68Ga-DOTATATE PET/CT Interobserver Agreement for Neuroendocrine Tumor Assessment: Results of a Prospective Study on 50 Patients.
68Ga-DOTATATE PET/CT Interobserver Agreement for Neuroendocrine Tumor Assessment: Results of a Prospective Study on 50 Patients.
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DOI：
10.2967/jnumed.116.179192
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发表时间：
2017-02
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影响因子：
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通讯作者：
Herrmann K
中科院分区：
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作者：
Fendler WP;Barrio M;Spick C;Allen-Auerbach M;Ambrosini V;Benz M;Bluemel C;Grewal RK;Lapa C;Miederer M;Nicolas G;Schuster T;Czernin J;Herrmann K
我们评估了神经内分泌肿瘤（NET）患者68Ga-DOTATATE PET/CT研究解释的观察者一致性。68Ga-DOTATATE PET/CT对50例小肠（19例）、胰腺（14例）、肺部（4例）或其他部位（13例）的已知或怀疑NET患者进行了68ga - dotate PET/CT检查。使用标准化方法进行图像解释的7名观察员对图像进行了审查。观察者被分为低水平（<500次扫描或<5年的68Ga-DOTATATE PET/CT工作经验，n = 4）和高水平（≥500次扫描和≥5年的68Ga-DOTATATE PET/CT工作经验，n = 3）。由核医学主治医师对所有临床和影像学资料进行无盲解释，作为参考标准。观察者间一致性由Cohen’s κ和类内相关系数（ICC）确定，并具有相应的95%置信区间（CI）。观察者之间的一致是实质性的，假发现（FF）的中位数在整体扫描结果中很低；即阳性与阴性研究（κ = 0.80, 95%CI 0.74-0.86; FF = 3）、器官受累（κ = 0.70, 95%CI 0.64-0.76; FF = 5）和淋巴结受累（κ = 0.71, 95%CI 0.65-0.78; FF = 6）。观察者间的一致几乎是完美的，与参考读者的器官和淋巴结转移数（ICC = 0.84, 95%CI 0.77 - 0.89， Δ = 0.45和ICC = 0.77, 95%CI 0.69-0.84， Δ = 0.45）、肿瘤SUVmax （ICC = 0.99, 95%CI 0.97-0.99， Δ = 0.44）和参考SUV （SUVmean脾脏：ICC = 0.81， Δ = 1.10； SUVmax肝脏ICC = 0.79， Δ = 0.62）的平均绝对差异（Δ）较低。观察者对肽受体放射性核素治疗（PRRT）适宜性的解释差异更大（κ = 0.64, 95%CI 0.57-0.70），经验水平低的观察者与经验水平高的观察者相比，PRRT假阳性推荐的频率更高（范围，7-12对4-8）。68Ga-DOTATATE PET/CT对NET分期的解释在低水平和高水平的读者中是一致的。然而，基于图像的支持或反对PRRT的建议需要经验和培训。
We evaluated the observer agreement for 68Ga-DOTATATE PET/CT study interpretations in patients with neuroendocrine tumors (NET). 68Ga-DOTATATE PET/CT was performed in 50 patients with known or suspected NET of the small bowel (n = 19), pancreas (n = 14), lung (n = 4) or other location (n = 13). Images were reviewed by seven observers who used a standardized approach for image interpretation. Observers were classified as having low (<500 scans or <5 years experience with 68Ga-DOTATATE PET/CT; n = 4) or high level of experience (≥500 scans and ≥5 years experience with 68Ga-DOTATATE PET/CT; n = 3). Interpretation by the primary nuclear medicine physician un-blinded to all clinical and imaging data served as reference standard. Interobserver agreement was determined by Cohen's κ and intraclass correlation coefficient (ICC) with corresponding 95% confidence interval (CI). Interobserver agreement was substantial and the median number of false findings (FF) was low for the overall scan result; i.e. positive versus negative study (κ = 0.80, 95%CI 0.74–0.86; FF = 3), organ involvement (κ = 0.70, 95%CI 0.64–0.76; FF = 5), and lymph node involvement (κ = 0.71, 95%CI 0.65–0.78; FF = 6). The interobserver agreement was substantial to almost-perfect and the average absolute difference (Δ) to the reference reader was low for number of organ and lymph node metastases (ICC = 0.84, 95%CI 0.77–0.89, Δ = 0.45 and ICC = 0.77, 95%CI 0.69–0.84, Δ = 0.45), tumor SUVmax (ICC = 0.99, 95%CI 0.97–0.99; Δ = 0.44) and reference SUV (SUVmean spleen: ICC = 0.81, Δ = 1.10; SUVmax liver ICC = 0.79, Δ = 0.62). Interpretations of the appropriateness for peptide-receptor radionuclide therapy (PRRT) varied more significantly among observers (κ = 0.64, 95%CI 0.57–0.70) and a higher frequency of false positive recommendations for PRRT occurred in observers with low versus high levels of experience (range, 7–12 versus 4–8). The interpretation of 68Ga-DOTATATE PET/CT for NET staging is consistent among readers with low and high levels of experience. However, image based recommendations for or against PRRT require experience and training.