Research ArticleCLINICAL INVESTIGATIONS

Observer Variation in Interpreting 18F-FDG PET/CT Findings for Lymphoma Staging

Michael S. Hofman, Nigel C. Smeeton, Sheila C. Rankin, Tom Nunan and Michael J. O'Doherty
Journal of Nuclear Medicine October 2009, 50 (10) 1594-1597; DOI: https://doi.org/10.2967/jnumed.109.064121

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    Axial (A) and coronal (B) PET and PET/CT images demonstrating focal increased metabolic activity in subcentimeter node (arrow) that was variably reported as supraclavicular, infraclavicular, or axillary. This did not result in a change in overall stage due to the presence of widespread disease, and this variability would therefore not change management.

  • FIGURE 2. 
    FIGURE 2. 

    Axial PET and PET/CT images demonstrating large-bowel lymphomatous involvement (arrow) in addition to mesenteric nodal involvement. Some reviewers reported only mesenteric nodal involvement, but involvement of bowel wall was clearly evident on review.

Tables

  • TABLE 1

    Lymphoma Subtypes

    Subtypen
    Diffuse large B cell40
    Hodgkin32
    Follicular9
    T cell9
    High-grade non-Hodgkin, unspecified3
    Burkitt1
    Anaplastic large cell2
    Mantle cell2
    Uncertain1
    Posttransplant lymphoproliferative disorder1
  • TABLE 2

    Percentage of Patients with Lymphomatous Involvement at Specific Nodal and Extranodal Sites

    SitePercentage
    Nodal
     Cervical55.8 (L); 47.4 (R)
     Axillary28.8 (L); 28.0 (R)
     Infraclavicular6.4 (L); 4.2 (R)
     Hilar23.0
     Mediastinal38.8
     Periaortic37.8
     Pelvic31.4 (L); 31.6 (R)
     Inguinal33.6 (L); 28.6 (R)
    Extranodal
     Spleen17.8
     Bone marrow or bone20.0
     Lung5.4
     Liver10.0
     Bowel or gastric5.4
    Other nodal sites*8.0

    • ↵* Muscle, subcutaneous tissue, breast, and uterus.

  • TABLE 3

    Intra- and Interobserver Variability

    IntraobserverInterobserver
    Parameter121 vs. 22 vs. 31 vs. 3
    Ann Arbor0.91 (0.82–0.97)0.88 (0.80–0.95)0.81 (0.69–0.90)0.79 (0.68–0.86)0.87 (0.77–0.94)
    Extranodal0.82 (0.70–0.93)0.86 (0.76–0.96)0.74 (0.61–0.87)0.82 (0.71–0.93)0.76 (0.63–0.89)
    No. of nodal groups0.93 (0.90–0.96)0.91 (0.87–0.94)0.83 (0.76–0.89)0.92 (0.89–0.95)0.88 (0.83–0.92)
    Nodal sites
     Cervical*0.84 (0.72–0.92)0.86 (0.78–0.93)0.81 (0.71–0.90)0.77 (0.66–0.86)0.79 (0.68–0.88)
     Axillary0.80 (0.68–0.89)0.74 (0.61–0.85)0.69 (0.56–0.81)0.69 (0.53–0.83)0.73 (0.60–0.84)
     Infraclavicular0.55 (−0.01–0.89)0.39 (0.10–0.73)0.23 (−0.02–0.55)0.37 (−0.01–0.68)0.14 (−0.04–0.50)
     Hilar0.82 (0.70–0.95)0.65 (0.48–0.83)0.56 (0.37–0.75)0.58 (0.36–0.79)0.63 (0.45–0.81)
     Pelvic0.82 (0.70–0.91)0.68 (0.53–0.81)0.65 (0.53–0.76)0.71 (0.60–0.82)0.68 (0.55–0.79)
     Inguinal or femoral0.82 (0.72–0.91)0.69 (0.55–0.82)0.71 (0.59–0.82)0.76 (0.64–0.87)0.69 (0.55–0.82)
     Mediastinal0.75 (0.61–0.88)0.75 (0.61–0.88)0.75 (0.61–0.88)0.77 (0.64–0.90)0.73 (0.59–0.87)
     Periaortic0.77 (0.65–0.90)0.76 (0.63–0.89)0.75 (0.62–0.88)0.81 (0.69–0.93)0.78 (0.65–0.90)
     Mesentery0.65 (0.47–0.83)0.61 (0.41–0.81)0.63 (0.44–0.81)0.61 (0.41–0.81)0.67 (0.49–0.85)
    Extranodal sites
     Spleen0.84 (0.69–0.99)0.81 (0.67–0.96)0.75 (0.57–0.92)0.81 (0.67–0.96)0.69 (0.51–0.88)
     Bone marrow0.94 (0.85–0.99)0.81 (0.67–0.96)0.76 (0.60–0.92)0.76 (0.60–0.92)0.93 (0.84–0.99)
     Lung0.82 (0.58–0.99)0.90 (0.72–0.99)0.58 (0.21–0.95)0.58 (0.21–0.95)0.65 (0.32–0.97)
     Liver0.95 (0.84–0.99)0.88 (0.71–0.99)0.84 (0.66–0.99)0.78 (0.57–0.99)0.59 (0.32–0.87)
     Bowel0.71 (0.40–0.99)0.56 (0.11–0.99)0.64 (0.35–0.93)0.59 (0.28–0.91)0.37 (−0.03–0.76)

    • ↵* Cervical includes supraclavicular and all head and neck nodal stations.

    • Data are intraclass correlation coefficient for number of nodal groups and κw for all other variables, with 95% confidence intervals in parentheses.

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