliability (ICC = 0.774; 95% 0.359, 0.960) for single measures and excellent reliability (ICC = 0.911; 95% 0.627, 0.986) for average measures. Conclusion: MIMS is a reliable method of evaluating the meniscal allograft transplant 12 months post-transplant. Further research with larger MAT cohort groups and patient reported outcome measures may be helpful to correlate its clinical significance and guide further management. Level of evidence: Level III. [ABSTRACT FROM AUTHOR]

Interobserver agreement (IOA) is important for research and practice, and supports the consistency of behavioral data (Kahng et al., 2011). Although general parameters for how much IOA is needed have been suggested (Bailey & Burch, 2018), it is unknown if the total number of sessions with IOA might impact the IOA coefficient. In this study, IOA was reanalyzed using functional analysis data at various cutoffs. Obtained IOA from these analyses was then compared to the original IOA. Overall, results suggested that, at least when using highly trained observers in a structured clinical setting, there were no significant differences in IOA across cutoffs. However, IOA was sensitive to overall rate of responding in the functional analysis. These data are encouraging, particularly for practitioners, because they provide preliminary support that the amount of sessions with IOA may not be as important as the consistency of the data. [ABSTRACT FROM AUTHOR]

Aims: Management of anal dysplasia relies upon the accurate diagnosis of anal biopsy specimens. As institutions move towards subspecialty signout (SSSO), decisions must be made regarding whether to assign anal biopsies to the gastrointestinal (GI) or gynaecological (GYN) pathology service. Materials and results: We identified 200 archival tissue biopsies of anal mucosa and circulated them among three GI pathologists and three GYN pathologists. Each pathologist separately scored each biopsy as normal, atypical, low‐grade squamous intra‐epithelial lesion (LSIL) or high‐grade squamous intra‐epithelial lesion (HSIL). Every case that was called HSIL by at least one pathologist was stained with p16 immunostain and a 'gold standard' interpretation of whether or not a case represented HSIL was made. The GI pathologists agreed on 97 (49%) cases prior to consensus; the GYN pathologists agreed on 33 (17%). The sensitivities of the three GI pathologists in detecting HSIL against the 'gold standard' were 47, 100 and 21% and for the GYN pathologists the sensitivities were 74, 89 and 84%; the sensitivities of the GI and GYN consensus diagnoses were 74% each. The specificities of the three GI pathologists in detecting HSIL were 99, 90 and 100% and for the GYN pathologists the specificities were 99, 92 and 91%; the specificities of both the GI and GYN consensus diagnoses were 100%. Conclusions: A mild to moderate degree of interobserver variability exists in the diagnosis of anal dysplasia among pathologists. Our study indicates the utility of some form of consensus conference, as overall agreement among GI pathologists and among GYN pathologists improved following in‐person consensus. [ABSTRACT FROM AUTHOR]

To evaluate recurrence rates and risk factors of relapse in stage IA vulvar squamous cell carcinoma (VSCC) patients. Population-based prospectively collected data on stage IA VSCC was retrieved through the Danish Gynecological Cancer Database (DGCD) during 2011–2017. A central pathology review was performed on tumors from women with recurrent disease. 62 women diagnosed and treated for stage IA VSCC were identified. Nine (14.5%) of the included cases relapsed within the observation period. The recurrences were in the vulva, groins or both in 5 (8.1%), 3 (4.8%) and 1 (1.6%) of the women, respectively. At central pathology review, including all recurrent cases (n = 9), 5 out of 21 reviewed patients were upstaged to stage IB due to depth of invasion >1 mm and two were downstaged to Carcinoma in situ. Two of the upstaged women developed an isolated groin recurrence and one an isolated vulvar relapse. After exclusion of the seven cases the overall recurrence rate decreased to 10.9% (n = 6). Among these cases (n = 55) resection margin <8 mm and tumor size were associated with cancer recurrence. Pathological assessment of stage IA VSCC (depth of invasion ≤1 mm) may be difficult. This may result in under-staging, which impact the choice of treatment and possibly the prognosis. This suggests a need for further clarification of the FIGO measurement and may require a more radical approach when it comes to treatment and groin exploration in stage IA VSCC. Resection margins <8 mm and tumor size were associated with relapse of the disease. • Measurement of depth of invasion ≤1 mm in vulvar cancer is a challenge and understaging may occur. • The rate of recurrence went from 14.5% to 10.9% after a central pathology review was performed. • Resection margins <8 mm and tumor size were associated with recurrence. [ABSTRACT FROM AUTHOR]

