Department of Nuclear Medicine, Yeditepe University Medical Faculty.
Department of Nuclear Medicine, Şişli Hamidiye Etfal Training and Education Hospital.
Nucl Med Commun. 2020 Aug;41(8):759-767. doi: 10.1097/MNM.0000000000001219.
In this study, we aimed to measure interobserver and intraobserver agreement in Ga-68-prostate-specific membrane antigen (PSMA) PET/computed tomography (CT) image interpretation. In addition, the limitations of these criteria and levels of personal confidence reported by the readers when reporting the findings were determined. The effects of interpersonal differences on clinical decisions were also investigated.
PSMA PET images from 133 cases were reported independently by four different readers at different times according to the molecular imaging TNM (miTNM) and PSMA-reporting and data system (RADS) templates.
There was substantial interobserver agreement for overall positivity, miT, miN and miM staging (Fleiss' κ = 0.65, 0.625, 0.731, and 0.779). Substantial agreement levels were observed in reporting of seminal vesicle invasion, the number of lymph node stations with metastasis, total number of intraprostatic areas containing tumors, and lymph node metastasis staging (Fleiss' κ = 0.622 and 0.779). The highest variation was seen in the reporting of intraprostatic distribution: In International Society of Urological Pathology (ISUP) grade group 1, moderate agreement was observed, and it was seen that the agreement level for the T staging increased with an increasing ISUP group in the staging group (Fleiss' κ = 0.531 vs. 0.655). There was near-perfect interobserver agreement in the reporting of five-point PSMA-RADS scoring [intraclass correlation coefficient (ICC) κ = 0.904; 95% CI, 0.865-0.934]. Disagreement according to miTNM staging had a major effect on clinical management in only 9% (n = 12) of the patients.
PSMA PET has a lower interobserver variability and higher reproducibility than other imaging methods used for imaging of prostate cancer do, including CT, MRI, and bone scintigraphy. The miTNM template provides a reporting format that is highly reproducible and has a high level of agreement among readers, but the prostatic template needs development. In contrast, the PSMA-RADS system leads to slightly increased interobserver reporting differences and reduces personal confidence, but at the same time, it still exhibits almost-perfect agreement in terms of scoring.
本研究旨在测量 Ga-68 前列腺特异性膜抗原（PSMA）PET/计算机断层扫描（CT）图像解读的观察者间和观察者内一致性。此外，还确定了读者在报告结果时报告的这些标准的局限性和个人置信水平。还研究了人际差异对临床决策的影响。
根据分子成像 TNM（miTNM）和 PSMA 报告和数据系统（RADS）模板，由四位不同的读者在不同时间独立报告了 133 例 PSMA PET 图像。
整体阳性、miT、miN 和 miM 分期的观察者间一致性很高（Fleiss'κ=0.65、0.625、0.731 和 0.779）。在精囊侵犯、淋巴结转移的淋巴结站数、前列腺内肿瘤累及的总区域数和淋巴结转移分期的报告中观察到高度一致的水平（Fleiss'κ=0.622 和 0.779）。在报告前列腺内分布时，观察到最大的变异：在国际泌尿病理学会（ISUP）分级组 1 中，观察到中度一致性，并且随着分期组中 ISUP 组的增加，T 分期的一致性水平增加（Fleiss'κ=0.531 与 0.655）。五分 PSMA-RADS 评分的观察者间报告具有近乎完美的一致性[组内相关系数（ICC）κ=0.904；95%CI，0.865-0.934]。根据 miTNM 分期的分歧仅对 9%（n=12）的患者的临床管理有重大影响。
与用于前列腺癌成像的其他成像方法（包括 CT、MRI 和骨闪烁扫描）相比，PSMA PET 的观察者间变异性较低，再现性更高。miTNM 模板提供了一种高度可重复的报告格式，并且读者之间具有很高的一致性，但前列腺模板需要进一步开发。相比之下，PSMA-RADS 系统会导致观察者间报告差异略有增加，降低个人信心，但同时在评分方面仍表现出几乎完美的一致性。
