TY - JOUR
T1 - 68Ga-PSMA-11 PET/CT interobserver agreement for prostate cancer assessments
T2 - an international multicenter prospective study
AU - Fendler, Wolfgang Peter
AU - Calais, Jeremie
AU - Allen-Auerbach, Martin
AU - Bluemel, Christina
AU - Eberhardt, Nina
AU - Emmett, Louise
AU - Gupta, Pawan
AU - Hartenbach, Markus
AU - Hope, Thomas A
AU - Okamoto, Shozo
AU - Pfob, Christian Helmut
AU - Pöppel, Thorsten D
AU - Rischpler, Christoph
AU - Schwarzenböck, Sarah
AU - Stebner, Vanessa
AU - Unterrainer, Marcus
AU - Zacho, Helle D
AU - Maurer, Tobias
AU - Gratzke, Christian
AU - Crispin, Alexander
AU - Czernin, Johannes
AU - Herrmann, Ken
AU - Eiber, Matthias
N1 - Copyright © 2017 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
PY - 2017
Y1 - 2017
N2 - Background: The interobserver agreement for (68)Ga-PSMA-11 Positron Emission Tomography/Computed Tomography (PET/CT) study interpretations in patients with prostate cancer is unknown. Methods:(68)Ga-PSMA-11 PET/CT was performed in 50 patients with prostate cancer for biochemical recurrence (n = 25), primary diagnosis (n = 10), biochemical persistence after primary therapy (n = 5) or staging of known metastatic disease (n = 10). Images were reviewed by 16 observers who used a standardized approach for interpretation of local (T), nodal (N), bone (Mb), or visceral (Mc) involvement. Observers were classified as having low (<30 prior (68)Ga-PSMA-11 PET/CT studies; n = 5), intermediate (30 to 300 studies; n = 5), or high level of experience (>300 studies; n = 6). Histopathology (n = 25, 50%), post-external beam radiation therapy prostate-specific antigen (PSA) response (n = 15, 30%), or follow-up PET/CT (n = 10, 20%) served as standard of reference (SOR). Observer groups were compared by overall agreement (% patients matching the SOR) and Fleiss' κ with mean and corresponding 95% confidence interval (CI). Results: Agreement among all observers was substantial for T (κ=0.62, 95%CI 0.59-0.64) and N (κ=0.74, 95%CI 0.71-0.76) staging and almost perfect for Mb (κ=0.88, 95%CI 0.86-0.91) staging. Level of experience positively correlated with agreement for T (κ=0.73/0.66/0.50 for high/intermediate/low experience, respectively), N (κ=0.80/0.76/0.64), and Mc staging (κ=0.61/0.46/0.36). Interobserver agreement for Mb was almost perfect irrespective of prior experience (κ=0.87/0.91/0.88). Observers with low experience, when compared to intermediate and high experience, demonstrated significantly lower median overall agreement (54% versus 66% and 76%, P = 0.041) and specificity for T staging (73% versus 88% and 93%, P = 0.032). Conclusion: The interpretation of (68)Ga-PSMA-11 PET/CT for prostate cancer staging is highly consistent among observers with high levels of experience, especially for nodal and bone assessments. Initial training on at least 30 patient cases is recommended to ensure acceptable performance.
AB - Background: The interobserver agreement for (68)Ga-PSMA-11 Positron Emission Tomography/Computed Tomography (PET/CT) study interpretations in patients with prostate cancer is unknown. Methods:(68)Ga-PSMA-11 PET/CT was performed in 50 patients with prostate cancer for biochemical recurrence (n = 25), primary diagnosis (n = 10), biochemical persistence after primary therapy (n = 5) or staging of known metastatic disease (n = 10). Images were reviewed by 16 observers who used a standardized approach for interpretation of local (T), nodal (N), bone (Mb), or visceral (Mc) involvement. Observers were classified as having low (<30 prior (68)Ga-PSMA-11 PET/CT studies; n = 5), intermediate (30 to 300 studies; n = 5), or high level of experience (>300 studies; n = 6). Histopathology (n = 25, 50%), post-external beam radiation therapy prostate-specific antigen (PSA) response (n = 15, 30%), or follow-up PET/CT (n = 10, 20%) served as standard of reference (SOR). Observer groups were compared by overall agreement (% patients matching the SOR) and Fleiss' κ with mean and corresponding 95% confidence interval (CI). Results: Agreement among all observers was substantial for T (κ=0.62, 95%CI 0.59-0.64) and N (κ=0.74, 95%CI 0.71-0.76) staging and almost perfect for Mb (κ=0.88, 95%CI 0.86-0.91) staging. Level of experience positively correlated with agreement for T (κ=0.73/0.66/0.50 for high/intermediate/low experience, respectively), N (κ=0.80/0.76/0.64), and Mc staging (κ=0.61/0.46/0.36). Interobserver agreement for Mb was almost perfect irrespective of prior experience (κ=0.87/0.91/0.88). Observers with low experience, when compared to intermediate and high experience, demonstrated significantly lower median overall agreement (54% versus 66% and 76%, P = 0.041) and specificity for T staging (73% versus 88% and 93%, P = 0.032). Conclusion: The interpretation of (68)Ga-PSMA-11 PET/CT for prostate cancer staging is highly consistent among observers with high levels of experience, especially for nodal and bone assessments. Initial training on at least 30 patient cases is recommended to ensure acceptable performance.
KW - Journal Article
U2 - 10.2967/jnumed.117.190827
DO - 10.2967/jnumed.117.190827
M3 - Journal article
C2 - 28408531
SN - 0161-5505
VL - 58
SP - 1617
EP - 1623
JO - Journal of Nuclear Medicine
JF - Journal of Nuclear Medicine
IS - 10
ER -