Kalman Noah S, Hugo Geoffrey D, Kahn Jenna M, Zhao Sherry S, Jan Nuzhat, Mahon Rebecca N, Weiss Elisabeth
Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia.
Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri.
Adv Radiat Oncol. 2018 May 25;3(4):655-661. doi: 10.1016/j.adro.2018.05.004. eCollection 2018 Oct-Dec.
Radiographic lung changes after stereotactic body radiation therapy (SBRT) vary widely between patients. Standardized descriptions of acute (≤6 months after treatment) and late (>6 months after treatment) benign lung changes have been proposed but the reliable application of these classification systems has not been demonstrated. Herein, we examine the interobserver reliability of classifying acute and late lung changes after SBRT.
A total of 280 follow-up computed tomography scans at 3, 6, and 12 months post-treatment were analyzed in 100 patients undergoing thoracic SBRT. Standardized descriptions of acute lung changes (3- and 6-month scans) include diffuse consolidation, patchy consolidation and ground glass opacity (GGO), diffuse GGO, patchy GGO, and no change. Late lung change classifications (12-month scans) include modified conventional pattern, mass-like pattern, scar-like pattern, and no change. Five physicians scored the images independently in a blinded fashion. Fleiss' kappa scores quantified the interobserver agreement.
The Kappa scores were 0.30 at 3 months, 0.20 at 6 months, and 0.25 at 12 months. The proportion of patients in each category at 3 and 6 months was as follows: Diffuse consolidation 11% and 21%; patchy consolidation and GGO 15% and 28%; diffuse GGO 10% and 11%; patchy GGO 15% and 15%; and no change 49% and 25%, respectively. The percentage of patients in each category at 12 months was as follows: Modified conventional 46%; mass-like 16%; scar-like 26%; and no change 12%. Uniform scoring between the observers occurred in 26, 8, and 14 cases at 3, 6, and 12 months, respectively.
Interobserver reliability scores indicate a fair agreement to classify radiographic lung changes after SBRT. Qualitative descriptions are insufficient to categorize these findings because most patient scans do not fit clearly into a single classification. Categorization at 6 months may be the most difficult because late and acute lung changes can arise at that time.
立体定向体部放疗（SBRT）后患者的肺部影像学改变差异很大。已有人提出对急性（治疗后≤6个月）和晚期（治疗后>6个月）良性肺部改变进行标准化描述，但这些分类系统的可靠应用尚未得到证实。在此，我们研究SBRT后急性和晚期肺部改变分类的观察者间可靠性。
对100例接受胸部SBRT的患者在治疗后3、6和12个月的280次随访计算机断层扫描进行分析。急性肺部改变（3个月和6个月扫描）的标准化描述包括弥漫性实变、斑片状实变和磨玻璃影（GGO）、弥漫性GGO、斑片状GGO以及无变化。晚期肺部改变分类（12个月扫描）包括改良传统型、肿块样型、瘢痕样型和无变化。五名医生以盲法独立对图像进行评分。Fleiss卡方评分量化观察者间的一致性。
3个月时卡方评分为0.30，6个月时为0.20，12个月时为0.25。3个月和6个月时各分类患者的比例如下：弥漫性实变分别为11%和21%；斑片状实变和GGO分别为15%和28%；弥漫性GGO分别为10%和11%；斑片状GGO分别为15%和15%；无变化分别为49%和25%。12个月时各分类患者的百分比分别为：改良传统型46%；肿块样型16%；瘢痕样型26%；无变化12%。观察者间评分一致的情况在3、6和12个月时分别为26、8和14例。
观察者间可靠性评分表明对SBRT后肺部影像学改变进行分类有一定程度的一致性。定性描述不足以对这些发现进行分类，因为大多数患者的扫描结果不能明确归入单一分类。6个月时的分类可能最困难，因为此时可能出现晚期和急性肺部改变。
