Inter-Reader Reliability of Early FDG-PET/CT Response Assessment Using the Deauville Scale after 2 Cycles of Intensive Chemotherapy (OEPA) in Hodgkin’s Lymphoma

Kluge, Regine; Chavdarova, Lidia; Hoffmann, Martha; Kobe, Carsten; Małkowski, Bogdan; Montravers, F.; Kurch, Lars; Georgi, Thomas; Dietlein, Markus; Wallace, William H.; Karlén, Jonas; Fernández‐Teijeiro, Ana; Cepelova, Michaela; Wilson, L; Bergstraesser, Eva; Sabri, Osama; Mauz‐Körholz, Christine; Körholz, Dieter; Hasenclever, Dirk

doi:10.1371/journal.pone.0149072

Cited by 46 publications

(43 citation statements)

References 22 publications

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“…[19,20] In previous studies of response assessment using D5PS, few reported the interobserver agreement for all 5 points of the scoring method, and only a fair degree of agreement was observed with Cohen κ ranging from 0.13 to 0.387. [21,22] The dichotomization of the D5PS (score 1–3 vs score 4–5) produced higher agreement with Cohen κ ranging from 0.502 to 0.96. [19,21,23] Overall, the results of our study and previous studies show a wide range of interobserver agreement in qualitative PET analysis.…”

Section: Discussionmentioning

confidence: 99%

FDG PET/CT response in diffuse large B-cell lymphoma

Han

O²,

Yoon³

et al. 2016

Medicine

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F-18-fluoro-2-deoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is essential for monitoring response to treatment in patients with diffuse large B-cell lymphoma (DLBCL) and qualitative interpretation is commonly applied in clinical practice. We aimed to evaluate the interobserver agreements of qualitative PET/CT response in patients with DLBCL and the predictive value of PET/CT results for clinical outcome.PET/CT images were obtained for patients with DLBCL 3 times: at baseline, after 3 cycles of first-line chemotherapy (interim), and after completion of chemotherapy. Two nuclear medicine physicians (with 3 and 8 years of experience with PET/CT) retrospectively assessed response to chemotherapy blinded to the clinical outcome using International Harmonization Project (IHP) criteria and Deauville 5-point score. The associations between PET/CT results and progression-free survival (PFS) and overall survival (OS) were assessed using Cox regression analysis.A total of 112 PET/CT images were included from 59 patients with DLBCL (36 male, 23 female; mean age 53 ± 14 years). Using the IHP criteria, interobserver agreement was substantial (Cohen κ = 0.76) with absolute agreement consistency of 89%. Using the Deauville score, interobserver agreement was moderate (Cohen weighted κ = 0.54) and absolute consistency was 62%. The most common cause of disagreements was discordant interpretation of residual tumor uptake. With median follow-up period of 60 months, estimated 5-year PFS and OS were 81% and 92%, respectively. Neither interim nor posttreatment PET/CT results by both readers were significantly associated with PFS. Interim PET/CT result by the more experienced reader using Deauville score was a significant factor for OS (P = 0.019).Moderate-to-substantial interobserver agreement was observed for response assessments according to qualitative PET/CT criteria, and interim PET/CT result could predict OS in patients with DLBCL. Further studies are necessary to further standardize the PET/CT-based response criteria for more consistent interpretation.

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Section: Discussionmentioning

confidence: 99%

FDG PET/CT response in diffuse large B-cell lymphoma

Han

O²,

Yoon³

et al. 2016

Medicine

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“…Furthermore, the Deauville scale was introduced to standardize the response interpretation, resulting in good reliability in some hands (Baratto et al, 2018). However, others show that there is only moderate inter-observer agreement in response classifications despite this approach (Han et al, 2016;Kluge et al, 2016). The problem with poor response agreement between observers is that the full potential of the PET/CT technique is not used.…”

Section: Ai Versus Radiolmentioning

confidence: 99%

Automated quantification of reference levels in liver and mediastinal blood pool for the Deauville therapy response classification using FDG‐PET/CT in Hodgkin and non‐Hodgkin lymphomas

Sadik

Lind

Polymeri

et al. 2018

Clin Physio Funct Imaging

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Background 18F-FDG-PET/CT has become a standard for assessing treatment response in patients with lymphoma. A subjective interpretation of the scan based on the Deauville 5-point scale has been widely adopted. However, inter-observer variability due to the subjectivity of the interpretation is a limitation. Our main goal is to develop an objective and automated method for evaluating response. The first step is to develop and validate an artificial intelligence (AI)-based method, for the automated quantification of reference levels in the liver and mediastinal blood pool in patients with lymphoma. Methods The AI-based method was trained to segment the liver and the mediastinal blood pool in CT images from 80 lymphoma patients, who had undergone 18F-FDG-PET/CT, and apply this to a validation group of six lymphoma patients. CT segmentations were transferred to the PET images to obtain automatic standardized uptake values (SUV). The AI-based analysis was compared to corresponding manual segmentations performed by two radiologists. Results The mean difference for the comparison between the AI-based liver SUV quantifications and those of the two radiologists in the validation group was 0Á02 and 0Á02, respectively, and 0Á02 and 0Á02 for mediastinal blood pool respectively. Conclusions An AI-based method for the automated quantification of reference levels in the liver and mediastinal blood pool shows good agreement with results obtained by experienced radiologists who had manually segmented the CT images. This is a first, promising step towards objective treatment response evaluation in patients with lymphoma based on 18F-FDG-PET/CT.

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“…Однако оценка накопления глюкозы при этом методе является субъективной. Проведенное исследование, в котором 5 независимых экспертов оценивали результаты ПЭТ/КТ по 5-балльной шкале Deauville после 2 блоков ОЕРА (винкристин, этопозид, преднизолон, доксорубицин), показало, что только в 42 % случаев совпали результаты у 2 экспертов [12]. Таким образом, становится понятной необходимость создания референс-центров по пересмотру визуализации больных ЛХ.…”

Section: определение групп рискаunclassified