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Assessment of Ultrasonographic Features of Polycystic Ovaries is Associated with Modest Levels of Inter-observer Agreement

Assessment of Ultrasonographic Features of Polycystic Ovaries is Associated with Modest Levels of Inter-observer Agreement

Marla E Lujan1, Donna R Chizen2, Andrew K Peppin3, Anita Dhir4 and Roger A Pierson2

1Division of Nutritional Sciences, Cornell University, Ithaca, USA
2Division of Obstetrics, Gynecology & Reproductive Sciences, University of Saskatchewan, Saskatoon, Canada
3Division of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Canada
4Division of Academic Department of Medical Imaging, University of Saskatchewan, Saskatoon, Canada

Journal of Ovarian Research 2009
Research Published: 10 June 2009

Abstract
Background
There is growing acceptance that polycystic ovaries are an important marker of polycystic ovary syndrome (PCOS) despite significant variability when making the ultrasound diagnosis. To better understand the nature of this variability, we proposed to evaluate the level of inter-observer agreement when identifying and quantifying individual ultrasonographic features of polycystic ovaries.

Methods
Digital recordings of transvaginal ultrasound scans performed in thirty women with PCOS were assessed by four observers with training in Radiology or Reproductive Endocrinology. Observers evaluated the scans for: 1) number of follicles ≥ 2 mm per ovary, 2) largest follicle diameter, 3) ovarian volume, 4) follicle distribution pattern and 5) presence of a corpus luteum (CL). Lin's concordance correlation coefficients and kappa statistics for multiple raters were used to assess inter-observer agreement.

Results
Agreement between observers ranged from 0.08 to 0.63 for follicle counts, 0.27 to 0.88 for largest follicle diameter, 0.63 to 0.86 for ovarian volume, 0.51 to 0.76 for follicle distribution pattern and 0.76 to 0.90 for presence of a CL. Overall, reproductive endocrinologists demonstrated better agreement when evaluating ultrasonographic features of polycystic ovaries compared to radiologists (0.71 versus 0.53; p = 0.04).

Conclusion
Inter-observer agreement for assessing ultrasonographic features of polycystic ovaries was moderate to poor. These findings support the need for standardized training modules to characterize polycystic ovarian morphology on ultrasonography.

The complete research is available in PDF format or at http://www.ovarianresearch.com/content/2/1/6
Open Access from BioMedCentral