Wilimas J A, Kaste S C, Kauffman W M, Winer-Muram H, Morris R, Luo X, Boyett J M
Department of Hematology-Oncology, St Jude Childrens Research Hospital, Memphis, TN 38105-2794, USA.
J Clin Oncol. 1997 Jul;15(7):2631-5. doi: 10.1200/JCO.1997.15.7.2631.
To determine the specificity and prognostic significance of computed tomography (CT) of the chest in pediatric Wilms' tumor.
Patients treated for newly diagnosed Wilms' tumor at St Jude Children's Research Hospital between December 1978 and July 1995 were included in the study if an initial chest radiograph and CT were available and if pulmonary involvement (determined by chest radiographs) was absent. For the 202 patients studied, radiographs and CT scans were reviewed blindly and independently by three experienced radiologists for the presence of pulmonary nodules. Outcome variables consisted of intraobserver variability (in a subsample of 40 cases) and concordance between ratings on radiographs and CT scans (both by McNemar's test), interrater variability (by logistic regression), and the cumulative incidence of pulmonary relapse for patients with and without positive CT scans, by reviewer.
As expected, ratings of pulmonary involvement on radiographs were discordant with CT ratings. There was marked variability among reviewers in CT ratings (P = .0001). Of 202 CT scans, 78 were read as positive by at least one reviewer, 41 were rated positive by only one reviewer, 18 by two reviewers, and 19 by all three. Intrarater variability on repeat reviews was not significant. Patients with nodules identified on CT had a significantly higher pulmonary relapse rate when analyzed separately by reviewer. However, for the 14 patients who had pulmonary relapse, CT scans were rated positive by all three reviewers in only five cases and as negative by all three in another five cases.
The variability in interpretation of chest CT scans in patients with Wilms' tumor limits the predictive utility of these studies. Optimal, standardized techniques and central review are essential if chest CT is to be used for staging in cooperative studies.
确定胸部计算机断层扫描（CT）在儿童肾母细胞瘤中的特异性及预后意义。
1978年12月至1995年7月在圣裘德儿童研究医院接受新诊断肾母细胞瘤治疗的患者，若有初始胸部X线片和CT且无肺部受累（由胸部X线片确定），则纳入本研究。对于所研究的202例患者，由三位经验丰富的放射科医生对X线片和CT扫描进行盲法独立复查，以确定是否存在肺结节。结果变量包括观察者内变异性（在40例的子样本中）以及X线片和CT扫描评级之间的一致性（均通过McNemar检验）、观察者间变异性（通过逻辑回归），以及根据复查者的结果，CT扫描阳性和阴性患者的肺复发累积发生率。
正如预期的那样，X线片上肺部受累的评级与CT评级不一致。复查者之间CT评级存在显著差异（P = 0.0001）。在202例CT扫描中，至少有一位复查者将78例判为阳性，仅一位复查者将41例评为阳性，两位复查者将18例评为阳性，三位复查者均将19例评为阳性。重复复查时观察者内变异性不显著。按复查者分别分析时，CT上发现有结节的患者肺复发率显著更高。然而，对于14例发生肺复发的患者，三位复查者均将CT扫描判为阳性的仅5例，均判为阴性的另5例。
肾母细胞瘤患者胸部CT扫描解读的变异性限制了这些检查的预测效用。如果要在合作研究中使用胸部CT进行分期，最佳的标准化技术和集中复查至关重要。