Background: Magnetic Resonance Imaging (MRI) is an important tool in preoperative evaluation of patients with lumbar spinal stenosis (LSS). Reported reliability of various MRI findings in LSS varies from fair to excellent. There are inconsistencies in the evaluated parameters and the methodology of the studies. The purpose of this study was to evaluate the reliability of the preoperative MRI findings in patients with LSS between musculoskeletal radiologists and orthopaedic spine surgeons, using established evaluation methods and imaging data from a prospective trial.Methods: Consecutive lumbar MRI examinations of candidates for surgical treatment of LSS from the Norwegian Spinal Stenosis and Degenerative Spondylolisthesis (NORDSTEN) study were independently evaluated by two musculoskeletal radiologists and two orthopaedic spine surgeons. The observers had a range of experience between six and 13 years and rated five categorical parameters (foraminal and central canal stenosis, facet joint osteoarthritis, redundant nerve roots and intraspinal synovial cysts) and one continuous parameter (dural sac cross-sectional area). All parameters were re-rated after 6 weeks by all the observers. Inter- and intraobserver agreement was assessed by Gwet's agreement coefficient (AC1) for categorical parameters and Intraclass Correlation Coefficient (ICC) for the dural sac cross-sectional area.Results: MRI examinations of 102 patients (mean age 66 ± 8 years, 53 men) were evaluated. The overall interobserver agreement was substantial or almost perfect for all categorical parameters (AC1 range 0.67 to 0.98), except for facet joint osteoarthritis, where the agreement was moderate (AC1 0.39). For the dural sac cross-sectional area, the overall interobserver agreement was good or excellent (ICC range 0.86 to 0.96). The intraobserver agreement was substantial or almost perfect/ excellent for all parameters (AC1 range 0.63 to 1.0 and ICC range 0.93 to 1.0).Conclusions: There is high inter- and intraobserver agreement between radiologists and spine surgeons for preoperative MRI findings of LSS. However, the interobserver agreement is not optimal for evaluation of facet joint osteoarthritis.Trial Registration: www.ClinicalTrials.gov identifier: NCT02007083 , registered December 2013. [ABSTRACT FROM AUTHOR]

Cystic renal lesions are common findings on abdominal imaging studies. Bosniak Classification version 2005 and 2019 consists of five categories of cystic masses. The 2019 modification is more detailed and extensive compared to version 2005. The novelties in version 2019 are implementation of diameter values of cystic septa and walls as well as inclusion of magnetic resonance imaging for classification of cystic renal masses. The aim of our study was to review a new proposal for the assessment of renal cysts and review the results of studies which compared diagnostic performance and interobserver agreement of both versions from 2005 and 2019. [ABSTRACT FROM AUTHOR]

Decisions regarding tumor staging, operability, resectability, and treatment strategy in patients with esophageal cancer are made at multidisciplinary team (MDT) conferences. We aimed to assess interobserver agreement from four national MDT conferences and whether this would have a clinical impact. A total of 20 patients with esophageal cancer were included across all four upper gastrointestinal (GI) cancer centers. Fully anonymized patient data were distributed among the MDT conferences which decided on TNM category, resectability, operability, curability, and treatment strategy blinded to each other's decisions. The interobserver agreement was expressed as both the raw observer agreement and with Krippendorff's α values. Finally, a case-by-case evaluation was performed to determine if disagreement would have had a clinical impact. A total of 80 MDT evaluations were available for analysis. A moderate to near-perfect observer agreement of 79.2%, 55.8%, and 82.5% for TNM category was observed, respectively. Substantial agreement for resectability and moderate agreement for curability were found. However, an only fair agreement was observed for the operability category. The treatment strategies had a slight agreement which corresponded to disagreement having a clinical impact in 12 patients. Esophageal cancer MDT conferences had an acceptable interobserver agreement on resectability and TM categories; however, the operability assessment had a high level of disagreement. Consequently, the agreement on treatment strategy was reduced with a potential clinical impact. In future MDT conferences, emphasis should be on prioritizing the relevant information being readily available (operability, T & M categories) to minimize the risk of disagreement in the assessments and treatment strategies, and thus, delayed or suboptimal treatment. [ABSTRACT FROM AUTHOR]

