title: Inter-Reader Reliability of Early FDG-PET/CT Response Assessment Using the Deauville Scale after 2 Cycles of Intensive Chemotherapy (OEPA) in Hodgkin's Lymphoma.
abstract: OBJECTIVE
  The five point Deauville (D) scale is widely used to assess interim PET metabolic response to chemotherapy in Hodgkin lymphoma (HL) patients. An International Validation Study reported good concordance among reviewers in ABVD treated advanced stage HL patients for the binary discrimination between score D1,2,3 and score D4,5. Inter-reader reliability of the whole scale is not well characterised.
  
  
  METHODS
  Five international expert readers scored 100 interim PET/CT scans from paediatric HL patients. Scans were acquired in 51 European hospitals after two courses of OEPA chemotherapy (according to the EuroNet-PHL-C1 study). Images were interpreted in direct comparison with staging PET/CTs.
  
  
  RESULTS
  The probability that two random readers concord on the five point D score of a random case is only 42% (global kappa = 0.24). Aggregating to a three point scale D1,2 vs. D3 vs. D4,5 improves concordance to 60% (kappa = 0.34). Concordance if one of two readers assigns a given score is 70% for score D1,2 only 36% for score D3 and 64% for D4,5. Concordance for the binary decisions D1,2 vs. D3,4,5 is 67% and 86% for D1,2,3 vs D4,5 (kappa = 0.36 resp. 0.56). If one reader assigns D1,2,3 concordance probability is 92%, but only 64% if D4,5 is called. Discrepancies occur mainly in mediastinum, neck and skeleton.
  
  
  CONCLUSIONS
  Inter-reader reliability of the five point D-scale is poor in this interobserver analysis of paediatric patients who underwent OEPA. Inter-reader variability is maximal in cases assigned to D2 or D3. The binary distinction D1,2,3 versus D4,5 is the most reliable criterion for clinical decision making.
authors.affiliation: Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Regine
authors.initials: R
authors.lastname: Kluge
authors.affiliation: Clinic of Nuclear Medicine, National Hospital for Active Treatment in Oncology, Sofia, Bulgaria.
authors.forename: Lidia
authors.initials: L
authors.lastname: Chavdarova
authors.affiliation: Department of Biomedical Imaging and Image-guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Martha
authors.initials: M
authors.lastname: Hoffmann
authors.affiliation: Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Kobe
authors.affiliation: Dept. of PET and Molecular Imaging, Nicolaus Copernicus University, Collegium MedicumBydgoszcz, Poland.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Malkowski
authors.affiliation: Department of Nuclear Medicine, Hopital Tenon, Assistance Publique Hôpitaux de Paris, Faculté de médecine Pierre et Marie Curie, Paris, France.
authors.forename: Françoise
authors.initials: F
authors.lastname: Montravers
authors.affiliation: Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Kurch
authors.affiliation: Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Georgi
authors.affiliation: Department of Nuclear Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Dietlein
authors.affiliation: Department of Paediatric Oncology, Royal Hospital for Sick Children, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: W Hamish
authors.initials: WH
authors.lastname: Wallace
authors.affiliation: Karolinska University Hospital, Astrid Lindgrens Childrens Hospital, Stockholm, Sweden.
authors.forename: Jonas
authors.initials: J
authors.lastname: Karlen
authors.affiliation: Pediatric Oncology Unit, Hospitales Universitarios Virgen Macarena y Virgen del Rocio, Sevilla, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Fernández-Teijeiro
authors.affiliation: Department of Pediatric Hematology and Oncology, University Hospital Motol and 2nd Medical Faculty of Charles University, Prague, Czech Republic.
authors.forename: Michaela
authors.initials: M
authors.lastname: Cepelova
authors.affiliation: Department of Nuclear Medicine, Blackrock Clinic, Dublin, Ireland.
authors.forename: Lorrain
authors.initials: L
authors.lastname: Wilson
authors.affiliation: Department of Paediatric Oncology, University Children's Hospital Zurich, Switzerland.
authors.forename: Eva
authors.initials: E
authors.lastname: Bergstraesser
authors.affiliation: Department of Nuclear Medicine, University of Leipzig, Leipzig, Germany.
authors.forename: Osama
authors.initials: O
authors.lastname: Sabri
authors.affiliation: Department of Pediatric Oncology, University of Halle, Halle/Saale, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Mauz-Körholz
authors.affiliation: Department of Pediatric Oncology, University of Halle, Halle/Saale, Germany.
authors.forename: Dieter
authors.initials: D
authors.lastname: Körholz
authors.affiliation: Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Hasenclever
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D019298:Glucose-6-Phosphate / Q000008:administration & dosage / Q000031:analogs & derivatives*; D006689:Hodgkin Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D006801:Humans; D008297:Male; D049268:Positron-Emission Tomography; D011241:Prednisone / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D014750:Vincristine / Q000008:administration & dosage
chemical_list: C047515:2-fluoro-2-deoxyglucose-6-phosphate; D019298:Glucose-6-Phosphate; D014750:Vincristine; D005047:Etoposide; D004317:Doxorubicin; D011241:Prednisone