Interobserver Variability in the Assessment of Fluorescence Angiography in the Colon
Background Fluorescence angiography in colorectal surgery is a technique that may lead to lower anastomotic leak rates. However, the interpretation of the fluorescent signal is not standardised and there is a paucity of data regarding interobserver agreement. The aim of this study is to assess inter...
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| Veröffentlicht in: | Surgical innovation 2023-02, Vol.30 (1), p.45-49 |
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| creator | Soares, Antonio S. Clancy, Neil T. Bano, Sophia Raza, Imran Diana, Michelle Lovat, Laurence B. Stoyanov, Danail Chand, Manish |
| description | Background
Fluorescence angiography in colorectal surgery is a technique that may lead to lower anastomotic leak rates. However, the interpretation of the fluorescent signal is not standardised and there is a paucity of data regarding interobserver agreement. The aim of this study is to assess interobserver variability in selection of the transection point during fluorescence angiography before anastomosis.
Methods
An online survey with still images of fluorescence angiography was distributed through colorectal surgery channels containing images from 13 patients where several areas for transection were displayed to be chosen by raters. Agreement was assessed overall and between pre-planned rater cohorts (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists), using Fleiss’ kappa statistic.
Results
101 raters had complete image ratings. No significant difference was found between raters when choosing a point of optimal bowel transection based on fluorescence angiography still images. There was no difference between pre-planned cohorts analysed (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists). Agreement between these cohorts was poor ( |
| doi_str_mv | 10.1177/15533506221132681 |
| format | Article |
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Fluorescence angiography in colorectal surgery is a technique that may lead to lower anastomotic leak rates. However, the interpretation of the fluorescent signal is not standardised and there is a paucity of data regarding interobserver agreement. The aim of this study is to assess interobserver variability in selection of the transection point during fluorescence angiography before anastomosis.
Methods
An online survey with still images of fluorescence angiography was distributed through colorectal surgery channels containing images from 13 patients where several areas for transection were displayed to be chosen by raters. Agreement was assessed overall and between pre-planned rater cohorts (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists), using Fleiss’ kappa statistic.
Results
101 raters had complete image ratings. No significant difference was found between raters when choosing a point of optimal bowel transection based on fluorescence angiography still images. There was no difference between pre-planned cohorts analysed (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists). Agreement between these cohorts was poor (<.26).
Conclusion
Whilst there is no learning curve for the technical adoption of FA, understanding the fluorescent signal characteristics is key to successful use. We found significant variation exists in interpretation of static fluorescence angiography data. Further efforts should be employed to standardise fluorescence angiography assessment.</description><identifier>ISSN: 1553-3506</identifier><identifier>EISSN: 1553-3514</identifier><identifier>DOI: 10.1177/15533506221132681</identifier><identifier>PMID: 36377296</identifier><language>eng</language><publisher>Los Angeles, CA: SAGE Publications</publisher><subject>Anastomosis, Surgical - methods ; Anastomotic Leak ; Colorectal Neoplasms - surgery ; Coloring Agents ; Fluorescein Angiography - methods ; Humans ; Indocyanine Green ; Observer Variation</subject><ispartof>Surgical innovation, 2023-02, Vol.30 (1), p.45-49</ispartof><rights>The Author(s) 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c383t-346c6f52f40b19b069d9e07b327fc406793b1f8d00124d4dc5da6649f2ac046b3</citedby><cites>FETCH-LOGICAL-c383t-346c6f52f40b19b069d9e07b327fc406793b1f8d00124d4dc5da6649f2ac046b3</cites><orcidid>0000-0001-7773-2427 ; 0000-0002-1390-8486</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://journals.sagepub.com/doi/pdf/10.1177/15533506221132681$$EPDF$$P50$$Gsage$$H</linktopdf><linktohtml>$$Uhttps://journals.sagepub.com/doi/10.1177/15533506221132681$$EHTML$$P50$$Gsage$$H</linktohtml><link.rule.ids>314,780,784,21819,27924,27925,43621,43622</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36377296$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Soares, Antonio S.</creatorcontrib><creatorcontrib>Clancy, Neil T.</creatorcontrib><creatorcontrib>Bano, Sophia</creatorcontrib><creatorcontrib>Raza, Imran</creatorcontrib><creatorcontrib>Diana, Michelle</creatorcontrib><creatorcontrib>Lovat, Laurence B.</creatorcontrib><creatorcontrib>Stoyanov, Danail</creatorcontrib><creatorcontrib>Chand, Manish</creatorcontrib><title>Interobserver Variability in the Assessment of Fluorescence Angiography in the Colon</title><title>Surgical innovation</title><addtitle>Surg Innov</addtitle><description>Background
Fluorescence angiography in colorectal surgery is a technique that may lead to lower anastomotic leak rates. However, the interpretation of the fluorescent signal is not standardised and there is a paucity of data regarding interobserver agreement. The aim of this study is to assess interobserver variability in selection of the transection point during fluorescence angiography before anastomosis.
Methods
An online survey with still images of fluorescence angiography was distributed through colorectal surgery channels containing images from 13 patients where several areas for transection were displayed to be chosen by raters. Agreement was assessed overall and between pre-planned rater cohorts (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists), using Fleiss’ kappa statistic.
Results
101 raters had complete image ratings. No significant difference was found between raters when choosing a point of optimal bowel transection based on fluorescence angiography still images. There was no difference between pre-planned cohorts analysed (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists). Agreement between these cohorts was poor (<.26).
