Zacho Helle D, Ravn Søren, Ejlersen June A, Fledelius Joan, Dolliner Peter, Nygaard Sofie T, Holdgaard Paw C, Lauridsen Jeppe F, Haarmark Christian, Hendel Helle W, Petersen Lars J
Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital.
Department of Clinical Medicine, Aalborg University.
Nucl Med Commun. 2022 Jun 1;43(6):680-686. doi: 10.1097/MNM.0000000000001550. Epub 2022 Apr 1.
To evaluate the diagnostic accuracy of observers with different levels of experience in reading 18F-sodium fluoride (NaF) PET/CT images for the diagnosis of bone metastases in prostate cancer (PCa) patients.
Nine observers with varying NaF PET/CT experience, ranging from no experience to 2000+ examinations, evaluated 211 NaF PET/CT scans from PCa patients participating in one of four prospective trials. Each observer evaluated each NaF PET/CT on a patient level using a trichotomous scale: M0 (no bone metastases), Me (equivocal for bone metastases) and M1 (bone metastases). Subsequently, a dichotomous evaluation was conducted (M0/M1). The final diagnosis was retrieved from the original study. For each observer, ROC curves and the diagnostic accuracy were calculated based on dichotomous and trichotomous scales; in the latter case, Me was first regarded as M1 and then M0.
Across all experience levels, the sensitivity, specificity and accuracy using the dichotomous scale ranged from 0.81 to 0.89, 0.93 to 1.00 and 0.91 to 0.94, respectively. Employing the trichotomous scale, novice and experienced observers chose Me in up to 20 vs. 10% of cases, respectively. Considering Me as M0, the sensitivity, specificity and accuracy ranged from 0.78 to 0.89, 0.95 to 1.00 and 0.91 to 0.95, respectively. Considering Me as M1, the sensitivity, specificity and accuracy ranged from 0.86 to 0.92, 0.71 to 0.96 and 0.77 to 0.94, respectively.
Novice observers used the equivocal option more frequently than observers with NaF PET/CT experience. However, on the dichotomous scale, all observers exhibited high and satisfactory accuracy for the detection of bone metastases, making NaF PET/CT an effective imaging modality even in unexperienced hands.
评估不同经验水平的观察者阅读18F - 氟化钠（NaF）PET/CT图像诊断前列腺癌（PCa）患者骨转移的诊断准确性。
9名具有不同NaF PET/CT经验（从无经验到2000多次检查）的观察者，对参与四项前瞻性试验之一的PCa患者的211次NaF PET/CT扫描进行评估。每位观察者在患者层面使用三分制量表对每次NaF PET/CT进行评估：M0（无骨转移）、Me（骨转移可疑）和M1（骨转移）。随后，进行二分法评估（M0/M1）。最终诊断从原始研究中获取。对于每位观察者，基于二分法和三分制量表计算ROC曲线和诊断准确性；在后一种情况下，Me首先被视为M1，然后被视为M0。
在所有经验水平上，使用二分法量表时，敏感性、特异性和准确性分别为0.81至0.89、0.93至1.00和0.91至0.94。采用三分制量表时，新手和经验丰富的观察者分别在高达20%和10%的病例中选择Me。将Me视为M0时，敏感性、特异性和准确性分别为0.78至0.89, 0.95至1.00和0.91至0.95。将Me视为M1时，敏感性、特异性和准确性分别为0.86至0.92、0.71至0.96和0.77至0.94。
新手观察者比有NaF PET/CT经验的观察者更频繁地使用可疑选项。然而，在二分法量表上，所有观察者在检测骨转移方面都表现出高且令人满意的准确性，这使得即使是没有经验的人操作，NaF PET/CT也是一种有效的成像方式。
