Development of 18 F-Fluoromisonidazole Hypoxia PET/CT Diagnostic Interpretation Criteria and Validation of Interreader Reliability, Reproducibility, and Performance.

Autor: Wray R; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York., Mauguen A; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York., Michaud L; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York., Leithner D; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York., Yeh R; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York., Riaz N; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York., Mirtcheva R; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York., Sherman E; Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York., Wong R; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; and., Humm J; Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York., Lee N; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York., Schöder H; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; schoderh@mskcc.org.
Jazyk: angličtina
Zdroj: Journal of nuclear medicine : official publication, Society of Nuclear Medicine [J Nucl Med] 2024 Oct 01; Vol. 65 (10), pp. 1526-1532. Date of Electronic Publication: 2024 Oct 01.
DOI: 10.2967/jnumed.124.267775
Abstrakt: Tumor hypoxia, an integral biomarker to guide radiotherapy, can be imaged with 18 F-fluoromisonidazole ( 18 F-FMISO) hypoxia PET. One major obstacle to its broader application is the lack of standardized interpretation criteria. We sought to develop and validate practical interpretation criteria and a dedicated training protocol for nuclear medicine physicians to interpret 18 F-FMISO hypoxia PET. Methods: We randomly selected 123 patients with human papillomavirus-positive oropharyngeal cancer enrolled in a phase II trial who underwent 123 18 F-FDG PET/CT and 134 18 F-FMISO PET/CT scans. Four independent nuclear medicine physicians with no 18 F-FMISO experience read the scans. Interpretation by a fifth nuclear medicine physician with over 2 decades of 18 F-FMISO experience was the reference standard. Performance was evaluated after initial instruction and subsequent dedicated training. Scans were considered positive for hypoxia by visual assessment if 18 F-FMISO uptake was greater than floor-of-mouth uptake. Additionally, SUV max was determined to evaluate whether quantitative assessment using tumor-to-background ratios could be helpful to define hypoxia positivity. Results: Visual assessment produced a mean sensitivity and specificity of 77.3% and 80.9%, with fair interreader agreement (κ = 0.34), after initial instruction. After dedicated training, mean sensitivity and specificity improved to 97.6% and 86.9%, with almost perfect agreement (κ = 0.86). Quantitative assessment with an estimated best SUV max ratio threshold of more than 1.2 to define hypoxia positivity produced a mean sensitivity and specificity of 56.8% and 95.9%, respectively, with substantial interreader agreement (κ = 0.66), after initial instruction. After dedicated training, mean sensitivity improved to 89.6% whereas mean specificity remained high at 95.3%, with near-perfect interreader agreement (κ = 0.86). Conclusion: Nuclear medicine physicians without 18 F-FMISO hypoxia PET reading experience demonstrate much improved interreader agreement with dedicated training using specific interpretation criteria.
(© 2024 by the Society of Nuclear Medicine and Molecular Imaging.)
Databáze: MEDLINE
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