Agreement between cone-beam computed tomography and nasoendoscopy evaluations of adenoid hypertrophy

• Cone-beam computed tomography images are accurate for evaluating adenoid size compared with nasoendoscopy (ICC, 0.80; 95% CI, ± 0.15).
• Cone-beam computed tomography evaluations are reliable between repeated evaluations from 1 person (intraobserver ICC, 0.85; 95% CI, ± 0.08) and among several observers (interobserver ICC, 0.836; 95% CI, ± 0.084).
• Cone-beam computed tomography can accurately identify clinically relevant adenoid hypertrophy with 88% sensitivity and 93% specificity.
• In the hands of orthodontists trained to look at adenoid size in relation to postnasal space, cone-beam computed tomography approaches the accuracy and reliability of nasoendoscopy.

IntroductionThe goals of this study were to evaluate (1) the reliability and accuracy of cone-beam computed tomography (CBCT) for assessing adenoid size compared with nasoendoscopy and (2) the influence of clinical experience on CBCT diagnosis.MethodsAdenoid size was graded on a 4-point scale for CBCT and nasoendoscopy by a pediatric otolaryngologist. Reliability was assessed with intraobserver and interobserver agreement. Accuracy was assessed with agreement between CBCT and nasoendoscopy, plus sensitivity and specificity analyses. The CBCT assessments were completed by a team of 4 evaluators: an oral and maxillofacial radiologist, an airway orthodontist who participates in the multidisciplinary team, an academic orthodontist whose primary research is in 3-dimensional imaging, and a highly experienced private practice orthodontist comfortable with CBCT imaging. Each evaluator was specifically chosen to represent a unique set of clinical and radiographic experiences. All evaluators were blinded to the subject's identity and clinical history, and they evaluated the images in a unique random order and evaluated each image 3 times separated by a minimum of 7 days. The same computer hardware and software were used.ResultsThirty-nine consecutively assessed, nonsyndromic subjects (ages, 11.5 ± 2.8 years) were evaluated. The CBCT demonstrated excellent sensitivity (88%) and specificity (93%), strong accuracy (ICC, 0.80; 95% CI, ± 0.15), and good reliability, both within observers (ICC, 0.85; 95% CI, ± 0.08) and between observers (ICC, 0.84; 95% CI, ± 0.08). The clinical experience of the CBCT evaluator did not have a statistically significant effect.ConclusionsCBCT is a reliable and accurate tool for identifying adenoid hypertrophy.