Score reproducibility and reliability in differentiating small bowel subepithelial masses from innocent bulges |
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| Institution: | 1. Division of Gastroenterology, Mater Dei Hospital, Malta;2. Digestive Endoscopy Unit, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy;3. Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca'' Granda Ospedale Maggiore Policlinico, Milano, Italy;7. TAGG Research Centre, Department of Clinical Medicine, Trinity Centre, Tallaght University Hospital, Dublin, Ireland;8. Gastroenterology Unit, Valduce Hospital, Como, Italy;11. Gastroenterology and Digestive Endoscopy Unit, “Città della Salute e della Scienza” Hospital, Torino, Italy;12. Agaplesion Bethesda Krankenhaus Bergedorf, Hamburg, Germany;13. Head, Department of Public Health, Faculty of Medicine & Surgery, University of Malta;14. Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy;15. Institute of Gastroenterology, Sheba Medical Center, Tel Hashomer, Israel;s. Pomeranian Medical University, Poland;t. Sorbonne Université, Centre d''Endoscopie Digestive, Hôpital Saint-Antoine, APHP, Paris, France |
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| Abstract: | AimsThe primary aim of this study was to assess the reliability, intra- and inter-observer variation of the SPICE, Mucosal protrusion angle (MPA) and SHYUNG scores in differentiating a subepithelial mass (SEM) from a bulge.MethodsThis retrospective multicentre study analysed the 3 scores, radiological studies, enteroscopy and/or surgical findings.Results100 patients with a potential SEM (mean age 57.6years) were recruited with 75 patients having pathology. In patients with a SEM the mean SPICE score was 2.04 (95% CI 1.82–2.26) as compared to 1.16 (95% CI 0.81–1.51) 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 agreement (Kappa 0.14, p<0.05). SPICE had a 37.3% sensitivity and 92.0% specificity in distinguishing between a SEM and bulge, whereas MPA<90? had 58.7% and 76.0% respectively, with poor intra-observer(p = 0.05) and interobserver agreement (p = 0.64). The SHYUNG 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).ConclusionsThough these scores are easy to use, they have, at best, slight to moderate intra and inter-observer agreement. Their overall diagnostic performances are limited. |
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