title: Interim positron emission tomography scans in diffuse large B-cell lymphoma: an independent expert nuclear medicine evaluation of the Eastern Cooperative Oncology Group E3404 study.
abstract: Positive interim positron emission tomography (PET) scans are thought to be associated with inferior outcomes in diffuse large B-cell lymphoma. In the E3404 diffuse large B-cell lymphoma study, PET scans at baseline and after 3 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone were centrally reviewed by a single reader. To determine the reproducibility of interim PET interpretation, an expert panel of 3 external nuclear medicine physicians visually scored baseline and interim PET scans independently and were blinded to clinical information. The binary Eastern Cooperative Oncology Group (ECOG) study criteria were based on modifications of the Harmonization Criteria; the London criteria were also applied. Of 38 interim scans, agreement was complete in 68% and 71% by ECOG and London criteria, respectively. The range of PET(+) interim scans was 16% to 34% (P = not significant) by reviewer. Moderate consistency of reviews was observed: kappa statistic = 0.445 using ECOG criteria, and kappa statistic = 0.502 using London criteria. These data, showing only moderate reproducibility among nuclear medicine experts, indicate the need to standardize PET interpretation in research and practice. This trial was registered at www.clinicaltrials.gov as #NCT00274924 [corrected].
authors.affiliation: Department of Medicine, Stanford University, CA, USA. sandra.horning@stanford.edu
authors.forename: Sandra J
authors.initials: SJ
authors.lastname: Horning
authors.forename: Malik E
authors.initials: ME
authors.lastname: Juweid
authors.forename: Heiko
authors.initials: H
authors.lastname: Schöder
authors.forename: Gregory
authors.initials: G
authors.lastname: Wiseman
authors.forename: Alex
authors.initials: A
authors.lastname: McMillan
authors.forename: Lode J
authors.initials: LJ
authors.lastname: Swinnen
authors.forename: Ranjana
authors.initials: R
authors.lastname: Advani
authors.forename: Randy
authors.initials: R
authors.lastname: Gascoyne
authors.forename: Andrew
authors.initials: A
authors.lastname: Quon
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D004502:Education, Medical, Continuing; D019788:Fluorodeoxyglucose F18; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000188:drug therapy; D009683:Nuclear Medicine / Q000592:standards* / Q000706:statistics & numerical data; D015588:Observer Variation; D049268:Positron-Emission Tomography / Q000592:standards* / Q000706:statistics & numerical data; D011241:Prednisone / Q000008:administration & dosage; D015203:Reproducibility of Results; D000069283:Rituximab; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D019788:Fluorodeoxyglucose F18; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone