Inter-reader agreement of RECIST and mRECIST criteria for assessing response to transarterial chemoembolization in hepatocellular carcinoma.

OBJECTIVES

To evaluate the reproducibilities of Response Evaluation Criteria in Solid Tumors (RECIST) and modified RECIST (mRECIST) for hepatocellular carcinoma (HCC) patients treated with transarterial chemoembolization (TACE) using contrast-enhanced computed tomography (CT).

METHODS

This retrospective study included 105 consecutive patients with confirmed HCC recruited from November 2002 to June 2012. The study protocol has been pre-registered at ( https://osf.io/nxg4q/ ) on the Open Science Framework (OSF) platform. Patients with pre-procedural and follow-up CT scans who had solely received TACE were included. The tumor response evaluation to TACE was conducted using RECIST 1.1 and mRECIST guidelines. Three experienced board-certified abdominal radiologists interpreted CT scans.

RESULTS

For pre-procedure CT, the agreement was more excellent when using RECIST guidelines with a "marginally significant" p-value of 0.056. This trend continued for post-procedural CT scans, with RECIST again showing significantly higher agreement with a p-value of 0.001. When evaluating the four categories of response, Gwet's coefficient was 0.90 (CI = 0.83 to 0.97) for RECIST and 0.80 (CI = 0.63 to 0.90) for mRECIST. Conversely, the Fleiss Kappa analysis demonstrated a higher agreement for the mRECIST guideline. There was an insignificant difference in RECIST and mRECIST guidelines inter-reader agreement when categorizing the tumor response with a p-value of 0.101.

CONCLUSION

Both guidelines' inter-reader reproducibility in assessing tumor response through CT after the TACE procedure was excellent, with RECIST's reproducibility being very slightly better.