This article proposes a Boolean approach to representing and analyzing interobserver agreement in dichotomous coding. Building on the notion that observations are samples of a universe of observations, it submits that coding can be viewed as a process in which observers sample pieces of evidence on constructs. It distinguishes between formal and functional interobserver agreement based on whether events coded by observers are, respectively, the same or different but equivalent samples of the same classes of events. Formal and functional agreement are defined as Boolean functions. The article reports on an investigation in which a Boolean approach was used to examine agreement in the coding of teacher–student social interactions. Agreement maps (devices that represent the relative frequencies of coding cases—different combinations of 1s and 0s in the observers' coding) allowed detail examination of how interobserver agreement was shaped by the nature of the events coded and the characteristics of the individuals whose behaviors were coded. Results provide empirical evidence of formal and functional agreement as distinguishable forms of interobserver agreement. Results also show that Boolean coding analysis allows detection of ways in which coding procedures confound absence of evidence with evidence of absence. Practical and methodological implications are discussed. [ABSTRACT FROM AUTHOR]

Objectives: The Lower Anogenital Squamous Terminology (LAST) recommendations classify human papillomavirus-associated squamous lesions into low- and high-grade squamous intraepithelial lesions (LSILs/HSILs). Our study aimed to assess interobserver agreement among 6 experienced pathologists in assigning 40 anal lesions previously diagnosed as anal intraepithelial neoplasia 2 (AIN 2) to either HSIL or non-HSIL categories.Methods: Agreement based on photomicrographs of H&E alone or H&E plus p16 immunohistochemistry was calculated using κ coefficients.Results: Agreement was fair based on H&E alone (κ = 0.42; 95% confidence interval [CI], 0.34-0.52). Adding p16 improved agreement to moderate (κ = 0.55; 95% CI, 0.54-0.62). On final diagnosis, 21 cases (53%) had unanimous diagnoses, and 19 (47%) were divided. When designating p16 results as positive or negative, agreement was excellent (κ = 0.92; 95% CI, 0.83-0.95). Among variables (staining location, extent, and intensity), staining of the basal/parabasal layers was a consistent feature in cases with consensus for positive results (20/20). Of the 67 H&E diagnoses with conflicting p16 results, participants modified 32 (48%), downgrading 23 HSILs and upgrading 9 non-HSILs.Conclusions: Although p16 increased interobserver agreement, disagreement remained considerable regarding intermediate lesions. p16 expression, particularly if negative, can reduce unwarranted HSIL diagnoses and unnecessary treatment. [ABSTRACT FROM AUTHOR]

Purpose: No clinical CT-based classification system is currently in use for lumbar foraminal stenosis. MRI scanners are not easily available, are expensive and may be contraindicated in an increasing number of patients. This study aimed to propose and evaluate the reproducibility of a novel CT-based classification for lumbar foraminal stenosis. Materials and methods: The grading was developed as four grades: normal foramen—Grade 0, anteroposterior (AP)/superoinferior (SI) (single plane) fat compression—Grade 1, both AP/SI compression (two planes) without distortion of nerve root—Grade 2 and Grade 2 with distortion of nerve root—Grade 3. A total of 800 lumbar foramen of a cohort of 100 random patients over the age of 60 who had undergone both CT and MRI scans were reviewed by two radiologists independently to assess agreement of the novel CT classification against the MRI-based grading system of Lee et al. Interobserver(n = 400) and intraobserver agreement(n = 160) was also evaluated. Agreement analysis was performed using the weighted kappa statistic. Results: A total of 100 patients (M:F = 45:55) with a mean age of 68.5 years (range 60–83 years were included in the study. The duration between CT and MRI scans was 98 days (range 0–540, SD—108). There was good correlation between CT and MRI with kappa scores (k = 0.81) and intraobserver kappa of 0.89 and 0.98 for the two readers. Conclusion: The novel CT-based classification correlates well with the MRI grading system and can safely and accurately replace it where required. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to quantitatively assess the longitudinal acquisition repeatability of MRI radiomics features in a three‐dimensional (3D) T1‐weighted (T1W) TSE sequence via a well‐controlled prospective phantom study. Methods: Thirty consecutive daily datasets of an ACR‐MRI phantom were acquired on two 1.5T MRI simulators using a 3D T1W TSE sequence. Images were blindly segmented by two observers. Post‐acquisition processing was minimized but an intensity discretization (fixed bin size of 25). One hundred and one radiomics features (shape n = 12; first order n = 16; texture n = 73) were extracted. Longitudinal repeatability of each feature was evaluated by Pearson correlation and coefficient of variance (CV68%). Interobserver feature value agreement was also quantified using intraclass correlation coefficient (ICC) and Bland–Altman analysis. A most repeatable radiomics feature set on both scanners was determined by feature coefficient of variance (CV68%<5%), ICC (>0.75), and the ratio of the interobserver difference to the interobserver mean δ<5%. Results: No trend of radiomics feature value changed with time. Longitudinal feature repeatability CV68% ranged 0.01–38.60% (mean/median: 12.5%/9.9%), and 0.01–40.47%, (8.49%/7.34%) on the scanners A and B. Shape features exhibited significantly better repeatability than first‐order and texture features (all P < 0.01). Significant longitudinal repeatability difference was observed in texture features (P < 0.001) between the two scanners, but not in shape and first‐order features (P > 0.30). First‐order and texture features had smaller interobserver‐dependent variation than acquisition‐dependent variation. They also showed good interobserver agreement on both scanners (A:ICC = 0.80 ± 0.23; B:ICC = 0.80 ± 0.22), independent of acquisition repeatability. The repeatable radiomics features in common on both scanners, including 12 shape features, 0 first‐order features, and 3 texture features, were determined as the most repeatable MRI radiomics feature set. Conclusions: Radiomics features exhibited heterogeneous longitudinal repeatability, while the shape features were the most repeatable, in this phantom study with a 3D T1W TSE acquisition. The most repeatable radiomics feature set derived in this study should be helpful for the selection of reliable radiomics features in the future clinical use. [ABSTRACT FROM AUTHOR]

