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Interobserver and intraobserver agreement in PET/CT with [18F]DCFPyL according to TNM molecular and PSMA-RADS 2.0
M Guerra-Gómez1, A Rodríguez-Pajuelo1, L Brero-Sánchez1
1Departamento de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, Spain.
Purpose:
The aim of this study was to determine the agreement between three observers with different levels of experience using the PSMA-RADS 2.0 criteria and the miTNM system for the interpretation of PET-PSMA with [18F]DCFPyL in males with prostate cancer.
Materials And Methods:
PET-PSMA images from 114 prostate cancer patients were blindly reported twice by three different observers at intervals of 8 weeks. The evaluations were performed according to the molecular imaging TNM (miTNM) and PSMA-RADS 2.0 criteria. We used Fleiss' Kappa to analyse inter and intraobserver agreements.
Results:
Moderate overall agreement was obtained in the assessment of the PET-PSMA results (Fleiss'k = 0.53; 95% CI 0.45-0.62; p < 0.001), with significant agreement in the miT, miN and miM reports. There was a substantial level of agreement in the reporting of prostatic disease and lymphatic involvement (Fleiss'k = 0.66 and 0.65), being lower than that observed in the reporting of metastatic disease (Fleiss'k = 0.86), especially in the M0 group (Fleiss'k = 0.99). Upon re-evaluation of the images, observer 1 had moderate overall agreement for miT (Fleiss'k = 0.51) and substantial agreement for miN and miM (Fleiss'k 0.75 and 0.63, respectively).
Conclusions:
The use of a structured scoring system such as PSMA-RADS 2.0, as well as the miTNM classification system in the interpretation of PET-PSMA images in prostate cancer patients, provides a highly reproducible report format. High levels of interobserver and intraobserver agreement are found, especially when ruling out disease, which supports its use in routine clinical practice.
Insights
This study shows that using PSMA-RADS 2.0 criteria and the miTNM system for prostate cancer PET-PSMA imaging leads to reproducible results. Observers achieved good agreement, especially when ruling out disease, supporting its clinical use.
Area of Science:
- Nuclear Medicine
- Radiology
- Oncology
Background:
- Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is crucial for staging prostate cancer.
- Standardized criteria are needed to improve the interpretation of PSMA PET-PSMA images.
Purpose of the Study:
- To assess the agreement between observers with varying experience using PSMA-RADS 2.0 and miTNM systems for interpreting [18F]DCFPyL PET-PSMA in prostate cancer patients.
- To evaluate the reproducibility of these interpretation systems.
Main Methods:
- 114 prostate cancer patients' PET-PSMA images were independently reviewed twice by three observers.
- Interpretations were performed using the molecular imaging TNM (miTNM) and PSMA-RADS 2.0 criteria.
- Inter- and intraobserver agreement were analyzed using Fleiss' Kappa.
Main Results:
- Moderate overall agreement was observed (Fleiss' Kappa = 0.53).
- Substantial agreement was found for prostatic disease and lymphatic involvement (Kappa = 0.66 and 0.65, respectively).
- High agreement was noted for metastatic disease (Kappa = 0.86), particularly in the M0 group (Kappa = 0.99).
Conclusions:
- The PSMA-RADS 2.0 and miTNM systems provide a highly reproducible format for interpreting PSMA PET-PSMA images in prostate cancer.
- High inter- and intraobserver agreement, especially in excluding disease, supports the routine clinical application of these systems.
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