Interobserver Variability in the Detection of Cervical-Thoracic Hodgkin's Disease by Computed Tomography

1999 ◽  
Vol 17 (7) ◽  
pp. 2153-2153 ◽  
Author(s):  
Barry D. Fletcher ◽  
Arvin S. Glicksman ◽  
Peter Gieser
Keyword(s):  
Computed Tomography ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Response To Therapy ◽  
Ct Scans ◽  
Disease Treatment ◽  
Disease Extent ◽  
Treatment Protocols ◽  
Moderate Agreement ◽  
Pediatric Oncology Group

PURPOSE: Computed tomography (CT) scans of the neck and chest are obtained at diagnosis of Hodgkin's disease to establish disease extent, plan radiotherapy, and serve as baseline studies for subsequent evaluation of response to therapy. However, differences in interpretation may occur even among experienced radiologists. This study was designed to test the extent of variation among expert radiologists' interpretations and to assess how their interpretations differed from that of the primary (institutional) radiologists. MATERIALS AND METHODS: Five radiologists independently reviewed randomly selected CT scans of 59 patients enrolled onto two Pediatric Oncology Group Hodgkin's disease treatment protocols. For each patient, 31 potential disease sites were scored as positive, negative, uncertain, or unassessable. Agreement among the reviewers and between the reviewers and the primary readers was analyzed. RESULTS: For 58% of the sites, at least four of the five reviewers agreed in ≥ 80% of the cases. Kappa analysis showed moderate agreement in approximately two thirds of the sites and poor agreement in the remainder. There was moderate agreement between a majority of the expert readers and the primary radiologist reports for approximately one third of the sites, and agreement was poor in two thirds. CONCLUSION: There are disparities among radiologists' interpretations of cervical-thoracic CT imaging of patients with Hodgkin's disease. This variability may affect patient care and the performance and results of multi-institutional clinical trials. We propose that a standardized method of reporting might improve the consistency of interpretation of CT scans in these patients.

Report of a committee convened to discuss the evaluation and staging of patients with Hodgkin's disease: Cotswolds meeting.

1989 ◽  
Vol 7 (11) ◽  
pp. 1630-1636 ◽  
Author(s):  
T A Lister ◽  
D Crowther ◽  
S B Sutcliffe ◽  
E Glatstein ◽  
G P Canellos ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Hodgkin's Disease ◽  
Imaging Techniques ◽  
Hodgkin’S Disease ◽  
Response To Therapy ◽  
Maximum Dimension ◽  
New Techniques ◽  
Bulky Disease ◽  
Ann Arbor ◽  
Uncertain Significance

The Ann Arbor classification for describing the stage of Hodgkin's disease at initial presentation has formed the basis upon which treatment is selected and has allowed comparison of results achieved by different investigators for almost two decades. A meeting was convened to review the classification and modify it in the light of experience gained in its use and new techniques for evaluating disease. It was concluded that the structure of the classification be maintained. It was particularly recommended: (1) that computed tomography (CT) be included as a technique for evaluating intrathoracic and infradiaphragmatic lymph nodes; (2) that the criteria for clinical involvement of the spleen and liver be modified to include evidence of focal defects with two imaging techniques and that abnormalities of liver function be ignored; (3) that the suffix 'X' to designate bulky disease (greater than 10 cm maximum dimension) be introduced; and (4) that a new category of response to therapy, unconfirmed/uncertain complete remission (CR[u]), be introduced to accommodate the difficulty of persistent radiological abnormalities of uncertain significance.

Computed Tomography as an Adjunct in the Staging of Hodgkin's Disease and Non-Hodgkin's Lymphomas

Radiology ◽  
1977 ◽  
Vol 124 (2) ◽  
pp. 381-385 ◽  
Author(s):  
Helen C. Redman ◽  
Eli Glatstein ◽  
Ronald A. Castellino ◽  
W. Aubrey Federal
Keyword(s):  
Computed Tomography ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Hodgkin's Lymphomas

Outcome of patients with Hodgkin's disease failing after primary MOPP-ABVD.