Quality parameters for upper gastrointestinal endoscopy have introduced intraprocedural indicators, including adequate mucosal visualization free of saliva, mucus, or bubbles, which may increase the possibility of earlystage injury detection. The use of mucolytics and anti-foaming agents has shown great efficiency variability depending on the type of solution, concentrations, exposure times and visibility scale applied. Objectives: To determine the effectiveness of different premedication solutions for cleaning the digestive mucosa; to validate, by means of an interobserver concordance test, a new scale for the adequate visualization of the mucosa (TVMS) for the esophagus, stomach, and duodenum; and to report adverse events or complications associated with the solutions used and the procedures performed. Material and methods: Prospective, comparative cohort study. 412 adult patients, ASA I and ASA II, were included for diagnostic endoscopy under conscious sedation. They were distributed in 6 similar cohorts and divided into two groups: non-premedication, 2 in C1 (fasting 6 to 8 hours) and C2 (water 100 mL) cohorts; premedication, 4 C3 to C6 cohorts (C3: water 100 mL + simethicone 1000 mg; C4: water 100 ml + simethicone 200 mg + N-acetylcysteine 600 mg; C5: water 100 ml + simethicone 200 mg + N-acetylcysteine 1000 mg; C6: water 100 ml + simethicone 200 mg + Hedera helix 70 mg). The solution was swallowed 15 to 30 minutes passing through the cricopharyngeus muscle. The Kappa test was performed to measure interobserver concordance of the TVMS scale. Results: Of 412 patients, 58 % were female; 23 % (136) were included in the C1 and C2 cohorts; and 67 % (276) were in the C3 to C6 cohorts. The average exposure time to each solution was 24.4 minutes. The wash volume for proper visualization was significantly different between the two groups. In premedicated patients, 75.6 mL of solution were used, while in patients without premedication, 124 mL were used (p = 0.000), with an excellent quality of TVMS of 88.7% versus 41.4%, respectively. The C4 cohort (water 100 mL + simethicone 200 mg + N-acetylcysteine 600 mg) was the most effective with a significant difference (p = 0.001) compared with the C1 (fasting) and C2 (placebo with water 100 mL) cohorts. It also had better efficiency compared to the C3, C5 and C6 cohorts in that order. There were no adverse events or complications associated with endoscopy, sedation, or premedication products. Conclusions: The most effective solution as a premedication to achieve excellent visibility of the digestive mucosa was that used in the C4 cohort (SIM 200 + NAC 600 + H2OR 100 mL). The proposed TVMS scale is a very complete and easy tool to apply by more than one observer. Premedication ingested, with anti-foam, mucolytic and water up to 100 mL, between 15 and 30 minutes before endoscopy, is safe under the conditions described in this study. [ABSTRACT FROM AUTHOR]

