Interrater Reliability of NI-RADS on Posttreatment PET/Contrast-enhanced CT Scans in Head and Neck Squamous Cell Carcinoma

Hsu, Derek; Rath, Tanya J.; Branstetter, Barton F.; Anzai, Yoshimi; Phillips, C. Douglas; Juliano, Amy F.; Mosier, Kristine M.; Bazylewicz, Michael; Poliashenko, Stan M; Kulzer, Matthew; Rhyner, Patricia A.; Risk, Benjamin B.; Wiggins, Richard H.; Aiken, Ashley H.

doi:10.1148/rycan.2021200131

Cited by 12 publications

(6 citation statements)

References 23 publications

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“…Considering the success of this prior intervention in the standardization of surveillance neck CT imaging, we now aim to perform a similar quality-improvement implementation study on the use of a systematic PET/CT reporting system for posttreatment imaging of patients treated for HNSCC. Similar diagnostic accuracy of 4 interpretation criteria (NI-RADS, Porceddu, Hopkins Criteria, and Deauville) have been observed . Given this similarity in accuracy across multiple standardized interpretation criteria, and our findings that are associated with a high propensity for discordance/miscommunication using freeform reporting, we contend that from prognostic and interdisciplinary communication standpoints, the decision to use a standardized interpretation and reporting system rather than freeform reporting is more important than the specific system selected.…”

Section: Discussionsupporting

confidence: 68%

Discordance Between Oncology Clinician–Perceived and Radiologist-Intended Meaning of the Postradiotherapy Positron Emission Tomography/Computed Tomography Freeform Report for Head and Neck Cancer

Patel

Schroeder

Bunch

et al. 2022

JAMA Otolaryngol Head Neck Surg

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ImportanceAssessment of response after radiotherapy (RT) using 18F–fluorodeoxyglucose positron emission tomography (PET) with computed tomography (CT) is routine in managing head and neck squamous cell carcinoma (HNSCC). Freeform reporting may contribute to a clinician’s misunderstanding of the nuclear medicine (NM) physician’s image interpretation, with important clinical implications.ObjectiveTo assess clinician-perceived freeform report meaning and discordance with NM interpretation using the modified Deauville score (MDS).Design, Setting, and ParticipantsIn this retrospective cohort study that was conducted at an academic referral center and National Cancer Institute–designated Comprehensive Cancer Center and included patients with HNSCC treated with RT between January 2014 and December 2019 with a posttreatment PET/CT and 1 year or longer of follow-up, 4 masked clinicians independently reviewed freeform PET/CT reports and assigned perceived MDS responses. Interrater reliability was determined. Clinician consensus–perceived MDS was then compared with the criterion standard NM MDS response derived from image review. Data analysis was conducted between December 2021 and February 2022.ExposuresPatients were treated with RT in either the definitive or adjuvant setting, with or without concurrent chemotherapy. They then underwent posttreatment PET/CT response assessment.Main Outcomes and MeasuresClinician-perceived (based on the freeform PET/CT report) and NM-defined response categories were assigned according to MDS. Clinical outcomes included locoregional control, progression-free survival, and overall survival.ResultsA total of 171 patients were included (45 women [26.3%]; median [IQR] age, 61 [54-65] years), with 149 (87%) with stage III to IV disease. Of these patients, 52 (30%) received postoperative RT and 153 (89%) received concurrent chemotherapy. Interrater reliability was moderate (κ = 0.68) among oncology clinicians and minimal (κ = 0.36) between clinician consensus and NM. Exact agreement between clinician consensus and the NM was 64%. The NM-rated MDS was significantly associated with locoregional control, progression-free survival, and overall survival.Conclusions and RelevanceThe results of this cohort study suggest that considerable variation in perceived meaning exists among oncology clinicians reading freeform HNSCC post-RT PET/CT reports, with only minimal agreement between MDS derived from clinician perception and NM image interpretation. The NM use of a standardized reporting system, such as MDS, may improve clinician-NM communication and increase the value of HNSCC post-RT PET/CT reports.

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Section: Discussionsupporting

confidence: 68%

Discordance Between Oncology Clinician–Perceived and Radiologist-Intended Meaning of the Postradiotherapy Positron Emission Tomography/Computed Tomography Freeform Report for Head and Neck Cancer

Patel

Schroeder

Bunch

et al. 2022

JAMA Otolaryngol Head Neck Surg

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“…There are limitations to this quality improvement study. We did not attempt to validate NI‐RADS but note that the validation efforts of others have been previously reported in the literature 14,16,17,21–23 . Although NI‐RADS can also be used to report head and neck cancer surveillance MRI and PET/CT examinations, we focused solely on neck CT for the purposes of initial adoption to narrow the focus on the specific examination performed most commonly at our institution.…”

Section: Discussionmentioning

confidence: 99%

“…We did not attempt to validate NI-RADS but note that the validation efforts of others have been previously reported in the literature. 14,16,17,[21][22][23] Although NI-RADS can also be used to report head and neck cancer surveillance MRI and PET/CT examinations, we focused solely on neck CT for the purposes of initial adoption to narrow the focus on the specific examination performed most commonly at our institution. This report includes survey responses from a diverse group of multidisciplinary head and neck tumor board members as well as attending and fellow neuroradiologists with no previous firsthand experience using NI-RADS; however, our single institution experience necessarily represents the perspectives of a relatively small number of physicians and is therefore is not necessarily generalizable to other institutions or other practice settings (e.g., community practice).…”

Section: Discussionmentioning

confidence: 99%

Initial Referring Physician and Radiologist Experience with Neck Imaging Reporting and Data System

et al. 2021

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Objectives/Hypothesis: Neck Imaging Reporting and Data System (NI-RADS) is a radiology reporting system developed for head and neck cancer surveillance imaging, using standardized terminology, numeric levels of suspicion, and linked management recommendations. Through a multidisciplinary, interdepartmental quality improvement initiative, we implemented NI-RADS for the reporting of head and neck cancer surveillance CT. Our objective is to summarize our initial experience from the standpoints of head and neck cancer providers and radiologists.Study Design: Quality improvement study. Methods: Before and 3 months post-implementation, surveys were offered to referring physicians (n = 21 pre-adoption; 22 post-adoption) and radiologists (n = 17 pre-and post-adoption). NI-RADS utilization was assessed over time.Results: Survey response rates were 62% (13/21) and 73% (16/22) for referring physicians pre-and post-adoption, respectively, and 94% (16/17) for radiologists pre-and post-adoption. Among post-adoption provider respondents, 100% (16/16) strongly agreed or agreed with "I want our radiologists to continue using NI-RADS," "The NI-RADS numerical rating of radiologic suspicion is helpful," and "The language and style of NI-RADS neck CT reports are clear and understandable." Among radiologist respondents, 88% (14/16) strongly agreed or agreed with "NI-RADS improves consistency among our radiologists in the reporting of surveillance neck CTs." Radiologist NI-RADS utilization increased over time (46% month 1; 72% month 3).Conclusions: Most referring physicians and radiologists preferred NI-RADS. Head and neck cancer providers indicated that NI-RADS reports are clear, understandable, direct, and helpful in guiding clinical management. Radiologists indicated that NI-RADS improves radiologist consistency in the reporting of surveillance neck CT, and radiologists increasingly used NI-RADS over time.

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“…NI-RADS categories for PET-CT include information for both FDG uptake and findings on contrast-enhanced CT, further supporting the value of a high-quality thin section contrast-enhanced CT, either separately or concurrently with the PET scan. NI-RADS has been shown to result in moderate inter-observer variability between both experienced and novice readers and a high negative predictive value (91% for category 1 and 85% for category 2) [ 8 , 9 ]. One limitation of NI-RADS is that it does not address a category of mild-moderate FDG uptake in a residual mass or lymph node than has decreased in size but is still enlarged.…”

Section: Head and Neck Cancermentioning

confidence: 99%

PET-CT in Clinical Adult Oncology—V. Head and Neck and Neuro Oncology

Wiggins

Hoffman

Fine

et al. 2022

Cancers

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PET-CT is an advanced imaging modality with many oncologic applications, including staging, assessment of response to therapy, restaging, and longitudinal surveillance for recurrence. The goal of this series of six review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for specific oncologic indications, and the potential pitfalls and nuances that characterize these applications. In addition, key tumor-specific clinical information and representative PET-CT images are provided to outline the role that PET-CT plays in the management of oncology patients. Hundreds of different types of tumors exist, both pediatric and adult. A discussion of the role of FDG PET for all of these is beyond the scope of this review. Rather, this series of articles focuses on the most common adult malignancies that may be encountered in clinical practice. It also focuses on FDA-approved and clinically available radiopharmaceuticals, rather than research tracers or those requiring a local cyclotron. The fifth review article in this series focuses on PET-CT imaging in head and neck tumors, as well as brain tumors. Common normal variants, key anatomic features, and benign mimics of these tumors are reviewed. The goal of this review article is to provide the imaging professional with guidance in the interpretation of PET-CT for the more common head and neck malignancies and neuro oncology, and to inform the referring providers so that they can have realistic expectations of the value and limitations of PET-CT for the specific type of tumor being addressed.

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Interrater Reliability of NI-RADS on Posttreatment PET/Contrast-enhanced CT Scans in Head and Neck Squamous Cell Carcinoma

Cited by 12 publications

References 23 publications

Discordance Between Oncology Clinician–Perceived and Radiologist-Intended Meaning of the Postradiotherapy Positron Emission Tomography/Computed Tomography Freeform Report for Head and Neck Cancer

Discordance Between Oncology Clinician–Perceived and Radiologist-Intended Meaning of the Postradiotherapy Positron Emission Tomography/Computed Tomography Freeform Report for Head and Neck Cancer

Initial Referring Physician and Radiologist Experience with Neck Imaging Reporting and Data System

PET-CT in Clinical Adult Oncology—V. Head and Neck and Neuro Oncology

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