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Computed Tomography Observer Agreement in Staging Malignant Lymphoma.

Antoinette de Jong1, Thomas C Kwee, Henriëtte M E Quarles van Ufford

  • 1From the *Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht; †Department of Radiology, Medical Center Haaglanden, The Hague; Departments of ‡Radiology and §Nuclear Medicine, Meander Medical Center, Amersfoort; ∥Department of Haematology, VU University Medical Center, Amsterdam; ¶Department of Hematology, Meander Medical Center, Amersfoort; and #Department of Internal Medicine, Bernhove Hospital, Uden; and Departments of **Hematology and ††Radiology, Academic Medical Center, Amsterdam, The Netherlands.

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Summary

Computed tomography (CT) observer agreement for newly diagnosed lymphoma is suboptimal. Radiologists showed variability in assessing nodal and extranodal involvement, impacting staging accuracy.

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Area of Science:

  • Radiology
  • Oncology
  • Medical Imaging

Background:

  • Accurate staging of lymphoma is crucial for treatment planning and prognosis.
  • Computed tomography (CT) is a primary imaging modality for lymphoma staging.
  • Observer agreement in CT interpretation can influence diagnostic accuracy.

Purpose of the Study:

  • To evaluate interobserver and intraobserver agreement among radiologists interpreting pretreatment CT scans in newly diagnosed lymphoma patients.
  • To assess the reliability of CT in identifying nodal and extranodal involvement for lymphoma staging.
  • To determine the consistency of Ann Arbor staging based on CT findings.

Main Methods:

  • Review of 49 CT scans from newly diagnosed lymphoma patients by 3 experienced radiologists.
  • Each scan was assessed twice by a single observer to evaluate intraobserver agreement.
  • Assessment of predefined nodal and extranodal regions, followed by Ann Arbor stage assignment.
  • Calculation of K-statistics to quantify agreement levels (poor, fair, moderate, substantial, almost perfect).

Main Results:

  • Nodal interobserver agreement ranged widely (0.09 to 0.95), with substantial to almost perfect intraobserver agreement, except for infraclavicular nodes.
  • Extranodal interobserver agreement was substantial (0.56-0.88), with substantial to almost perfect intraobserver agreement.
  • Ann Arbor stage interobserver agreement was moderate (0.57-0.69), with substantial intraobserver agreement.

Conclusions:

  • Computed tomography observer agreement in staging malignant lymphoma is suboptimal, particularly for certain nodal regions.
  • Variability in interpretation highlights potential challenges in consistent lymphoma staging using CT.
  • Further standardization or training may be needed to improve CT observer agreement in lymphoma staging.