Objective: Many recent studies are pointing out the heterogeneity between pathologists in the classification of malignant pleural mesotheliomas. Besides, they reported the prognostic impact of classifying epithelioid mesotheliomas according to the predominant architectural features and the nuclear grade. The authors assessed the interobserver and the intraobserver agreement of subtyping mesotheliomas between 2 pathologists used to thoracic pathology. Material and Method: The observers reviewed all the slides of the malignant pleural mesotheliomas diagnosed during the period ranging from 2004 to 2017. The Cohen Kappa was performed in order to evaluate the agreement between both observers into classifying mesotheliomas, subtyping and grading epithelioid mesotheliomas. Two rounds of examination were planned with a delay period of one month. After the first round, the reviewers discussed the different difficulties and challenges they faced. All the statistic tests were performed using the SPSS software version 12.0. Results: After the first round, a fair agreement between both observers was reported. After the second round, an improvement of the concordance rate with a good agreement in subtyping epithelioid mesotheliomas was noticed. Concerning the grading of mesotheliomas, the interobserver agreement was poor even after the second round examination. The intraobserver reproducibility of epithelioid mesothelioma subtyping was fair or moderate for both reviewers. The intraobserver agreement was poor concerning the grading of epithelioid mesothelioma. Conclusion: Integrating subtyping and grading of epithelioid mesotheliomas into a new classification necessitates an important training of the pathologists. The architectural features' definitions have to be clarified in order to avoid using own subjective opinions and habits by pathologists. [ABSTRACT FROM AUTHOR]

In 2009, the Coimbra Method was created to standardize observations of entheseal changes, which are often studied as markers of vigorous physical activity formed during life. Low percentage agreement rates of interobserver replicability led to a revised version of the Coimbra Method published in 2016. Robust statistical significance should be expected of a standardized method, yet neither published method statistically tested interobserver and intraobserver agreement. This paper tests reliability of both Coimbra Method versions using Cohen's Kappa and percentage of agreement for comparison with the originally published rates. This paper also marks the first test of reliability for the Coimbra Method that is independent of the original authors. Fibrocartilaginous entheses of the humerus, radius and scapula were observed on 82 individuals from Scottish and Cretan collections. Results ranged from high intraobserver agreement (86.9% to 91.8%) to lower interobserver agreement (70.5% to 76.7%) for both methods. Interobserver agreement only slightly improved between the original (71.8%) and revised (75.2%) Coimbra Methods. Results for Kappa ranged from substantial for intraobserver agreement (k = 0.70) but only moderate for interobserver agreement (k = 0.57) for both methods. Either 80% or 'substantial' kappa agreement is considered the minimum for a standardized method, and these results indicate that interobserver agreement from even the revised Coimbra Method is still too low. Future tests and revisions are recommended to further explore the possibility of the Coimbra Method as a standard. [ABSTRACT FROM AUTHOR]

Background: The addition of 3D CT scans for observers evaluating tibial plateau fractures decreases agreement and diagnostic accuracy, possibly due to obstruction of the view by unfractured bones (i.e., patella, fibula, and femur) in 3D reconstructions.Questions/purposes: This study compared (1) the interobserver agreement between (subgroups of) observers classifying 3DCT reconstructions of tibial plateau fractures according to Schatzker, Luo, and AO/OTA, (2) recognition of different fracture characteristics, and (3) the level of confidence on a scale from 0 to 10 with and without subtraction of the unfractured bones.Methods: We selected twenty consecutive 3DCT reconstructions of tibial plateau fractures treated in a level I trauma center between 2013 and 2014. Members of the Science of Variation Group were randomized (1:1) to evaluate reconstructions with or without subtraction of the unfractured bone. Forty-nine surgeons completed the survey. The interobserver agreement was determined using Fleiss' kappa, and bootstrapping (resamples = 1000) was used to calculate the standard error, z statistic, and confidence intervals.Results: Overall, subtraction of unfractured bones did not affect interobserver agreement in Schatzker, Luo, and AO/OTA classification systems, agreement on the presence of fracture characteristics, and level of confidence. In subgroup analysis, non-trauma surgeons had significantly higher agreement in the three classification systems with subtraction. For fracture characteristics, some subgroups had higher agreement while others had lower agreement with subtraction.Discussion: The finding that agreement on classification of tibial plateau fractures is limited on 3DCT scan and is not improved by subtraction of unfractured bones suggests that disagreement may be based on variations in understanding and bias. Reliability of these classification systems might benefit from a focus on accounting for these pre-existing conceptualizations rather than further emphasis on imaging detail.Level Of Evidence: Diagnostic, level 1. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to assess the clinical applicability of a new analytical software program by determining the inter- and intraobserver agreement for 2D placental biometry and three-dimensional (3D) placental volume (PV) in the first trimester.Methods: A prospective study of 25 singleton pregnancies between 11 and 14 weeks was conducted. 3D datasets were captured, and PV was estimated using the Phillips QLAB GI3DQ ultrasound quantification software. The basal plate (BP), chorionic plate (CP), placental thickness (PT), and the free uterine surface (FUS) area not occupied by placenta were considered for 2D biometry evaluation. Each variable was measured in 2 orthogonal planes with mean values used for the analysis. Intra- and interobserver agreement was evaluated.Results: Intraobserver agreement for both 2D and 3D measurements was high, particularly for the PV and PT (interclass correlation coefficient [ICC] 0.989 [95% confidence interval (CI) 0.97-0.99] and ICC 0.936 [95% CI 0.86-0.97], respectively). Interobserver agreement was good for the PV (ICC 0.963 [95% CI 0.91-0.98]), PT (ICC 0.822 [95% CI 0.63-0.91]), and CP (ICC 0.708 [95% CI 0.44-0.86]), but moderate for BP and FUS.Conclusions: PV, PT, and CP are reproducible measurements to evaluate first trimester placental biometry. Further research is needed to assess the clinical utility of these variables as predictors of poor obstetric outcomes. [ABSTRACT FROM AUTHOR]

