Wang Haoru, Chen Mingjing, He Ling, Chen Xin
Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Neurodevelopment and Cognitive Disorders, Chongqing, China.
Department of Radiology, Jining First People's Hospital, Jining, China.
Abdom Radiol (NY). 2025 May;50(5):2194-2200. doi: 10.1007/s00261-024-04647-4. Epub 2024 Oct 29.
Risk stratification for locoregional neuroblastoma partially relies on image-defined risk factors (IDRFs). This study aimed to evaluate how inter-observer variability in assessing IDRFs impacts risk stratification in locoregional abdominopelvic neuroblastoma.
A retrospective analysis was conducted on 123 patients who underwent upfront contrast-enhanced CT scans. Two radiologists independently assessed the presence of IDRFs. Patients were staged as either L1 (IDRF-negative) or L2 (IDRF-positive) according to the International Neuroblastoma Risk Group Staging System. Based on the radiologists' evaluations, 97 cases with sufficient clinical data were classified into risk groups using the revised Children's Oncology Group neuroblastoma risk classifier. The kappa values and 95% confidence intervals (CIs) were calculated to assess inter-radiologist agreement on IDRF evaluation and risk stratification.
There was low agreement between radiologists in assessing L1/L2 status with a kappa value of 0.28 (95% CI: 0.14-0.42). However, agreement for evaluating the number of IDRFs was good, with an intraclass correlation coefficient of 0.73 (95% CI: 0.64-0.80). Based on the first radiologist's evaluation, 13 patients were classified as low-risk, 52 as intermediate-risk, and 32 as high-risk. Based on the second radiologist's evaluation, 37 patients were classified as low-risk, 37 as intermediate-risk, and 23 as high-risk. The kappa value for risk stratification between the two radiologists was 0.47 (95% CI: 0.33-0.62).
Inter-observer variability in assessing IDRF presence may affect risk stratification in locoregional abdominopelvic neuroblastoma.
局部区域神经母细胞瘤的风险分层部分依赖于影像定义的风险因素（IDRFs）。本研究旨在评估评估IDRFs时观察者间的变异性如何影响局部区域腹盆腔神经母细胞瘤的风险分层。
对123例接受 upfront 对比增强CT扫描的患者进行回顾性分析。两名放射科医生独立评估IDRFs的存在情况。根据国际神经母细胞瘤风险组分期系统，患者被分期为L1（IDRF阴性）或L2（IDRF阳性）。根据放射科医生的评估，使用修订后的儿童肿瘤组神经母细胞瘤风险分类器将97例具有充分临床数据的病例分为风险组。计算kappa值和95%置信区间（CIs），以评估放射科医生之间在IDRF评估和风险分层方面的一致性。
放射科医生在评估L1/L2状态时一致性较低，kappa值为0.28（95%CI：0.14 - 0.42）。然而，在评估IDRFs数量方面的一致性良好，组内相关系数为0.73（95%CI：0.64 - 0.80）。根据第一位放射科医生的评估，13例患者被分类为低风险，52例为中风险，32例为高风险。根据第二位放射科医生的评估，37例患者被分类为低风险，37例为中风险，23例为高风险。两位放射科医生之间风险分层的kappa值为0.47（95%CI：0.33 - 0.62）。
评估IDRFs存在时观察者间的变异性可能会影响局部区域腹盆腔神经母细胞瘤的风险分层。
