SCORE REPRODUCIBILITY AND RELIABILITY IN DIFFERENTIATING SMALL BOWEL SUBEPITHELIAL MASSES FROM INNOCENT BULGES

Aims To assess the reliability, intra- and inter-observer variation of the smooth of the smooth protruding lesions index at capsule endoscopy (SPICE), Mucosal protrusion angle (MPA) and SHYUNG scores in differentiating a subepithelial mass (SEM) from a bulge.

Methods This is a retrospective multicentre study where in patients with intraluminal protrusion findings, the 3 scores were analysed for intra and interobserver variation by 14 expert SBCE readers. The results of radiological studies, device assisted-enteroscopy and/or surgical findings were analysed.

Results 100 patients with a potential SEM were recruited, with 75 patients having a pathology, the most common being NETs (25.3%),GIST (24%) and adenocarcinoma (6.6%).

The mean SPICE score in patients with SEM was 2.04 vs 1.16 in those without any pathology (AUC 0.74; p<0.001) with a fair intra -observer agreement (Kappa 0.3, p<0.001) and slight inter-observer score agreement (Kappa 0.14, p<0.05). It had a 37.3% sensitivity and 92% specificity in distinguishing between a SEM and bulge.

The sensitivity and specificity of MPA<90˚ in distinguishing a SEM from a bulge was 58.7% and 76%, with poor intra-observer (p=0.05) and interobserver agreement (p=0.64). The SHYUNG Score demonstrated a moderate intra-observer (Kappa 0.44, p<0.001) and slight inter-observer reliability (Kappa 0.18 p<0.001). The sensitivity of an elevated SHYUNG score (≥4) in identifying a SEM was 18.7% with a specificity of 92.0% (AUC 0.71, p=0.002).

Conclusions Though these scores are easy to use, they have at best slight to moderate intra and inter-observer agreement. Cross-sectional imaging and enteroscopy remain the cornerstone in distinguishing between SEM and bulges.

Publication History

Article published online:
14 April 2022