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Inter-observer variability influences the Lugano classification when restaging lymphoma

BACKGROUND: Lymphoma is an important and potentially curable oncological disease in South Africa. The staging and restaging of lymphoma have evolved over the years, with the latest international consensus guideline being the Lugano classification (LC). Prior to routine implementation of the LC, its...

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Autores principales: Möller, Jacobus, Steyn, Tiaan, Combrinck, Nantes, Joubert, Gina, Sherriff, Alicia, van Rensburg, Jacques Janse
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AOSIS 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837819/
https://www.ncbi.nlm.nih.gov/pubmed/31754505
http://dx.doi.org/10.4102/sajr.v22i1.1357
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author Möller, Jacobus
Steyn, Tiaan
Combrinck, Nantes
Joubert, Gina
Sherriff, Alicia
van Rensburg, Jacques Janse
author_facet Möller, Jacobus
Steyn, Tiaan
Combrinck, Nantes
Joubert, Gina
Sherriff, Alicia
van Rensburg, Jacques Janse
author_sort Möller, Jacobus
collection PubMed
description BACKGROUND: Lymphoma is an important and potentially curable oncological disease in South Africa. The staging and restaging of lymphoma have evolved over the years, with the latest international consensus guideline being the Lugano classification (LC). Prior to routine implementation of the LC, its robustness in the local setting should be determined. OBJECTIVES: To determine the Inter-observer variability in response assignment when applying the LC in patients with lymphoma who were staged and restaged with computed tomography. In case of excessive discordance, specific mitigating measures will have to be taken before and during any proposed implementation of the LC. METHOD: A total of 61 computed tomography scans in 21 patients were evaluated independently by four reviewers according to the LC, of which 21 scans were done at baseline, 21 at initial restaging and 19 at follow-up restaging. A retrospective comparative analysis was performed. Kappa values were calculated to determine agreement between observers. RESULTS: Only a moderate inter-observer agreement of 52% in the overall response classification was demonstrated. The most important sources of discrepancy were inconsistency in the assessment of target lesion regression to normal, determining the percentage change in the summed cross-sectional area of the target lesions and ascribing new lesions as either due to lymphoma or other causes. CONCLUSION: Implementing the Lugano classification when restaging lymphoma is desirable to improve consistency and to conform to international guidelines. However, our study shows substantial inter-observer variability in response classification, potentially altering the treatment plan. Dedicated training and continuous quality control should, therefore, accompany the process.
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spelling pubmed-68378192019-11-21 Inter-observer variability influences the Lugano classification when restaging lymphoma Möller, Jacobus Steyn, Tiaan Combrinck, Nantes Joubert, Gina Sherriff, Alicia van Rensburg, Jacques Janse SA J Radiol Original Research BACKGROUND: Lymphoma is an important and potentially curable oncological disease in South Africa. The staging and restaging of lymphoma have evolved over the years, with the latest international consensus guideline being the Lugano classification (LC). Prior to routine implementation of the LC, its robustness in the local setting should be determined. OBJECTIVES: To determine the Inter-observer variability in response assignment when applying the LC in patients with lymphoma who were staged and restaged with computed tomography. In case of excessive discordance, specific mitigating measures will have to be taken before and during any proposed implementation of the LC. METHOD: A total of 61 computed tomography scans in 21 patients were evaluated independently by four reviewers according to the LC, of which 21 scans were done at baseline, 21 at initial restaging and 19 at follow-up restaging. A retrospective comparative analysis was performed. Kappa values were calculated to determine agreement between observers. RESULTS: Only a moderate inter-observer agreement of 52% in the overall response classification was demonstrated. The most important sources of discrepancy were inconsistency in the assessment of target lesion regression to normal, determining the percentage change in the summed cross-sectional area of the target lesions and ascribing new lesions as either due to lymphoma or other causes. CONCLUSION: Implementing the Lugano classification when restaging lymphoma is desirable to improve consistency and to conform to international guidelines. However, our study shows substantial inter-observer variability in response classification, potentially altering the treatment plan. Dedicated training and continuous quality control should, therefore, accompany the process. AOSIS 2018-07-31 /pmc/articles/PMC6837819/ /pubmed/31754505 http://dx.doi.org/10.4102/sajr.v22i1.1357 Text en © 2018. The Authors https://creativecommons.org/licenses/by/4.0/ Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License.
spellingShingle Original Research
Möller, Jacobus
Steyn, Tiaan
Combrinck, Nantes
Joubert, Gina
Sherriff, Alicia
van Rensburg, Jacques Janse
Inter-observer variability influences the Lugano classification when restaging lymphoma
title Inter-observer variability influences the Lugano classification when restaging lymphoma
title_full Inter-observer variability influences the Lugano classification when restaging lymphoma
title_fullStr Inter-observer variability influences the Lugano classification when restaging lymphoma
title_full_unstemmed Inter-observer variability influences the Lugano classification when restaging lymphoma
title_short Inter-observer variability influences the Lugano classification when restaging lymphoma
title_sort inter-observer variability influences the lugano classification when restaging lymphoma
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6837819/
https://www.ncbi.nlm.nih.gov/pubmed/31754505
http://dx.doi.org/10.4102/sajr.v22i1.1357
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