{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:21:27Z","timestamp":1789690887758,"version":"4.0.1"},"reference-count":17,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,3,8]]},"abstract":"<jats:p>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 (\u03ba = 0.600, <jats:italic>P<\/jats:italic> &lt; 0.0001) and substantial for test images (\u03ba = 0.644, <jats:italic>P<\/jats:italic> &lt; 0.0001), with substantial to almost perfect interobserver reliability for stages with pathognomonic signs (CE1, CE2, and CE3) for WHO (0.618 &lt; \u03ba &lt; 0.904) and test images (0.642 &lt; \u03ba &lt; 0.768). Comparisons of expert performances against the majority classification for each image were significant for WHO (0.413 &lt; \u03ba &lt; 1.000, <jats:italic>P<\/jats:italic> &lt; 0.005) and test images (0.718 &lt; \u03ba &lt; 0.905, <jats:italic>P<\/jats:italic> &lt; 0.0001); and intraobserver reliability was significant for WHO (0.520 &lt; \u03ba &lt; 1.000, <jats:italic>P<\/jats:italic> &lt; 0.005) and test images (0.690 &lt; \u03ba &lt; 0.896, <jats:italic>P<\/jats:italic> &lt; 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.<\/jats:p>","DOI":"10.4269\/ajtmh.16-0659","type":"journal-article","created":{"date-parts":[[2017,1,10]],"date-time":"2017-01-10T02:20:35Z","timestamp":1484014835000},"page":"686-691","source":"Crossref","is-referenced-by-count":28,"title":["Expert Reliability for the World Health Organization Standardized Ultrasound Classification of Cystic Echinococcosis"],"prefix":"10.4269","volume":"96","author":[{"given":"Nadia","family":"Solomon","sequence":"first","affiliation":[{"name":"Windward Islands Research and Education Foundation (WINDREF), St. George's, Grenada."},{"name":"School of Medicine, St. George's University, St. George's, Grenada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J.","family":"Fields","sequence":"additional","affiliation":[{"name":"Windward Islands Research and Education Foundation (WINDREF), St. George's, Grenada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Tamarozzi","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Brunetti","sequence":"additional","affiliation":[{"name":"WHO Collaborating Centre for Clinical Management of Cystic Echinococcosis, University of Pavia, Pavia, Italy."},{"name":"Department of Infectious Diseases, San Matteo Hospital Foundation, Pavia, Italy."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calum N. L.","family":"Macpherson","sequence":"additional","affiliation":[{"name":"Windward Islands Research and Education Foundation (WINDREF), St. George's, Grenada."},{"name":"School of Medicine, St. George's University, St. George's, Grenada."},{"name":"School of Veterinary Medicine, St. George's University, St. George's, Grenada."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"ref1","series-title":"WHO\/OIE Manual on Echinococcosis in Humans and Animals: A Public Health Problem of Global Concern","first-page":"1","article-title":"Aetiology: parasites and life-cycles","author":"Thompson","year":"2001"},{"key":"ref2","series-title":"PLoS Negl Trop Dis","first-page":"e1146","article-title":"Cystic echinococcosis: chronic, complex, and still neglected","volume":"5","author":"Brunetti","year":"2011"},{"key":"ref3","series-title":"Langenbecks Arch Surg","first-page":"413","article-title":"Echinococcus granulosus infection: clinical presentation, medical treatment and outcome","volume":"388","author":"Kern","year":"2003"},{"key":"ref4","series-title":"Lancet","first-page":"861","article-title":"Cyst growth and spontaneous cure in hydatid disease","volume":"1","author":"Romig","year":"1986"},{"key":"ref5","series-title":"Eur Respir J","first-page":"503","article-title":"A placebo controlled study of albendazole in the treatment of pulmonary echinococcosis","volume":"14","author":"Keshmiri","year":"1999"},{"key":"ref6","series-title":"Trends Parasitol","first-page":"431","article-title":"Hydatid cysts: does every picture tell a story?","volume":"22","author":"Rogan","year":"2006"},{"key":"ref7","series-title":"Acta Trop","first-page":"1","article-title":"Programme for ultrasound diagnoses and treatment with albendazole of cystic echinococcosis in asymptomatic carriers: 10 years of follow-up of cases","volume":"117","author":"Larrieu","year":"2011"},{"key":"ref8","series-title":"J Hepatol","first-page":"228","article-title":"Long-term outcome of asymptomatic liver hydatidosis","volume":"30","author":"Frider","year":"1999"},{"key":"ref9","series-title":"Lancet","first-page":"1269","article-title":"Randomised controlled trial of efficacy of albendazole in intra-abdominal hydatid disease","volume":"342","author":"Gil-Grande","year":"1993"},{"key":"ref10","series-title":"NMR Biomed","first-page":"734","article-title":"Metabolic viability assessment of cystic echinococcosis using high-field 1H MRS of cyst contents","volume":"21","author":"Hosch","year":"2008"},{"key":"ref11","series-title":"Acta Trop","first-page":"253","article-title":"International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings","volume":"85","author":"WHO Informal Working Group","year":"2003"},{"issue":"(Suppl)","key":"ref12","series-title":"Parasitology","first-page":"S21","article-title":"Application of ultrasound in diagnosis, treatment, epidemiology, public health and control of Echinococcus granulosus and E. multilocularis","volume":"127","author":"Macpherson","year":"2003"},{"key":"ref13","series-title":"Acta Trop","first-page":"203","article-title":"Performance characteristics and quality control of community based ultrasound surveys for cystic and alveolar echinococcosis","volume":"85","author":"Macpherson","year":"2003"},{"key":"ref14","series-title":"Lancet","first-page":"259","article-title":"Portable ultrasound scanner versus serology in screening for hydatid cysts in a nomadic population","volume":"2","author":"Macpherson","year":"1987"},{"key":"ref15","series-title":"Acta Trop","first-page":"1","article-title":"Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans","volume":"114","author":"Brunetti","year":"2010"},{"key":"ref16","series-title":"Microsoft Excel","author":"Microsoft","year":"2010"},{"key":"ref17","series-title":"Biometrics","first-page":"159","article-title":"The measurement of observer agreement for categorical data","volume":"33","author":"Landis","year":"1977"}],"container-title":["The American Society of Tropical Medicine and 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