1997 ◽  
Vol 15 (2) ◽  
pp. 528-534 ◽  
Author(s):  
V Bonfante ◽  
A Santoro ◽  
S Viviani ◽  
L Devizzi ◽  
M Balzarotti ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Complete Remission ◽  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Response Duration ◽  
Long Term Results ◽  
High Dose ◽  
First Line ◽  
Disease Extent

PURPOSE This study analyzed long-term results in patients with Hodgkin's disease who were resistant to or relapsed after first-line treatment with MOPP and ABVD. Response to salvage treatments and prognostic factors were also evaluated. PATIENTS AND METHODS The study population included 115 refractory or relapsed patients among a total of 415 patients treated with alternating or hybrid MOPP-ABVD followed by radiotherapy (25 to 30 Gy) to initial bulky sites. The median follow-up duration of the present series was 91 months. Thirty-nine of 115 patients (34%) showed disease progression while on primary treatment (induction failures); 48 relapsed after complete remissions that lasted < or = 12 months and 28 after complete remission that lasted more than 12 months from the end of all treatments. RESULTS At 8 years, the overall survival rate was 27%, being 54% and 28% in patients whose initial complete remission was longer or shorter than 12 months, respectively, and 8% in induction failures (P < .001). Response to first-line chemotherapy and disease extent at first progression significantly influenced long-term results, as well as the incidence and duration of complete remission. CONCLUSION The present data confirm previous observations that showed the main prognostic factors to influence outcome after salvage treatment are response duration to first-line therapy and disease extent at relapse. The results indicate that patients who relapse after the alternating MOPP/ABVD regimen have a prognosis similar to that of patients who relapse after a four-drug regimen (MOPP or ABVD alone). Re-treatment with initial chemotherapy seems the treatment of choice for patients who relapse after an initial complete remission that lasts greater than 12 months, while the real impact of high-dose chemotherapy or new regimens should be assessed in resistant patients.

scholarly journals Comparative analysis of density histograms and visual scores in incremental and volumetric high-resolution computed tomography of the chest in idiopathic pulmonary fibrosis patients

2020 ◽  
Author(s):  
Gaetano Rea ◽  
Marina De Martino ◽  
Annalisa Capaccio ◽  
Pasquale Dolce ◽  
Tullio Valente ◽  
...  
Keyword(s):  
Computed Tomography ◽  
High Resolution ◽  
Lung Function ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Ct Scans ◽  
High Resolution Computed Tomography ◽  
Disease Extent ◽  
Single Breath ◽  
Volumetric Ct

Abstract Background Volumetric high-resolution computed tomography (HRCT) of the chest has recently replaced incremental CT in the diagnostic workup of idiopathic pulmonary fibrosis (IPF). Concomitantly, visual and quantitative scores have been proposed for disease extent assessment to ameliorate disease management. Purpose To compare the performance of density histograms (mean lung attenuation, skewness, and kurtosis) and visual scores, along with lung function correlations, in IPF patients submitted to incremental or volumetric thorax HRCT. Material and methods Clinical data and CT scans of 89 newly diagnosed and therapy-naive IPF patients were retrospectively evaluated. Results Forty-six incremental and 43 volumetric CT scans were reviewed. No differences of density histograms and visual scores estimates were found by comparing two HRCT techniques, with an optimal inter-operator agreement (concordance correlation coefficient >0.90 in all instances). Single-breath diffusing lung capacity for carbon monoxide (DLCOsb) was inversely related with the Best score (r = −00.416; p = 0.014), the Kazerooni fibrosis extent (r = −0.481; p = 0.004) and the mean lung attenuation (r = −0.382; p = 0.026), while a positive correlation was observed with skewness (r = 0.583; p = 0.001) and kurtosis (r = 0.543; p = 0.001) in the incremental HRCT sub-group. Similarly, in the volumetric CT sub-cohort, DLCOsb was significantly associated with skewness (r = 0.581; p = 0.007) and kurtosis (r = 0.549; p = 0.018). Correlations with visual scores were not confirmed. Forced vital capacity significantly related to all density indices independently on HRCT technique. Conclusions Density histograms and visual scores similarly perform in incremental and volumetric HRCT. Density quantification displays an optimal reproducibility and proves to be superior to visual scoring as more strongly correlated with lung function.

