123I-mIBG scintigraphy in neuroblastoma: development of a SIOPEN semi-quantitative reporting ,method by an international panel.
OBJECTIVE
A robust method is required to standardise objective reporting of diagnostic123I-mIBG images in neuroblastoma. Prerequisites for an appropriate system are low inter- and intra-observer error and reproducibility across a broad disease spectrum. We present a new reporting method, developed and tested for SIOPEN by an international expert panel.


METHODS
Patterns of abnormal skeletal123I-mIBG uptake were defined and assigned numerical scores [0-6] based on disease extent within 12 body segments. Uptake intensity was excluded from the analysis. Data sets from 82 patients were scored independently by six experienced specialists as unblinded pairs (pre- and post-induction chemotherapy) and in random order as a blinded study. Response was defined as ≥50 % reduction in post induction score compared with baseline.


RESULTS
In total, 1968 image sets were reviewed individually. Response rates of 88 % and 82 % were recorded for patients with baseline skeletal scores ≤23 and 24-48 respectively, compared with 44 % response in patients with skeletal scores >48 (p = 0.02). Reducing the number of segments or extension scale had a small but statistically negative impact upon the number of responses detected. Intraclass correlation coefficients [ICCs] calculated for the unblinded and blinded study were 0.95 at diagnosis and 0.98 and 0.99 post-induction chemotherapy, respectively.


CONCLUSIONS
The SIOPEN mIBG score method is reproducible across the full spectrum of disease in high risk neuroblastoma. Numerical assessment of skeletal disease extent avoids subjective evaluation of uptake intensity. This robust approach provides a reliable means with which to examine the role of 123I mIBG scintigraphy as a prognostic indicator in neuroblastoma.
King's College, London, UK. Valerie.lewington@kcl.ac.uk.
V
http://orcid.org/0000-0002-8521-5478
V
Lewington
Radiology and Nuclear Medicine, Ghent University, Ghent, Belgium.
B
B
Lambert
Department for Studies and Statistics on Integrated Research and Projects (S2IRP), Children's Cancer Research Institute, Vienna, Austria.
U
U
Poetschger
Schneider Children's Medical Centre of Israel, Petach-Tikva, Israel.
Z Bar
ZB
Sever
CHLS, Pierre-Benite, France.
F
F
Giammarile
Cross Cancer Institute, Edmonton, Canada.
A J B
AJB
McEwan
Nuclear Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Rita
R
Castellani
Northern Ireland Cancer Centre, Belfast, UK.
T
T
Lynch
St Jude's Children's Research Hospital, Memphis, USA.
B
B
Shulkin
AIT Austrian Institute of Technology GmbH Safety & Security Department, Information Management & eHealth, Vienna, Austria.
M
M
Drobics
AKH, Vienna, Austria.
A
A
Staudenherz
Department for Studies and Statistics on Integrated Research and Projects (S2IRP), Children's Cancer Research Institute, Vienna, Austria.|St. Anna Children's Hospital and Medical University, Vienna, Austria.
R
R
Ladenstein
D019797:3-Iodobenzylguanidine; D001859:Bone Neoplasms / Q000145:classification / Q000000981:diagnostic imaging*; D005060:Europe; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000592:standards*; D038622:Internationality; D009447:Neuroblastoma / Q000145:classification / Q000000981:diagnostic imaging*; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods* / Q000592:standards*
D019275:Radiopharmaceuticals; D019797:3-Iodobenzylguanidine
123-meta-iodobenzylguanidine [123I-mIBG]; Imaging; Neuroblastoma; SIOPEN-R-NET; Scintigraphy; Skeleton
Q J Nucl Med Mol Imaging. 2008 Dec;52(4):388-402
19088693
Br J Cancer. 2010 Apr 27;102(9):1319-26
20424613
Eur J Nucl Med Mol Imaging. 2003 May;30(5):B45-50
12658506
Nucl Med Biol. 2000 Oct;27(7):643-6
11091106
Lancet. 1986 Feb 8;1(8476):307-10
2868172
J Clin Oncol. 2004 Oct 1;22(19):3909-15
15459212
J Clin Oncol. 2003 Jul 1;21(13):2486-91
12829667
Med Pediatr Oncol. 2000 Apr;34(4):237-41
10742058
Psychol Bull. 1979 Mar;86(2):420-8
18839484
Radiology. 1999 Nov;213(2):521-5
10551235
Lancet Oncol. 2008 Mar;9(3):247-56
18308250
Pediatr Blood Cancer. 2009 Jul;52(7):784-90
19185008
J Clin Oncol. 2009 Nov 10;27(32):5343-9
19805691
Eur J Cancer. 1995;31A(2):256-61
7718334