• 1.

    Thompson RCA, McManus DP, 2001. Aetiology: parasites and life-cycles. Eckert J, Gemmell MA, Meslin F-X, Pawlowski ZS, eds. WHO/OIE Manual on Echinococcosis in Humans and Animals: A Public Health Problem of Global Concern. Paris, France: World Organisation for Animal Health (Office International des Epizooties), 119.

    • Search Google Scholar
    • Export Citation
  • 2.

    Brunetti E, Garcia HH, Junghanss T, 2011. Cystic echinococcosis: chronic, complex, and still neglected. PLoS Negl Trop Dis 5: e1146.

  • 3.

    Kern P, 2003. Echinococcus granulosus infection: clinical presentation, medical treatment and outcome. Langenbecks Arch Surg 388: 413420.

    • Search Google Scholar
    • Export Citation
  • 4.

    Romig T, Zeyhle E, Macpherson CN, Rees PH, Were JB, 1986. Cyst growth and spontaneous cure in hydatid disease. Lancet 1: 861.

  • 5.

    Keshmiri M, Baharvahdat H, Fattahi SH, Davachi B, Dabiri RH, Baradaran H, Ghiasi T, Rajabimashhadi MT, Rajabzadeh F, 1999. A placebo controlled study of albendazole in the treatment of pulmonary echinococcosis. Eur Respir J 14: 503507.

    • Search Google Scholar
    • Export Citation
  • 6.

    Rogan MT, Hai WY, Richardson R, Zeyhle E, Craig PS, 2006. Hydatid cysts: does every picture tell a story? Trends Parasitol 22: 431438.

  • 7.

    Larrieu E, Del Carpio M, Mercapide CH, Salvitti JC, Sustercic J, Moguilensky J, Panomarenko H, Uchiumi L, Herrero E, Talmon G, Volpe M, Araya D, Mujica G, Mancini S, Labanchi JL, Odriozola M, 2011. Programme for ultrasound diagnoses and treatment with albendazole of cystic echinococcosis in asymptomatic carriers: 10 years of follow-up of cases. Acta Trop 117: 15.

    • Search Google Scholar
    • Export Citation
  • 8.

    Frider B, Larrieu E, Odriozola M, 1999. Long-term outcome of asymptomatic liver hydatidosis. J Hepatol 30: 228231.

  • 9.

    Gil-Grande LA, Rodriguez-Caabeiro F, Prieto JG, Sánchez-Ruano JJ, Brasa C, Aguilar L, García-Hoz F, Casado N, Bárcena R, Alvarez AI, 1993. Randomised controlled trial of efficacy of albendazole in intra-abdominal hydatid disease. Lancet 342: 12691272.

    • Search Google Scholar
    • Export Citation
  • 10.

    Hosch W, Junghanss T, Stojkovic M, Brunetti E, Heye T, Kauffmann GW, Hull WE, 2008. Metabolic viability assessment of cystic echinococcosis using high-field 1H MRS of cyst contents. NMR Biomed 21: 734754.

    • Search Google Scholar
    • Export Citation
  • 11.

    WHO Informal Working Group, 2003. International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop 85: 253261.

    • Search Google Scholar
    • Export Citation
  • 12.

    Macpherson CN, Bartholomot B, Frider B, 2003. Application of ultrasound in diagnosis, treatment, epidemiology, public health and control of Echinococcus granulosus and E. multilocularis. Parasitology 127 (Suppl): S21S35.

    • Search Google Scholar
    • Export Citation
  • 13.

    Macpherson CN, Milner R, 2003. Performance characteristics and quality control of community based ultrasound surveys for cystic and alveolar echinococcosis. Acta Trop 85: 203209.

    • Search Google Scholar
    • Export Citation
  • 14.

    Macpherson CN, Romig T, Zeyhle E, Rees PH, Were JB, 1987. Portable ultrasound scanner versus serology in screening for hydatid cysts in a nomadic population. Lancet 2: 259261.

    • Search Google Scholar
    • Export Citation
  • 15.

    Brunetti E, Kern P, Vuitton DA, 2010. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 114: 116.

    • Search Google Scholar
    • Export Citation
  • 16.

    Microsoft, 2010. Microsoft Excel. Redmond, WA: Microsoft.

  • 17.

    Landis JR, Koch GG, 1977. The measurement of observer agreement for categorical data. Biometrics 33: 159174.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Expert Reliability for the World Health Organization Standardized Ultrasound Classification of Cystic Echinococcosis

View More View Less
  • 1 Windward Islands Research and Education Foundation (WINDREF), St. George's, Grenada.
  • | 2 School of Medicine, St. George's University, St. George's, Grenada.
  • | 3 School of Veterinary Medicine, St. George's University, St. George's, Grenada.
  • | 4 WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy.
  • | 5 Department of Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy.
Restricted access

Cystic echinococcosis (CE), a parasitic zoonosis, results in cyst formation in the viscera. Cyst morphology depends on developmental stage. In 2003, the World Health Organization (WHO) published a standardized ultrasound (US) classification for CE, for use among experts as a standard of comparison. This study examined the reliability of this classification. Eleven international CE and US experts completed an assessment of eight WHO classification images and 88 test images representing cyst stages. Inter- and intraobserver reliability and observer performance were assessed using Fleiss' and Cohen's kappa. Interobserver reliability was moderate for WHO images (κ = 0.600, P < 0.0001) and substantial for test images (κ = 0.644, P < 0.0001), with substantial to almost perfect interobserver reliability for stages with pathognomonic signs (CE1, CE2, and CE3) for WHO (0.618 < κ < 0.904) and test images (0.642 < κ < 0.768). Comparisons of expert performances against the majority classification for each image were significant for WHO (0.413 < κ < 1.000, P < 0.005) and test images (0.718 < κ < 0.905, P < 0.0001); and intraobserver reliability was significant for WHO (0.520 < κ < 1.000, P < 0.005) and test images (0.690 < κ < 0.896, P < 0.0001). Findings demonstrate moderate to substantial interobserver and substantial to almost perfect intraobserver reliability for the WHO classification, with substantial to almost perfect interobserver reliability for pathognomonic stages. This confirms experts' abilities to reliably identify WHO-defined pathognomonic signs of CE, demonstrating that the WHO classification provides a reproducible way of staging CE.

Author Notes

* Address correspondence to Calum N. L. Macpherson, School of Medicine, St. George's University, True Blue Campus, True Blue, P.O. Box 7, St. George's, Grenada. E-mail: cmacpherson@sgu.edu

Authors' addresses: Nadia Solomon and Calum N. L. Macpherson, Windward Islands Research and Educational Foundation (WINDREF), St. George's, Grenada, and St. George's University School of Medicine, St. George's, Grenada, E-mails: nsolomon12@gmail.com and cmacpherson@sgu.edu. Paul J. Fields, Windward Islands Research and Educational Foundation (WINDREF), St. George's, Grenada, E-mail: pjfphd@comcast.net. Francesca Tamarozzi, WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy, E-mail: f_tamarozzi@yahoo.com. Enrico Brunetti, WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy, and Department of Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy, E-mails: enrico.brunetti@unipv.it.

Save