Abstract：
OBJECTIVE: To assess intra- and inter-institutional concordance and identify methods to increase precision in radiologic extranodal extension (rENE) ascertainment in HPV+ oropharyngeal carcinoma.
METHODS: Six radiologists, blinded to clinical outcomes, from three centers assessed rENE in two phases: Phase-I (20 cases) utilized each individual\'s a priori appreciation of the literature. Phase-II (30 additional cases) was performed after deliberating experience and consolidating operating definitions. Intra- and inter-institutional Kappa were calculated at >50% and >75% certainty levels, respectively.
RESULTS: The Phase-I intra-institutional kappa was 0.76, 0.32, and 0.44 at >50% certainty and improved to 0.89, 0.61, and 0.66 at >75% certainty. Inter-institutional Fleiss\' kappa also improved with higher certainty (from 0.40 to 0.57, p = 0.039). The Phase-II inter-rater kappa was significantly higher than Phase-I at the same certainty level (both p < 0.001).
CONCLUSIONS: A learning curve exists for rENE assessment. Strategies to augment reliability include high certainty for declaration, consolidated operating definitions, and sharing experience among radiologists.
METHODS: Six radiologists, blinded to clinical outcomes, from three centers assessed rENE in two phases: Phase-I (20 cases) utilized each individual\'s a priori appreciation of the literature. Phase-II (30 additional cases) was performed after deliberating experience and consolidating operating definitions. Intra- and inter-institutional Kappa were calculated at >50% and >75% certainty levels, respectively.
RESULTS: The Phase-I intra-institutional kappa was 0.76, 0.32, and 0.44 at >50% certainty and improved to 0.89, 0.61, and 0.66 at >75% certainty. Inter-institutional Fleiss\' kappa also improved with higher certainty (from 0.40 to 0.57, p = 0.039). The Phase-II inter-rater kappa was significantly higher than Phase-I at the same certainty level (both p < 0.001).
CONCLUSIONS: A learning curve exists for rENE assessment. Strategies to augment reliability include high certainty for declaration, consolidated operating definitions, and sharing experience among radiologists.
摘要：
目的：评估机构内和机构间的一致性，并确定提高HPV+口咽癌放射学结外延伸（rENE）确定精度的方法。
方法：六位放射科医师，对临床结果视而不见，来自三个中心的rene分两个阶段进行评估：第一阶段(20例)利用每个人对文献的先验评价。在经过深思熟虑的经验和合并操作定义之后，进行了第二阶段（另外30个案例）。机构内和机构间Kappa在>50%和>75%的确定性水平下计算，分别。
结果：在>50％的确定性下，I期机构内部kappa为0.76、0.32和0.44，在>75％的确定性下提高到0.89、0.61和0.66。机构间Fleiss\'kappa也以更高的确定性得到改善(从0.40提高到0.57，p=0.039)。在相同的确定性水平下，II期评分者之间的κ明显高于I期（均p<0.001）。
结论：rENE评估存在学习曲线。增加可靠性的策略包括申报的高确定性，合并的运营定义，并在放射科医师之间分享经验。
方法：六位放射科医师，对临床结果视而不见，来自三个中心的rene分两个阶段进行评估：第一阶段(20例)利用每个人对文献的先验评价。在经过深思熟虑的经验和合并操作定义之后，进行了第二阶段（另外30个案例）。机构内和机构间Kappa在>50%和>75%的确定性水平下计算，分别。
结果：在>50％的确定性下，I期机构内部kappa为0.76、0.32和0.44，在>75％的确定性下提高到0.89、0.61和0.66。机构间Fleiss\'kappa也以更高的确定性得到改善(从0.40提高到0.57，p=0.039)。在相同的确定性水平下，II期评分者之间的κ明显高于I期（均p<0.001）。
结论：rENE评估存在学习曲线。增加可靠性的策略包括申报的高确定性，合并的运营定义，并在放射科医师之间分享经验。
