Dajczman E, Hanley J, Lisbona A, Wolkove N, Kreisman H
Department of Pulmonary Medicine, Sir Mortimer B. Davis-Jewish General Hospital, Montreal, Quebec, Canada.
Lung Cancer. 1994 Jul;11(1-2):51-60. doi: 10.1016/0169-5002(94)90282-8.
The percentage of patients achieving a complete response (CR) to therapy is often used as a measure of treatment efficacy in SCLC. Chest radiographs are difficult to evaluate following therapy and differences in reported response rates may be due to interobserver variation. CT scans of the thorax are more costly and are not as easily obtained as routine studies. We wanted to determine whether the measurability rate and interobserver agreement on response was superior when using CT scans, compared to chest radiographs alone. Fourteen radiologists with expertise in CT imaging of the thorax, reviewed 15 cases of SCLC pre- and post-chemotherapy (210 observations). In the first session, reviewers were required to measure or evaluate all possible lesions on the plain chest radiograph done at pre- and post-treatment. In the second session, accompanying CT scans were provided in order to make the same assessments. The number of instances in which neoplastic disease was measurable in two cross-sectional diameters on pretreatment films was 164 (79%) on chest radiographs and 202 (97%) on CT scans. Interobserver agreement was assessed by comparing tumour measurements, as well as reports of complete disappearance of tumour (CR) among the 15 observers. The rate of CR ranged from 0 to 87% with the use of the chest radiograph, and from 0 to 95% using the CT scan. Usually after viewing the CT scan, readers changed their opinion as to whether CR had actually occurred. For example, in one case, 87% of readers judged response to therapy as a CR based on chest radiograph; upon reevaluation with a CT scan this figure decreased to 15%. Agreement as to response was better on review of the CT scans, compared to the chest radiograph in all but two cases. It is therefore recommended that pre- and post-treatment CT scans, and not just chest radiographs, be used for assessment of response to therapy.
在小细胞肺癌（SCLC）中，达到完全缓解（CR）的患者百分比常被用作治疗效果的衡量指标。治疗后胸部X光片难以评估，报告的缓解率差异可能归因于观察者间的差异。胸部CT扫描成本更高，且不像常规检查那样容易获得。我们想确定与单独使用胸部X光片相比，使用CT扫描时，可测量率和观察者间对缓解的一致性是否更好。14名在胸部CT成像方面有专长的放射科医生对15例SCLC化疗前后的病例进行了评估（共210次观察）。在第一阶段，要求评估者测量或评估治疗前和治疗后拍摄的胸部X光平片上所有可能的病变。在第二阶段，提供了相应的CT扫描图像以便进行同样的评估。在治疗前的片子上，肿瘤疾病在两个横截面上可测量的病例数，胸部X光片上为164例（79%），CT扫描上为202例（97%）。通过比较15名观察者之间的肿瘤测量结果以及肿瘤完全消失（CR）的报告来评估观察者间的一致性。使用胸部X光片时CR率在0%至87%之间，使用CT扫描时在0%至95%之间。通常在查看CT扫描后，读者会改变他们对是否真的出现CR的看法。例如，在一个病例中，87%的读者根据胸部X光片判断治疗反应为CR；用CT扫描重新评估后，这一数字降至15%。除两例情况外，在所有病例中，与胸部X光片相比，对CT扫描结果的反应一致性更好。因此，建议使用治疗前和治疗后的CT扫描，而不仅仅是胸部X光片，来评估治疗反应。
