Guldbrandsen Kasper Foged, Lonsdale Markus Nowak, Nellemann Hanne Marie, Bylov Catharina Mølgaard, Fledelius Joan, Hjorthaug Karin, Jørgensen Barbara Jolanta, Krakauer Martin, Schødt Mette, Gørtz Peter Michael, Nielsen Mie Kiszka, Nielsen Anne Lerberg, Amtoft Annemarie Gjelstrup, Albrecht-Beste Elisabeth, Dejanovic Danijela, Lausten-Thomsen Marie Josée Zareh, Holdgaard Paw Christian, Kubik Magdalene, Nielsen Søren Steen, Gerke Oke, Rasmussen Torben Riis, Fischer Barbara Malene
Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark.
Eur J Nucl Med Mol Imaging. 2025 Jun 21. doi: 10.1007/s00259-025-07420-x.
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography ([F]FDG PET/CT) has shown promise for post-treatment surveillance in patients with non-small cell lung cancer (NSCLC). This study evaluated interobserver agreement of PET/CT interpretation for NSCLC surveillance in a multicenter setting.
Nine teams from seven centers, each team consisting of a nuclear medicine specialist and a radiologist, participated in the study. A total of 150 PET/CT scans were selected, and each was independently reviewed by two randomly assigned teams. Scans were performed six months post-treatment for scheduled recurrence assessment in stage Ia-IIIc NSCLC patients. Each scan was evaluated for suspicion of recurrence using two methods; without any pre-specified criteria (conventional assessment) and using pre-specified, qualitative criteria (Hopkins criteria). Both scoring methods were compared to a reference standard to assess accuracy.
Conventional assessment showed moderate interobserver agreement (κ = 0.55, 95% CI 0.41-0.69; 79% overall agreement) for the diagnosis of recurrence. Hopkins criteria demonstrated substantial agreement (κ = 0.61, 95% CI 0.45-0.77; 87% overall agreement). There was no difference in the area under the curve (AUC) between conventional assessment (0.80, 95% CI 0.72-0.88) and Hopkins criteria (0.82, 95% CI 0.74-0.90) compared to the reference standard (p = 0.21).
Interobserver agreement for [F]FDG PET/CT interpretation in NSCLC surveillance was moderate to substantial. While applying pre-specified reporting criteria did not significantly improve the agreement, it did not hinder the diagnostic accuracy. Efforts to reduce the variability of reporting, including continuous training and structured reporting, could improve the clinical impact of this technology.
氟-18氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（[F]FDG PET/CT）已显示出在非小细胞肺癌（NSCLC）患者治疗后监测中的应用前景。本研究评估了多中心环境下PET/CT解读在NSCLC监测中的观察者间一致性。
来自七个中心的九个团队参与了研究，每个团队由一名核医学专家和一名放射科医生组成。共选择了150例PET/CT扫描，每例由两个随机分配的团队独立进行评估。扫描在Ia-IIIc期NSCLC患者治疗后6个月进行，用于定期复发评估。使用两种方法对每次扫描进行复发可疑性评估；一种是不使用任何预先指定的标准（传统评估），另一种是使用预先指定的定性标准（霍普金斯标准）。将两种评分方法与参考标准进行比较以评估准确性。
传统评估在复发诊断方面显示出中等程度的观察者间一致性（κ = 0.55，95%CI 0.41 - 0.69；总体一致性为79%）。霍普金斯标准显示出高度一致性（κ = 0.61，95%CI 0.45 - 0.77；总体一致性为87%）。与参考标准相比（p = 0.21），传统评估（曲线下面积[AUC]为0.80，95%CI 0.72 - 0.88）和霍普金斯标准（AUC为0.82，95%CI 0.74 - 0.90）之间的AUC没有差异。
在NSCLC监测中，[F]FDG PET/CT解读的观察者间一致性为中等至高度。虽然应用预先指定的报告标准并没有显著提高一致性，但也没有妨碍诊断准确性。减少报告变异性的努力，包括持续培训和结构化报告，可能会提高这项技术对临床治疗的影响。
