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Significant inter-observer variation in the diagnosis of extrapancreatic necrosis and type of pancreatic collections in acute pancreatitis – An international multicenter evaluation of the revised Atlanta classification

Sternby, Hanna LU ; Verdonk, Robert C.; Aguilar, Guadalupe; Dimova, Alexandra; Ignatavicius, Povilas; Ilzarbe, Lucas; Koiva, Peeter; Lantto, Eila; Loigom, Tonis and Penttilä, Anne, et al. (2016) In Pancreatology 16(5). p.791-797
Abstract

Background For consistent reporting and better comparison of data in research the revised Atlanta classification (RAC) proposes new computed tomography (CT) criteria to describe the morphology of acute pancreatitis (AP). The aim of this study was to analyse the interobserver agreement among radiologists in evaluating CT morphology by using the new RAC criteria in patients with AP. Methods Patients with a first episode of AP who obtained a CT were identified and consecutively enrolled at six European centres backwards from January 2013 to January 2012. A local radiologist at each center and a central expert radiologist scored the CTs separately using the RAC criteria. Center dependent and independent interobserver agreement was... (More)

Background For consistent reporting and better comparison of data in research the revised Atlanta classification (RAC) proposes new computed tomography (CT) criteria to describe the morphology of acute pancreatitis (AP). The aim of this study was to analyse the interobserver agreement among radiologists in evaluating CT morphology by using the new RAC criteria in patients with AP. Methods Patients with a first episode of AP who obtained a CT were identified and consecutively enrolled at six European centres backwards from January 2013 to January 2012. A local radiologist at each center and a central expert radiologist scored the CTs separately using the RAC criteria. Center dependent and independent interobserver agreement was determined using Kappa statistics. Results In total, 285 patients with 388 CTs were included. For most CT criteria, interobserver agreement was moderate to substantial. In four categories, the center independent kappa values were fair: extrapancreatic necrosis (EXPN) (0.326), type of pancreatitis (0.370), characteristics of collections (0.408), and appropriate term of collections (0.356). The fair kappa values relate to discrepancies in the identification of extrapancreatic necrotic material. The local radiologists diagnosed EXPN (33% versus 59%, P < 0.0001) and non-homogeneous collections (35% versus 66%, P < 0.0001) significantly less frequent than the central expert. Cases read by the central expert showed superior correlation with clinical outcome. Conclusion Diagnosis of EXPN and recognition of non-homogeneous collections show only fair agreement potentially resulting in inconsistent reporting of morphologic findings.

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publication status
published
subject
keywords
Acute pancreatitis, Classification, Computed tomography, Extrapancreatic necrosis, Necrotising pancreatitis
in
Pancreatology
volume
16
issue
5
pages
7 pages
publisher
Karger
external identifiers
  • scopus:84991633802
  • wos:000384785700018
ISSN
1424-3903
DOI
10.1016/j.pan.2016.08.007
language
English
LU publication?
yes
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5f254f51-e582-4083-80b1-950ad08a3688
date added to LUP
2016-11-18 11:02:14
date last changed
2017-08-21 11:16:44
@article{5f254f51-e582-4083-80b1-950ad08a3688,
  abstract     = {<p>Background For consistent reporting and better comparison of data in research the revised Atlanta classification (RAC) proposes new computed tomography (CT) criteria to describe the morphology of acute pancreatitis (AP). The aim of this study was to analyse the interobserver agreement among radiologists in evaluating CT morphology by using the new RAC criteria in patients with AP. Methods Patients with a first episode of AP who obtained a CT were identified and consecutively enrolled at six European centres backwards from January 2013 to January 2012. A local radiologist at each center and a central expert radiologist scored the CTs separately using the RAC criteria. Center dependent and independent interobserver agreement was determined using Kappa statistics. Results In total, 285 patients with 388 CTs were included. For most CT criteria, interobserver agreement was moderate to substantial. In four categories, the center independent kappa values were fair: extrapancreatic necrosis (EXPN) (0.326), type of pancreatitis (0.370), characteristics of collections (0.408), and appropriate term of collections (0.356). The fair kappa values relate to discrepancies in the identification of extrapancreatic necrotic material. The local radiologists diagnosed EXPN (33% versus 59%, P &lt; 0.0001) and non-homogeneous collections (35% versus 66%, P &lt; 0.0001) significantly less frequent than the central expert. Cases read by the central expert showed superior correlation with clinical outcome. Conclusion Diagnosis of EXPN and recognition of non-homogeneous collections show only fair agreement potentially resulting in inconsistent reporting of morphologic findings.</p>},
  author       = {Sternby, Hanna and Verdonk, Robert C. and Aguilar, Guadalupe and Dimova, Alexandra and Ignatavicius, Povilas and Ilzarbe, Lucas and Koiva, Peeter and Lantto, Eila and Loigom, Tonis and Penttilä, Anne and Regnér, Sara and Rosendahl, Jonas and Strahinova, Vanya and Zackrisson, Sophia and Zviniene, Kristina and Bollen, Thomas L.},
  issn         = {1424-3903},
  keyword      = {Acute pancreatitis,Classification,Computed tomography,Extrapancreatic necrosis,Necrotising pancreatitis},
  language     = {eng},
  month        = {09},
  number       = {5},
  pages        = {791--797},
  publisher    = {Karger},
  series       = {Pancreatology},
  title        = {Significant inter-observer variation in the diagnosis of extrapancreatic necrosis and type of pancreatic collections in acute pancreatitis – An international multicenter evaluation of the revised Atlanta classification},
  url          = {http://dx.doi.org/10.1016/j.pan.2016.08.007},
  volume       = {16},
  year         = {2016},
}