Conclusion
Whilst there is no learning curve for the technical adoption of FA, understanding the fluorescent signal characteristics is key to successful use. We found significant variation exists in interpretation of static fluorescence angiography data. Further efforts should be employed to standardise fluorescence angiography assessment.</description><subject>Anastomosis, Surgical - methods</subject><subject>Anastomotic Leak</subject><subject>Colorectal Neoplasms - surgery</subject><subject>Coloring Agents</subject><subject>Fluorescein Angiography - methods</subject><subject>Humans</subject><subject>Indocyanine Green</subject><subject>Observer Variation</subject><issn>1553-3506</issn><issn>1553-3514</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9PAjEQxRujEUQ_gBezRy-L0__skRBRExIv6HXTdltYsrTY7prw7V0CcjHxNJOZ33uZeQjdYxhjLOUT5pxSDoIQjCkRE3yBhodZTjlml-cexADdpLQBYBwDv0YDKqiUpBBDtHzzrY1BJxu_bcw-VayVrpu63We1z9q1zaYp2ZS21rdZcNm86UK0yVhv-pVf1WEV1W59pmehCf4WXTnVJHt3qiP0MX9ezl7zxfvL22y6yA2d0DanTBjhOHEMNC40iKIqLEhNiXSGgZAF1dhNKgBMWMUqwyslBCscUQaY0HSEHo--uxi-Opvaclv3pzWN8jZ0qSSSCiEog6JH8RE1MaQUrSt3sd6quC8xlIcwyz9h9pqHk32nt7Y6K37T64HxEUhqZctN6KLv3_3H8Qdt6HvF</recordid><startdate>202302</startdate><enddate>202302</enddate><creator>Soares, Antonio S.</creator><creator>Clancy, Neil T.</creator><creator>Bano, Sophia</creator><creator>Raza, Imran</creator><creator>Diana, Michelle</creator><creator>Lovat, Laurence B.</creator><creator>Stoyanov, Danail</creator><creator>Chand, Manish</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7773-2427</orcidid><orcidid>https://orcid.org/0000-0002-1390-8486</orcidid></search><sort><creationdate>202302</creationdate><title>Interobserver Variability in the Assessment of Fluorescence Angiography in the Colon</title><author>Soares, Antonio S. ; Clancy, Neil T. ; Bano, Sophia ; Raza, Imran ; Diana, Michelle ; Lovat, Laurence B. ; Stoyanov, Danail ; Chand, Manish</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c383t-346c6f52f40b19b069d9e07b327fc406793b1f8d00124d4dc5da6649f2ac046b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Anastomosis, Surgical - methods</topic><topic>Anastomotic Leak</topic><topic>Colorectal Neoplasms - surgery</topic><topic>Coloring Agents</topic><topic>Fluorescein Angiography - methods</topic><topic>Humans</topic><topic>Indocyanine Green</topic><topic>Observer Variation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soares, Antonio S.</creatorcontrib><creatorcontrib>Clancy, Neil T.</creatorcontrib><creatorcontrib>Bano, Sophia</creatorcontrib><creatorcontrib>Raza, Imran</creatorcontrib><creatorcontrib>Diana, Michelle</creatorcontrib><creatorcontrib>Lovat, Laurence B.</creatorcontrib><creatorcontrib>Stoyanov, Danail</creatorcontrib><creatorcontrib>Chand, Manish</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical innovation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soares, Antonio S.</au><au>Clancy, Neil T.</au><au>Bano, Sophia</au><au>Raza, Imran</au><au>Diana, Michelle</au><au>Lovat, Laurence B.</au><au>Stoyanov, Danail</au><au>Chand, Manish</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Interobserver Variability in the Assessment of Fluorescence Angiography in the Colon</atitle><jtitle>Surgical innovation</jtitle><addtitle>Surg Innov</addtitle><date>2023-02</date><risdate>2023</risdate><volume>30</volume><issue>1</issue><spage>45</spage><epage>49</epage><pages>45-49</pages><issn>1553-3506</issn><eissn>1553-3514</eissn><abstract>Background
Fluorescence angiography in colorectal surgery is a technique that may lead to lower anastomotic leak rates. However, the interpretation of the fluorescent signal is not standardised and there is a paucity of data regarding interobserver agreement. The aim of this study is to assess interobserver variability in selection of the transection point during fluorescence angiography before anastomosis.
Methods
An online survey with still images of fluorescence angiography was distributed through colorectal surgery channels containing images from 13 patients where several areas for transection were displayed to be chosen by raters. Agreement was assessed overall and between pre-planned rater cohorts (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists), using Fleiss’ kappa statistic.
Results
101 raters had complete image ratings. No significant difference was found between raters when choosing a point of optimal bowel transection based on fluorescence angiography still images. There was no difference between pre-planned cohorts analysed (experts vs non-experts; trainees vs consultants; colorectal specialists vs non colorectal specialists). Agreement between these cohorts was poor (<.26).
Conclusion
Whilst there is no learning curve for the technical adoption of FA, understanding the fluorescent signal characteristics is key to successful use. We found significant variation exists in interpretation of static fluorescence angiography data. Further efforts should be employed to standardise fluorescence angiography assessment.</abstract><cop>Los Angeles, CA</cop><pub>SAGE Publications</pub><pmid>36377296</pmid><doi>10.1177/15533506221132681</doi><tpages>5</tpages><orcidid>https://orcid.org/0000-0001-7773-2427</orcidid><orcidid>https://orcid.org/0000-0002-1390-8486</orcidid><oa>free_for_read</oa></addata></record> |
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| language | eng |
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| source | MEDLINE; SAGE Complete A-Z List; Alma/SFX Local Collection |
| subjects | Anastomosis, Surgical - methods Anastomotic Leak Colorectal Neoplasms - surgery Coloring Agents Fluorescein Angiography - methods Humans Indocyanine Green Observer Variation |
| title | Interobserver Variability in the Assessment of Fluorescence Angiography in the Colon |
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