Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
J Nucl Med. 2020 Mar;61(3):344-349. doi: 10.2967/jnumed.119.232686. Epub 2019 Sep 3.
Our aim was to evaluate the interobserver agreement in F-sodium fluoride (NaF) PET/CT for the detection of bone metastases in patients with prostate cancer (PCa). F-NaF PET/CT scans were retrieved from all patients who participated in 4 recent prospective trials. Two experienced observers independently evaluated the F-NaF PET/CT scans on a patient level using a 3-category scale (no bone metastases [M0], equivocal for bone metastases, and bone metastases present [M1]) and on a dichotomous scale (M0/M1). In patients with no more than 10 lesions, the location and number of lesions were recorded. On a patient level, the diagnostic performance was calculated using a sensitivity analysis, in which equivocal lesions were handled as M0 as well as M1. F-NaF PET/CT scans from 219 patients with PCa were included, of whom 129 patients were scanned for primary staging, 67 for biochemical recurrence, and 23 for metastatic castration-resistant PCa. Agreement between the observers was almost perfect on a patient level (3-category unweighted κ = 0.83 ± 0.05, linear weighted κ = 0.90 ± 0.06, and dichotomous κ = 0.91 ± 0.07). On a lesion level (dichotomous scale), the observers agreed on the number and location of bone metastases in 205 (93.6%) patients. In the remaining 14 patients, the readers disagreed on the number of lesions in 13 patients and the location of bone metastases in 1 patient. A final diagnosis of bone metastases was made for 211 of 219 patients. The sensitivity ranged from 0.86 to 0.92, specificity from 0.83 to 0.97, positive predictive value from 0.70 to 0.93, and negative predictive value from 0.94 to 0.96. The interobserver agreement on F-NaF PET/CT for the detection of bone metastases in patients with PCa was very high among trained observers, both on a patient level and on a lesion level. Moreover, the diagnostic performance of F-NaF PET/CT was satisfactory, rendering F-NaF PET/CT a robust tool in the diagnostic armamentarium.
我们的目的是评估氟-18 氟化钠（F-NaF）正电子发射断层扫描/计算机断层扫描（PET/CT）在前列腺癌（PCa）患者骨转移检测中的观察者间一致性。从参与最近 4 项前瞻性试验的所有患者中检索 F-NaF PET/CT 扫描。两名经验丰富的观察者分别在患者水平（无骨转移[M0]、可疑骨转移和存在骨转移[M1]）和二分类水平（M0/M1）上使用 3 级量表独立评估 F-NaF PET/CT 扫描。对于病变数不超过 10 个的患者，记录病变的位置和数量。在患者水平上，通过敏感性分析计算诊断性能，其中可疑病变也视为 M0 和 M1。共纳入 219 例 PCa 患者的 F-NaF PET/CT 扫描，其中 129 例患者行原发分期扫描，67 例患者行生化复发扫描，23 例患者行转移性去势抵抗性 PCa 扫描。观察者间的一致性在患者水平上几乎为完美（3 级非加权 κ=0.83±0.05，线性加权 κ=0.90±0.06，二分类 κ=0.91±0.07）。在病变水平（二分类），观察者在 205（93.6%）例患者中对骨转移的数量和位置达成一致。在其余 14 例患者中，13 例患者的观察者对病变数量存在分歧，1 例患者对骨转移位置存在分歧。219 例患者中最终诊断为骨转移 211 例。敏感性范围为 0.86 至 0.92，特异性范围为 0.83 至 0.97，阳性预测值范围为 0.70 至 0.93，阴性预测值范围为 0.94 至 0.96。在有经验的观察者中，F-NaF PET/CT 对 PCa 患者骨转移的检测具有非常高的观察者间一致性，无论是在患者水平还是在病变水平上。此外，F-NaF PET/CT 的诊断性能令人满意，使其成为诊断工具中的有力工具。
