qPET methodology provides semi-automatic quantification for interim FDG-PET response in lymphoma extending ordinal Deauville scoring to a continuous scale. Deauville categories correspond to certain qPET cut values. Thresholds between normal and abnormal response can be derived from the qPET-distribution without need for follow-up data. In our patients, qPET < 1.3 excludes abnormal response with high sensitivity.
PurposeThe five point Deauville (D) scale is widely used to assess interim PET metabolic response to chemotherapy in Hodgkin lymphoma (HL) patients. An International Validation Study reported good concordance among reviewers in ABVD treated advanced stage HL patients for the binary discrimination between score D1,2,3 and score D4,5. Inter-reader reliability of the whole scale is not well characterised.MethodsFive international expert readers scored 100 interim PET/CT scans from paediatric HL patients. Scans were acquired in 51 European hospitals after two courses of OEPA chemotherapy (according to the EuroNet-PHL-C1 study). Images were interpreted in direct comparison with staging PET/CTs.ResultsThe probability that two random readers concord on the five point D score of a random case is only 42% (global kappa = 0.24). Aggregating to a three point scale D1,2 vs. D3 vs. D4,5 improves concordance to 60% (kappa = 0.34). Concordance if one of two readers assigns a given score is 70% for score D1,2 only 36% for score D3 and 64% for D4,5. Concordance for the binary decisions D1,2 vs. D3,4,5 is 67% and 86% for D1,2,3 vs D4,5 (kappa = 0.36 resp. 0.56). If one reader assigns D1,2,3 concordance probability is 92%, but only 64% if D4,5 is called. Discrepancies occur mainly in mediastinum, neck and skeleton.ConclusionInter-reader reliability of the five point D-scale is poor in this interobserver analysis of paediatric patients who underwent OEPA. Inter-reader variability is maximal in cases assigned to D2 or D3. The binary distinction D1,2,3 versus D4,5 is the most reliable criterion for clinical decision making.
Since 2007, children and adolescents with Hodgkin lymphomas are treated in the Europe-wide EuroNet-PHL trials. A real time central review process for stratification of the patients enhances quality control and efficient therapy management. This process includes reading of all cross-sectional-images. Since reference evaluation is time critical, a fast, easy to handle and safe data transfer is important. In addition, immediate and constant access to all the data has to be guaranteed in case of queries and for regulatory reasons. To meet the mentioned requirements the EuroNet Paediatric Hodgkin Data Network (funded by the European Union - Project Number: 2007108) was established between 2008 and 2011. A respective tailored data protection plan was formulated. The aim of this article is to describe the networks' mode of operation and the advantages for multi-centre trials that include centralized image review.
In diffuse large B-cell lymphoma, early assessment of treatment response by 18fluorodeoxyglucose positron emission tomography (PET) may trigger treatment modification. Reliable identification of good and poor responders is important. We compared three competing methods of interim PET evaluation. MethodsImages from 449 patients participating in the 'Positron Emission Tomography-Guided Therapy of Aggressive Non-Hodgkin Lymphomas' trial were re-analyzed by applying the visual Deauville score and the standardized uptake value (SUV)-based qPET and SUVmax scales to interim PET scans performed after two cycles of chemotherapy.qPET relates residual lymphoma 18-fluorodeoxyglucose uptake to physiological liver uptake, converting the ordinal Deauville scale into a continuous scale and permitting a direct comparison with the continuous SUVmax scale, which is based on SUVmax changes between baseline and interim scans. Positive and negative predictive values were calculated for progression-free survival. ResultsUsing established thresholds to distinguish between good and poor responders (visual Deauville score 1-3 vs. 4-5; SUVmax >66% vs. SUVmax ≤66%), the positive predictive value was significantly lower with Deauville thanSUVmax (38.4% versus 56.6%; p=0.03). qPET and SUVmax were strongly correlated on the log scale (Pearson's r=0.75). When plotted along corresponding percentiles, the positive predictive value curves for qPET and SUVmax were superimposable, with low values up to the 85 th percentile and a steep rise thereafter. The recommended threshold of 66% SUVmax reduction for the identification of poor responders was equivalent to qPET=2.26 corresponding to score 5 on the visual Deauville scale. The negative predictive value curves were also superimposable, but remained flat between 80% and 70%. ConclusionsContinuous scales are better suited for interim PET-based outcome prediction than the ordinal Deauville scale. qPET and SUVmax essentially carry the same information. The proportion of poor risk patients identified is less than 15%.
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