期刊
HEMATOLOGICAL ONCOLOGY
卷 35, 期 4, 页码 548-553出版社
WILEY
DOI: 10.1002/hon.2339
关键词
F-18-FDG PET-CT; interobserver agreement; Lugano classification; primary mediastinal B-cell lymphoma; reading criteria
资金
- Swiss National Science Foundation [32003B-146931]
- Swiss Cancer Research [KFS-2852-08-2011]
- Swiss National Science Foundation (SNF) [32003B_146931] Funding Source: Swiss National Science Foundation (SNF)
- Cancer Research UK [16247, 16463] Funding Source: researchfish
The International Extranodal Lymphoma Study Group (IELSG)-37 is a prospective randomized trial assessing the role of consolidation mediastinal radiotherapy after immunochemotherapy to patients with newly diagnosed primary mediastinal large B-cell lymphoma (PMBCL). It is a positron emission tomography (PET) response-guided study where patients obtaining a complete metabolic response on an end-of-therapy PET-computed tomography (CT) scan evaluated by a central review are randomized to receive radiotherapy or no further treatment. The aims of this study were to measure agreement between reviewers reporting PET-CT scans for this trial and to determine the effect of training upon concordance rates. The review panel comprised 6 experienced nuclear physicians who read PET-CT scans using the 5-point Deauville scale. Interobserver agreement (IOA) was measured at 4 time points: after a blinded review of a training set of 20 patients with PMBCL from the previous IELSG-26 study (phase 1); after the first 10 clinical cases enrolled in the IELSG-37 (phase 2); and after 2 further groups of 50 (phase 3) and 40 clinical cases (phase 4). After feedback from the training set and the first 10 cases, a meeting was held to discuss interpretation, and a detailed set of instructions for the review procedure was agreed and acted upon. Between 2012 and 2014, the first 100 patients were reviewed. Using Deauville score 3 as the cutoff for a complete metabolic response, the overall IOA among the reviewers was good (Krippendorff a = 0.72.) The binary concordance between pairs of reviewers (Cohen.) ranged from 0.60 to 0.78. The IOA, initially moderate, improved progressively from phase 1 to 4 (Krippendorff a from 0.53 to 0.81; Cohen. from 0.35-0.72 to 0.77-0.87). Our experience indicates that the agreement among expert nuclear physicians reporting PMBCL, even using standardized criteria, was only moderate when the study began. However, agreement improved using a harmonization process, which included a training exercise with discussion of points leading to disagreement and compiling practical rules to sit alongside commonly adopted interpretation criteria.
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