Japanese Journal of Clinical Oncology Advance Access published online on August 18, 2007
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hym064
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© 2007 Foundation for Promotion of Cancer Research
Inter-observer Variations in FDG-PET Interpretation for Cancer Screening
1 Department of Radiology, School of Medicine, Yokohama City University, Yokohama
2 Department of Diagnostic Radiology, Kyoto Graduate University School of Medicine, Kyoto
3 Research Center for Cancer Prevention and Screening, Cancer Screening Division, National Cancer Center, Tokyo
4 Diagnostic Imaging Center, Radiology, Yuai Clinic, Yokohama
5 Department of Radiology, PET/RI center, Okayama Kyokuto Hospital, Okayama
6 HIMEDIC Imaging Center at Lake Yamanaka, Yamanashi
7 Utsunomiya Central Clinic PET Center, Utsunomiya
8 Department of Radiology, School of Medicine, Yokohama City University, Yokohama
9 Institute of Biomedical Research and Innovation, Kobe
10 Nishidai Clinic Diagnostic Imaging Center, Tokyo, Japan
For reprints and all correspondence: Akiko Suzuki, Department of Radiology, School of Medicine, Yokohama City University, 3–9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan. E-mail: akiko225{at}yokohama-cu.ac.jp
Received October 16, 2006; accepted March 20, 2007
Background: Diagnostic guidelines for the use of 2-(fluorine 18) fluoro-2 deoxy-D-glucose (FDG)-positron emission tomography (PET) in cancer screening have yet to be established. We assessed inter-observer variability in screening FDG-PET.
Methods: Subjects comprised 40 individuals who underwent FDG-PET and computed tomography (CT) for cancer screening. To assess various patterns of FDG uptakes, three subsets of the cases were selected: ‘Cancer’, 15 cases with cancer; ‘Not malignant’, 15 cases with suspected cancer by FDG-PET who were confirmed as cancer-free; and ‘Normal’, 10 cases without remarkable FDG uptake who were confirmed as cancer-free. A total of 68 lesions made up of malignancy (n = 18), benign (n = 21), and physiological FDG uptake (n = 29) were interpreted by six physicians. Each observer reviewed each case three times. Step 1 involved interpretation of PET images alone, Step 2 involved side-by-side reading of PET and CT images, and Step 3 involved re-evaluation of findings with the results of other screening tests. We assessed inter-observer agreement for each step.
Results: Inter-observer agreement for all lesions at each step was moderate, compared to fair agreement for ‘Normal’ subjects. Inter-observer agreement of ‘Cancer’ and ‘Not malignant’ subjects in Step 1 were better than those in Step 2 and 3; however, the differences were not statistically significant.
Conclusion: The interpretation of FDG-PET is adequately reproducible, while that of ‘Normal’ subjects is less reproducible. Improvement of inter-observer variability in assessing physiological FDG uptakes requires universal reporting criteria in FDG-PET. Correlative interpretation of PET, CT and other information may require standardization in subjects with suspected cancer by FDG-PET.
Key Words: radiology • PET • radiology • CT/MRI • cancer screening
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