title: Semiquantitative visual approach to scoring lung cancer treatment response using computed tomography: a pilot study.
abstract: OBJECTIVE
  Our objective was to compare a newly developed semiquantitative visual scoring (SVS) method with the current standard, the Response Evaluation Criteria in Solid Tumors (RECIST) method, in the categorization of treatment response and reader agreement for patients with metastatic lung cancer followed by computed tomography.
  
  
  METHODS
  The 18 subjects (5 women and 13 men; mean age, 62.8 years) were from an institutional review board-approved phase 2 study that evaluated a second-line chemotherapy regimen for metastatic (stages III and IV) non-small cell lung cancer. Four radiologists, blinded to the patient outcome and each other's reads, evaluated the change in the patients' tumor burden from the baseline to the first restaging computed tomographic scan using either the RECIST or the SVS method. We compared the numbers of patients placed into the partial response, the stable disease (SD), and the progressive disease (PD) categories (Fisher exact test) and observer agreement (kappa statistic).
  
  
  RESULTS
  Requiring the concordance of 3 of the 4 readers resulted in the RECIST placing 17 (100%) of 17 patients in the SD category compared with the SVS placing 9 (60%) of 15 patients in the partial response, 5 (33%) of the 15 patients in the SD, and 1 (6.7%) of the 15 patients in the PD categories (P < 0.0001). Interobserver agreement was higher among the readers using the SVS method (kappa, 0.54; P < 0.0001) compared with that of the readers using the RECIST method (kappa, -0.01; P = 0.5378).
  
  
  CONCLUSIONS
  Using the SVS method, the readers more finely discriminated between the patient response categories with superior agreement compared with the RECIST method, which could potentially result in large differences in early treatment decisions for advanced lung cancer.
authors.affiliation: Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA. ronald.gottlieb@roswellpark.org
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gottlieb
authors.forename: Prasanna
authors.initials: P
authors.lastname: Kumar
authors.forename: Peter
authors.initials: P
authors.lastname: Loud
authors.forename: Donald
authors.initials: D
authors.lastname: Klippenstein
authors.forename: Cheryl
authors.initials: C
authors.lastname: Raczyk
authors.forename: Wei
authors.initials: W
authors.lastname: Tan
authors.forename: Jenny
authors.initials: J
authors.lastname: Lu
authors.forename: Nithya
authors.initials: N
authors.lastname: Ramnath
mesh_terms: D000328:Adult; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000145:classification / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality / Q000556:secondary*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000145:classification* / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011379:Prognosis; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome