Nodular Leptomeningeal Disease-A Distinct Pattern of Recurrence After Postresection Stereotactic Radiosurgery for Brain Metastases: A Multi-institutional Study of Interobserver Reliability.
Nodular Leptomeningeal Disease-A Distinct Pattern of Recurrence After Postresection Stereotactic Radiosurgery for Brain Metastases: A Multi-institutional Study of Interobserver Reliability.
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DOI：
10.1016/j.ijrobp.2019.10.002
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发表时间：
2020-03-01
影响因子：
7
通讯作者：
Soltys, Scott G.
中科院分区：
文献类型：
--
作者：
Turner, Brandon E.;Prabhu, Roshan S.;Burri, Stuart H.;Brown, Paul D.;Pollom, Erqi L.;Milano, Michael T.;Weiss, Stephanie E.;Iv, Michael;Fischbein, Nancy;Soliman, Hany;Lo, Simon S.;Chao, Samuel T.;Cox, Brett W.;Murphy, James D.;Li, Gordon;Gephart, Melanie Hayden;Nagpal, Seema;Atalar, Banu;Azoulay, Melissa;Thomas, Reena;Tillman, Gayle;Durkee, Ben Y.;Shah, Jennifer L.;Soltys, Scott G.
对于脑转移瘤，手术切除和术后立体定向放射外科手术是一种新兴的护理标准。术后腔内立体定向放射外科与一种特定的、未被充分认识的颅内复发模式相关，本文称为结节性软脑膜疾病（nLMD），其与经典的软脑膜疾病不同。我们假设关于 LMD 的定义尚未达成共识，并且正式的自引导培训模块将提高诊断 LMD 的参与者间可靠性 (IRR) 和有效性。 16 家机构的 22 名医生（其中 15 名具有中枢神经系统专业知识的医生）完成了一项两阶段调查，其中包括 30 名患者的磁共振成像和治疗信息。在“预训练”阶段，医生使用前瞻性研究中常见的 3 种复发模式来标记病例：局部复发 (LR)、远处实质复发 (DR) 和 LMD。经过自我指导的培训模块后，参与的医生完成了“培训后”阶段，并使用以下 4 个标签重新标记了 30 个病例：LR、DR、经典软脑膜疾病和 nLMD。训练后 IRR 增加了 34%（Fleiss’ Kappa K = 0.41 至 K = 0.55，P < .001）。非中枢神经系统专家的 IRR 增加最多（+58%，P < .001）。训练前，LMD 的 IRR 最低 (K = 0.33)。训练后，所有复发亚组的 IRR 均有所增加，其中 LMD 增加最多（+67%）。训练后，≥27% 最初标记为 LR 或 DR 的病例后来被识别为 nLMD。这项研究强调了临床医生对 nLMD 的认识存在很大程度的不一致。我们的研究结果表明，区分 nLMD 的简短自我引导培训模块可以显着提高所有复发模式的 IRR，尤其是 nLMD。为了优化结果报告，脑转移的前瞻性试验应纳入中央影像学审查和研究者培训。
For brain metastases, surgical resection with postoperative stereotactic radiosurgery is an emerging standard of care. Postoperative cavity stereotactic radiosurgery is associated with a specific, underrecognized pattern of intracranial recurrence, herein termed nodular leptomeningeal disease (nLMD), which is distinct from classical leptomeningeal disease. We hypothesized that there is poor consensus regarding the definition of LMD, and that a formal, self-guided training module will improve interrater reliability (IRR) and validity in diagnosing LMD. Twenty-two physicians at 16 institutions, including 15 physicians with central nervous system expertise, completed a 2-phase survey that included magnetic resonance imaging and treatment information for 30 patients. In the “pretraining” phase, physicians labeled cases using 3 patterns of recurrence commonly reported in prospective studies: local recurrence (LR), distant parenchymal recurrence (DR), and LMD. After a self-directed training module, participating physicians completed the “posttraining” phase and relabeled the 30 cases using the 4 following labels: LR, DR, classical leptomeningeal disease, and nLMD. IRR increased 34% after training (Fleiss’ Kappa K = 0.41 to K = 0.55, P < .001). IRR increased most among noncentral nervous system specialists (+58%, P < .001). Before training, IRR was lowest for LMD (K = 0.33). After training, IRR increased across all recurrence subgroups and increased most for LMD (+67%). After training, ≥27% of cases initially labeled LR or DR were later recognized as nLMD. This study highlights the large degree of inconsistency among clinicians in recognizing nLMD. Our findings demonstrate that a brief self-guided training module distinguishing nLMD can significantly improve IRR across all patterns of recurrence, and particularly in nLMD. To optimize outcomes reporting, prospective trials in brain metastases should incorporate central imaging review and investigator training.
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影响因子：
28.4
作者：
Cagney, Daniel N.;Lamba, Nayan;Aizer, Ayal A.
通讯作者：
Aizer, Ayal A.
影响因子：
15.9
作者：
Chamberlain, Marc;Junck, Larry;Jaeckle, Kurt A.
通讯作者：
Jaeckle, Kurt A.
影响因子：
120.7
作者：
Aoyama, Hidefumi;Shirato, Hiroki;Kobashi, Gen
通讯作者：
Kobashi, Gen
影响因子：
45.3
作者：
ARMSTRONG, JG;WRONSKI, M;BURT, M
通讯作者：
BURT, M
DOI：
10.1016/j.ijrobp.2013.09.051
发表时间：
2014-01-01
影响因子：
7
作者：
Brennan, Cameron;Yang, T. Jonathan;Beal, Kathryn
通讯作者：
Beal, Kathryn