title: Concordance in the interpretation of PET after chemotherapy in advanced stage Hodgkin lymphoma.
abstract: The aim was to analyze the degree of agreement between the central review panel and the local PET interpretation within the HD15 trial and its impact on subsequent treatment and progression free survival.
  
  
  METHODS
  The analysis set consisted of 739 patients with residues ≥ 2.5 cm after 6 or 8 cycles of BEACOPPesc from the HD15 trial performed by the German Hodgkin Study Group. The recommendation for or against further radiotherapy was based on the central [(18)F]FDG-PET interpretation. Central PET interpretation was compared to the local PET interpretation and concordance was measured using Cohen's Kappa coefficient. Prognostic impact of the analysis of concordance between local and central PET interpretations was evaluated using progression free survival (PFS); groups were compared with the log rank test.
  
  
  RESULTS
  The central panel rated 548 of 739 patients (74%) as PET negative. Of these, 513 were also rated as PET negative in the local PET interpretation. PET positivity was seen by central reviewers in the remaining 191 patients (26%), in concordance with local reviewers in 155 cases. Even though substantial agreement was found (Cohen's Kappa 0.81), the interpretation of the central PET review panel led to a different therapeutic recommendation in 71/739 (10%) patients. PFS was equally high in groups in which the therapeutic regime had been changed on the basis of the central panel decision.
  
  
  CONCLUSIONS
  High concordance is found between local and central reviewers with regard to PET interpretation in residual tissue after intense chemotherapy. The existence of the central PET review panel allows the identification of additional patients as PET negative so that radiotherapy can be safely omitted (35 of 548 patients = 4.7%).
authors.affiliation: Carsten Kobe, Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany, Tel. +49/(0)221/478-50 24, Fax -67 77, carsten.kobe@uk-koeln.de.
authors.forename: C
authors.initials: C
authors.lastname: Kobe
authors.forename: G
authors.initials: G
authors.lastname: Kuhnert
authors.forename: H
authors.initials: H
authors.lastname: Haverkamp
authors.forename: M
authors.initials: M
authors.lastname: Fuchs
authors.forename: D
authors.initials: D
authors.lastname: Kahraman
authors.forename: H-T
authors.initials: HT
authors.lastname: Eich
authors.forename: J
authors.initials: J
authors.lastname: Kriz
authors.forename: C
authors.initials: C
authors.lastname: Baues
authors.forename: B
authors.initials: B
authors.lastname: Nast-Kolb
authors.forename: P J
authors.initials: PJ
authors.lastname: Bröckelmann
authors.forename: P
authors.initials: P
authors.lastname: Borchmann
authors.forename: A
authors.initials: A
authors.lastname: Drzezga
authors.forename: A
authors.initials: A
authors.lastname: Engert
authors.forename: M
authors.initials: M
authors.lastname: Dietlein
mesh_terms: D026683:Advisory Committees / Q000706:statistics & numerical data*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016903:Drug Monitoring; D005060:Europe / Q000453:epidemiology; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D015588:Observer Variation; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: Hodgkin lymphoma; PET; concordance; interpretation