Inter-Rater Reliability of Air/Saline HyCoSy, HyFoSy and HyFoSy Combined With Power Doppler for Screening Tubal Patency

Abstract

Purpose To estimate the inter-observer reliability and agreement of offline analyses of three different ultrasound techniques for assessing tubal patency.

Methods 100 tubes (n = 100) in 50 women were evaluated for tubal patency between November 2013 and July 2015 using ultrasound as index tests and laparoscopy as the reference standard. Three different ultrasound techniques were applied: two-dimensional grayscale ultrasound using air + saline as the contrast media (2D-HyCoSy); two- and three-dimensional grayscale ultrasound using foam as the contrast media (2 D/3D-HyFoSy); and the same technique but adding bi-directional power Doppler (2 D/3D-Doppler-HyFoSy). The videos containing full standardized exams using these three techniques were split into three parts, anonymized, encoded, randomized and reassessed in Nov. 2015 by two observers who assessed tubal patency using standardized criteria. These observers were blinded to any clinical information and each other’s results. Proportions of observed agreement (po) and Cohen's Kappa (κ) including the 95 % confidence intervals (CI) were calculated.

Results The inter-observer reliability/agreement in 2 D/3D-Doppler-HyFoSy (po = 0.99, κ = 0.95, 95 % CI: 0.93 – 0.97) was higher compared to 2D-air/saline-HyCoSy (po = 0.83, κ = 0.55, 95 % CI: 0.40 – 0.68) and 2 D/3D-HyFoSy (po = 0.92, κ = 0.67, 95 % CI: 0.54 – 0.76).

Conclusion The inter-observer reliability and agreement of the diagnosis of tubal patency evaluating stored videos are improved when foam and power Doppler are used during acquisition. Therefore, this technique may be preferred to minimize misclassification and misdiagnosis.

Zusammenfassung

Ziel Messung der Interrater Reliabilität und Übereinstimmung von Offline Aufnahmen von drei unterschiedlichen Ultraschalltechniken zur Untersuchung der Durchgängigkeit der Tuba uterina.

Methoden Zwischen November 2013 und Juli 2015 wurde die Durchgängigkeit von n = 100 Tuben von 50 Frauen mit Ultraschall als Indextest und Laparoskopie als Referenzstandard untersucht. Dabei kamen drei verschiedene Ultraschalltechniken zum Einsatz: Zweidimensionaler Schwarz-Weiß-Ultraschall mit Luft und Salzlösung als Kontrastmittel (2D-HyCoSy), Zwei- und Dreidimensionaler Schwarz-Weiß-Ultraschall mit Schaum als Kontrastmittel (2 D/3D-HyFoSy) und die gleiche Technik mit zusätzlichem bi-direktionalem Powerdoppler (2 D/3D-Doppler-HyFoSy). Die Videos enthielten die vollständigen standardisierten Untersuchungen, wurden drei Gruppen zugeordnet, randomisiert und im November 2015 beurteilten zwei Rater die Durchgängigkeit der Tuben anhand standardisierter Kriterien. Die Rater waren gegenüber anderen klinischen Informationen und gegenüber einander verblindet. Anteile von Übereinstimmungen (po), Cohen’s kappa (κ) und 95 % Konfidenz Intervalle (KI) wurden berechnet.

Ergebnisse Die Interrater Reliabilität und Übereinstimmung des 2 D/3D-Doppler-HyFoSy (po = 0,99, κ = 0,95, 95 % KI: 0,93 – 0,97) war höher als der 2D-Air/saline-HyCoSy (po = 0,83, κ = 0,55, 95 % KI: 0,40 – 0,68) und der 2 D/3D-HyFoSy (po = 0,92, κ = 0,67, 95 % KI: 0,54 – 0,76).

Schlussfolgerungen Die Interrater Reliabilität und Überstimmung zur Bestimmung der Durchgängigkeit der Tuba uterina bei aufgezeichneten Videos ist verbessert wenn Schaum und Power Doppler während der Aufzeichnung verwendet wird. Deshalb sollte dieser Technik bevorzugt werden um Fehlklassifikationen und Fehldiagnosen zu minimieren.

Key words

gynecology - infertility - fallopian tube patency test - reproducibility - specificity

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