Ricardo Villarreal1, Bozena B Wrobel2, Luis F Macias-Valle3, Greg E Davis4, Thomas J Prihoda5, Amber U Luong6, K Christopher McMains7, Erik K Weitzel8, William C Yao6, Joe Brunworth9, David W Clark10, Salil Nair11, Constanza J Valdés12, Ashleigh Halderman13, David W Jang14, Rahuram Sivasubramaniam15, Zhipeng Zhang2, Philip G Chen1. 1. Department of Otolaryngology-Head and Neck Surgery, University of Texas Health San Antonio, San Antonio, TX. 2. Caruso Department of Otolaryngology Head and Neck Surgery, University of Southern California, Keck School of Medicine, Los Angeles, CA. 3. Department of Otolaryngology Head and Neck Surgery, Hospital Español de México, Mexico City, México. 4. Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA. 5. Department of Pathology, University of Texas Health San Antonio, Graduate School of Biomedical Sciences, San Antonio, TX. 6. Department of Otorhinolaryngology-Head and Neck Surgery, University of Texas Health Science Center at Houston, Houston, TX. 7. Department of Surgery, South Texas Veterans Health Care System, San Antonio, TX. 8. United States Army Institute of Surgical Research Fort Sam Houston, TX. 9. Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, St Louis, MO. 10. Department of Otolaryngology, Texas A&M University College of Medicine/Baylor Scott & White Health, Temple TX. 11. Department of Otolaryngology, Auckland Hospitals and University of Auckland, Auckland, New Zealand. 12. Department of Otolaryngology- Head and Neck Surgery, Hospital del Salvador, Universidad de Chile, Santiago, Chile. 13. Department of Otolaryngology Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX. 14. Division of Head and Neck Surgery & Communication Sciences, Duke University Medical Center, Durham, NC. 15. Department of Otolaryngology, Auckland City Hospital, Auckland, Auckland, New Zealand.
Abstract
BACKGROUND: Inconsistencies in the nomenclature of structures of the frontal sinus have impeded the development of a validated "reference standard" classification system that surgeons can reliably agree upon. The International Frontal Sinus Anatomy Classification (IFAC) system was developed as a consensus document, based on expert opinion, attempting to address this issue. The purposes of this study are to: establish the reliability of the IFAC as a tool for classifying cells in the frontal recess among an international group of rhinologists; and improve communication and teaching of frontal endoscopic sinus surgery (ESS). METHODS: Forty-two computed tomography (CT) scans, each with a marked frontal cell, were reviewed by 15 international fellowship-trained rhinologists. Each marked cell was classified into 1 of 7 categories described in the IFAC, on 2 occasions separated by 2 weeks. Inter- and intrarater reliability were evaluated using Light's kappa (κ), the interclass correlation coefficient (ICC), and simple proportion of agreement. RESULTS: Interrater reliability showed pairwise κ values ranging from 0.7248 to 1.0, with a mean of 0.9162 (SD, 0.0537). The ICC was 0.98. Intrarater reliability showed κ values ranging from 0.8613 to 1.0, with a mean of 0.9407 (SD, 0.0376). The within-rater ICC was 0.98. CONCLUSION: Among a diverse sample of rhinologists (raters), there was substantial to almost perfect agreement between raters, and among individual raters at different timepoints. The IFAC is a reliable tool for classification of cells in the frontal sinus. Further outcome studies are still needed to determine the validity of the IFAC. Published 2018. This article is a U.S. government work and is in the public domain in the USA.
BACKGROUND: Inconsistencies in the nomenclature of structures of the frontal sinus have impeded the development of a validated "reference standard" classification system that surgeons can reliably agree upon. The International Frontal Sinus Anatomy Classification (IFAC) system was developed as a consensus document, based on expert opinion, attempting to address this issue. The purposes of this study are to: establish the reliability of the IFAC as a tool for classifying cells in the frontal recess among an international group of rhinologists; and improve communication and teaching of frontal endoscopic sinus surgery (ESS). METHODS: Forty-two computed tomography (CT) scans, each with a marked frontal cell, were reviewed by 15 international fellowship-trained rhinologists. Each marked cell was classified into 1 of 7 categories described in the IFAC, on 2 occasions separated by 2 weeks. Inter- and intrarater reliability were evaluated using Light's kappa (κ), the interclass correlation coefficient (ICC), and simple proportion of agreement. RESULTS: Interrater reliability showed pairwise κ values ranging from 0.7248 to 1.0, with a mean of 0.9162 (SD, 0.0537). The ICC was 0.98. Intrarater reliability showed κ values ranging from 0.8613 to 1.0, with a mean of 0.9407 (SD, 0.0376). The within-rater ICC was 0.98. CONCLUSION: Among a diverse sample of rhinologists (raters), there was substantial to almost perfect agreement between raters, and among individual raters at different timepoints. The IFAC is a reliable tool for classification of cells in the frontal sinus. Further outcome studies are still needed to determine the validity of the IFAC. Published 2018. This article is a U.S. government work and is in the public domain in the USA.
Authors: Noor Elyana Ahmad Fawzi; Norhafiza Mat Lazim; Mohd Ezane Aziz; Zahiruddin Wan Mohammad; Baharudin Abdullah Journal: Eur Arch Otorhinolaryngol Date: 2021-04-29 Impact factor: 2.503
Authors: Philip G Chen; Joshua M Levy; Garret Choby; Kristine Smith; William C Yao; Ashleigh Halderman; Gretchen M Oakley; Joseph Brunworth; Jeremiah A Alt Journal: Int Forum Allergy Rhinol Date: 2020-12-04 Impact factor: 3.858