Radiographic classification of mandibular osteoradionecrosis: A blinded prospective multi-disciplinary interobserver...

Area of Science:

• Radiology
• Oncology
• Oral Surgery

Background:

• Osteoradionecrosis (ORN) of the jaw is a severe complication of radiotherapy for head and neck cancers, affecting up to 15% of patients.
• The ClinRad system aids in ORN severity classification, but diagnostic accuracy can be influenced by imaging modality and physician expertise.
• Benchmarking physician performance is crucial for understanding and improving ORN diagnosis.

Purpose of the Study:

• To benchmark physician performance in diagnosing and staging osteoradionecrosis (ORN) of the jaw.
• To evaluate diagnostic accuracy across different medical specialties and imaging modalities.
• To assess the impact of combined imaging (CT and OPG) on ORN diagnosis.

Main Methods:

• A retrospective diagnostic validation study involving 20 physicians from oral oncology, radiation oncology, surgery, and neuroradiology.
• Physicians diagnosed and staged 85 imaging sets (CT and OPG) from 30 patients with confirmed ORN using the ClinRad system.
• Diagnostic accuracy was assessed using ROC analysis, and observer agreement was measured with Cohen's and Fleiss kappa statistics.

Main Results:

• Combined CT and OPG imaging significantly improved diagnostic performance across specialties (p < 0.001).
• Area Under the Curve (AUC) for diagnostic accuracy ranged from 0.79 (residents) to 0.98 (surgeons).
• Inter- and intra-rater agreement for ClinRad staging was consistently low, with median Fleiss kappa values ranging from 0.05 to 0.22.

Conclusions:

• This study establishes a benchmark for radiographic ORN detection, revealing significant diagnostic variability among specialties.
• Findings underscore the need for standardized imaging protocols and interdisciplinary training to enhance diagnostic accuracy.
• Multimodal imaging approaches are recommended to improve the detection and staging of osteoradionecrosis.