scholarly journals Second tumors and myeloproliferative diseases after Hodgkin's disease treatment

1986 ◽  
Vol 10 (7) ◽  
pp. 887
Author(s):  
F. Andrien ◽  
M. Lemaire ◽  
Y. Beguin ◽  
J. Bury ◽  
J. Closon ◽  
...  
Keyword(s):  
Hodgkin's Disease ◽  
Hodgkin’S Disease ◽  
Disease Treatment ◽  
Myeloproliferative Diseases ◽  
Second Tumors

Assessment of Tumor Size Reduction Improves Outcome Prediction of Positron Emission Tomography/Computed Tomography After Chemotherapy in Advanced-Stage Hodgkin Lymphoma

2014 ◽  
Vol 32 (17) ◽  
pp. 1776-1781 ◽  
Author(s):  
Carsten Kobe ◽  
Georg Kuhnert ◽  
Deniz Kahraman ◽  
Heinz Haverkamp ◽  
Hans-Theodor Eich ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Hodgkin Lymphoma ◽  
Hodgkin's Disease ◽  
Outcome Prediction ◽  
Hodgkin’S Disease ◽  
Emission Tomography ◽  
Advanced Stage ◽  
Positron Emission ◽  
Risk Of Progression

Purpose Positron emission tomography (PET) after chemotherapy can guide consolidating radiotherapy in advanced-stage Hodgkin lymphoma (HL). This analysis aims to improve outcome prediction by integrating additional criteria derived by computed tomography (CT). Patients and Methods The analysis set consisted of 739 patients with residues ≥ 2.5 cm after chemotherapy from a total of 2,126 patients treated in the HD15 trial (HD15 for advanced stage Hodgkin's disease: Quality assurance protocol for reduction of toxicity and the prognostic relevance of fluorodeoxyglucose-positron-emission tomography [FDG-PET] in the first-line treatment of advanced-stage Hodgkin's disease) performed by the German Hodgkin Study Group. A central panel performed image analysis and interpretation of CT scans before and after chemotherapy as well as PET scans after chemotherapy. Prognosis was evaluated by using progression-free survival (PFS); groups were compared with the log-rank test. Potential prognostic factors were investigated by using receiver operating characteristic analysis and logistic regression. Results In all, 548 (74%) of 739 patients had PET-negative residues after chemotherapy; these patients did not receive additional radiotherapy and showed a 4-year PFS of 91.5%. The 191 PET-positive patients (26%) receiving additional radiotherapy had a 4-year PFS of 86.1% (P = .022). CT alone did not allow further separation of patients in partial remission by risk of recurrence (P = .9). In the subgroup of the 54 PET-positive patients with a relative reduction of less than 40%, the risk of progression or relapse within the first year was 23.1% compared with 5.3% for patients with a larger reduction (difference, 17.9%; 95% CI, 5.8% to 30%). Conclusion Patients with HL who have PET-positive residual disease after chemotherapy and poor tumor shrinkage are at high risk of progression or relapse.

Urinary Neopterin in Malignant Lymphoma

1991 ◽  
Vol 6 (4) ◽  
pp. 231-236 ◽  
Author(s):  
L. Piccinini ◽  
S. Zironi ◽  
M. Federico ◽  
L. A. Pini ◽  
G. Luppi
Keyword(s):  
Hodgkin's Disease ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin’S Disease ◽  
Clinical Stage ◽  
Response To Therapy ◽  
Hodgkin's Lymphoma ