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Soft Tissue Reporting and Data System (Soft Tissue-RADS): preliminary validation among fellowship-trained
Avneesh Chhabra1,2,3, Ty Subhawong4, Angela He5
1UT Southwestern, Dallas, TX, USA. avneesh.chhabra@utsouthwestern.edu.
Objective:
To validate the MRI-based soft tissue tumor scoring system by comparing the accuracy of the Soft Tissue-RADS to qualitative assessment.
Materials And Methods:
In this cross-sectional study, adult MRIs of soft-tissue tumors and tumor-like lesions with known reference standards, obtained from June 2015 to May 2024, were included. Patients with incomplete imaging, no final diagnosis, and visceral tumors were excluded. The scoring categories were 1-6. The cases were presented to ten expert musculoskeletal (MSK) radiologists from ten institutions under curated image-review conditions. Inter-reader agreement and MRI accuracy were calculated and compared to the accuracy of final qualitative diagnoses and respective confidence scales.
Results:
Among 150 MRI scans from 150 patients (68 males; 82 females) from one center, 6 cases were category 1; 60, category 2; 32, category 3; 14, category 4; 22, category 5; and 16, category 6. Good-to-excellent inter-reader agreement was observed overall (Kappa: 0.79; 95% CI: 0.74, 0.83). The mean accuracy of Soft-Tissue RADS between benign (categories 1-3) versus suspicious (categories 4 and 5) tumors was 82% (95% CI: 80%, 84%) versus 61% (95% CI: 58%, 63%) for qualitative diagnoses (p < 0.001). The mean true positive rate for RADS 6 was 97%. AUC for ten readers was 0.85 to 0.91. Average confidence level using Soft-Tissue RADS was greater than qualitative diagnoses (4.35 ± 0.81 vs. 4.14 ± 0.99; p < 0.001).
Conclusion:
Soft Tissue-RADS is a reliable and accurate system for standardized terminology and recommended management of MRIs of soft-tissue tumors and tumor-like lesions among experts. Further validation in routine clinical workflows is necessary.
Key Points:
Question Given the limited accuracy of radiologists' rendered qualitative diagnoses, what is the diagnostic performance of Soft Tissue-RADS versus qualitative diagnoses? Findings Soft Tissue-RADS scoring is reliable (Kappa: 0.79; 95% CI: 0.74, 0.83) and more accurate (82% vs. 61%, p < 0.001) than qualitative diagnosis with better confidence levels (p < 0.001). Clinical relevance Soft Tissue-RADS system can potentially lead to consistent management recommendations and longitudinal data collection in the domain of sarcoma diagnosis.