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Inter-observer variability influences the Lugano classification when restaging lymphoma.

Jacobus Möller1, Tiaan Steyn1, Nantes Combrinck1

  • 1Department of Clinical Imaging Sciences, Universitas Academic Hospital and University of the Free State, South Africa.

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Implementing the Lugano classification for lymphoma restaging shows moderate agreement among observers. Substantial variability in response classification may impact treatment plans, necessitating dedicated training and quality control.

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Area of Science:

  • Oncology
  • Radiology
  • Medical Imaging

Background:

  • Lymphoma is a significant, potentially curable cancer in South Africa.
  • The Lugano classification (LC) is the latest international guideline for lymphoma staging and restaging.
  • Assessing the LC's reliability in the local context is crucial before widespread adoption.

Purpose of the Study:

  • To evaluate inter-observer variability in lymphoma response assignment using the Lugano classification.
  • To identify discrepancies in applying the LC for computed tomography (CT) staging and restaging.
  • To inform mitigation strategies for LC implementation if significant discordance arises.

Main Methods:

  • Four reviewers independently assessed 61 CT scans from 21 lymphoma patients using the LC.
  • Scans included baseline, initial restaging, and follow-up restaging.
  • Inter-observer agreement was quantified using Kappa values and comparative analysis.

Main Results:

  • Moderate inter-observer agreement (52%) was observed in overall response classification.
  • Key discrepancies arose from assessing target lesion regression, calculating changes in lesion size, and identifying new lesions.
  • Variability in interpreting CT findings may affect treatment decisions.

Conclusions:

  • Adopting the Lugano classification for lymphoma restaging is recommended for international guideline adherence and improved consistency.
  • Significant inter-observer variability in response classification was identified, potentially impacting patient treatment.
  • Mandatory training and ongoing quality control are essential for successful LC implementation.