Purpose: To identify discrepancies between intraoperative and histological evaluations of the appendix in acute appendicitis and to evaluate the effect on surgical outcome.Methods: Data was used from our previous multicentre, prospective, cohort study of patients with suspected acute appendicitis. Appendices were scored during intraoperative and histological evaluation as uncomplicated or complicated appendicitis. Primary outcome was percentage of concordance between intraoperative and histological evaluation. Secondary outcomes were (infectious) postoperative complications, length of hospital stay, hospital re-admission and re-intervention rate, all within 30 days of surgery.Results: A total of 1850 patients were included. In 65.7% (1215/1850) of the appendices, the intraoperative evaluation was uncomplicated and in 34.3% (635/1850), complicated appendicitis. Patients with uncomplicated appendicitis had a postoperative course with significantly less postoperative complications (7.2% vs 24.3%), a shorter length of hospital stay (2 vs 5 days) and a lower re-admission (4.2% vs 9.6%) and re-intervention rate (1.1% vs 4.3%) than intraoperative complicated appendicitis (p < 0.001). In 93.5% (1136/1215) of the intraoperative uncomplicated patients and in 46.6% (296/635) of the intraoperative complicated patients, there was an agreement with pathology (Kappa 0.45). In 23.9% (81/339) of patients with intraoperative complicated and histological uncomplicated appendicitis, a postoperative complication was observed, which was similar to the postoperative complication rate of complicated appendicitis both on intraoperative and histological evaluation (24.7% (73/296)).Conclusions: There is a moderate agreement between a surgeon and pathologist in diagnosing patients with complicated appendicitis. However, the intraoperative diagnosis of complicated appendicitis was significantly associated with postoperative complications. Routine histological evaluation should be preserved for excluding malignancies in suspect appendices. [ABSTRACT FROM AUTHOR]

Background & Objective: Most colorectal cancers (CRCs) arise from adenomatous polyps, and clinical management of this type of polyp is highly dependent on the reliability and validity of the pathological diagnosis. The aim of this study was to examine the interobserver agreement of five pathologists in assessing dysplasia in adenomatous polyps. Methods: In this study, a total of 146 adenomatous polyps of patients undergoing colonoscopy were selected from hospitals of Shahid Beheshti University of Medical Sciences, Tehran, Iran between 2017 and 2018. Five pathologists independently classified adenomatous polyps according to histologic type, nuclear pseudostratification, mitotic activity, nuclear polarity, nuclear pleomorphism, nuclear shape, nucleolus, chromatin pattern, cytology grade, architectural features, dysplasia, and final diagnosis. The overall kappa statistic (k) was used to assess agreement among pathologists. Results: The mean age of the patients was 62.06 ± 13.06 (mean ± SD) with a male-tofemale ratio of 2.2:1. The most common site of resection was the sigmoid colon (28.1%). The highest agreement was found for dysplasia grade (k=0.415) and histologic type (k=0.401), whereas the lowest agreement was found for mitotic activity (k=0.185), nuclear shape (k=0.187), and nucleolus (k=0.196). Conclusion: Our findings indicate that agreement among pathologists in assessing dysplasia in adenomatous polyps is within fair to moderate levels of agreement. Therefore, there is a vital need to better clarify the current diagnostic criteria. [ABSTRACT FROM AUTHOR]