From the Department of Radiology and Imaging Sciences, Clinical Center (A.S., M.B., F.F., N.M.B., L.R.F., E.C.J., R.M.S.), and National Cancer Institute, Medical Oncology Branch and Affiliates (A.B.A.), National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892.
Radiol Imaging Cancer. 2021 May;3(3):e200090. doi: 10.1148/rycan.2021200090.
Purpose To compare Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 with volumetric measurement in the setting of target lymph nodes that split into two or more nodes or merge into one conglomerate node. Materials and Methods In this retrospective study, target lymph nodes were evaluated on CT scans from 166 patients with different types of cancer; 158 of the scans came from The Cancer Imaging Archive. Each target node was measured using RECIST 1.1 criteria before and after merging or splitting, followed by volumetric segmentation. To compare RECIST 1.1 with volume, a single-dimension hypothetical diameter (HD) was determined from the nodal volume. The nodes were divided into three groups: one-target merged (one target node merged with other nodes); two-target merged (two neighboring target nodes merged); and split node (a conglomerate node cleaved into smaller fragments). Bland-Altman analysis and test were applied to compare RECIST 1.1 with HD. On the basis of the RECIST 1.1 concept, we compared response category changes between RECIST 1.1 and HD. Results The data set consisted of 30 merged nodes (19 one-target merged and 11 two-target merged) and 20 split nodes (mean age for all 50 included patients, 50 years ± 7 [standard deviation]; 38 men). RECIST 1.1, volumetric, and HD measurements indicated an increase in size in all one-target merged nodes. While volume and HD indicated an increase in size for nodes in the two-target merged group, RECIST 1.1 showed a decrease in size in all two-target merged nodes. Although volume and HD demonstrated a decrease in size of all split nodes, RECIST 1.1 indicated an increase in size in 60% (12 of 20) of the nodes. Discrepancy of the response categories between RECIST 1.1 and HD was observed in 5% (one of 19) in one-target merged, 82% (nine of 11) in two-target merged, and 55% (11 of 20) in split nodes. Conclusion RECIST 1.1 does not optimally reflect size changes when lymph nodes merge or split. CT, Lymphatic, Tumor Response © RSNA, 2021.
目的 比较实体瘤反应评估标准 1.1 版（RECIST 1.1）与目标淋巴结分为两个或多个淋巴结或融合为一个大结节时的体积测量。
材料与方法 本回顾性研究对来自 166 例不同类型癌症患者的 CT 扫描中的目标淋巴结进行了评估；其中 158 例扫描来自癌症影像档案。在融合或分裂前后，使用 RECIST 1.1 标准对每个目标淋巴结进行测量，然后进行体积分割。为了比较 RECIST 1.1 与体积，从淋巴结体积中确定了一个单维假设直径（HD）。将淋巴结分为三组：一个目标融合（一个目标淋巴结与其他淋巴结融合）；两个目标融合（两个相邻的目标淋巴结融合）；和分裂节点（一个融合节点分裂成较小的碎片）。应用 Bland-Altman 分析和 检验比较 RECIST 1.1 与 HD。根据 RECIST 1.1 概念，我们比较了 RECIST 1.1 和 HD 之间的反应类别变化。
结果 数据集包括 30 个融合淋巴结（19 个一个目标融合和 11 个两个目标融合）和 20 个分裂淋巴结（所有 50 例纳入患者的平均年龄，50 岁±7[标准差]；38 名男性）。在所有一个目标融合淋巴结中，RECIST 1.1、体积和 HD 测量均显示大小增加。虽然体积和 HD 显示两个目标融合组中的淋巴结大小增加，但 RECIST 1.1 显示所有两个目标融合淋巴结的大小减小。虽然所有分裂淋巴结的体积和 HD 均显示尺寸减小，但 RECIST 1.1 显示尺寸增大的占 60%（20 个中的 12 个）。在一个目标融合中，观察到 RECIST 1.1 和 HD 之间的反应类别差异为 5%（19 个中的 1 个），在两个目标融合中为 82%（11 个中的 9 个），在分裂节点中为 55%（20 个中的 11 个）。
结论 当淋巴结融合或分裂时，RECIST 1.1 不能最佳地反映大小变化。
CT、淋巴、肿瘤反应
©RSNA，2021
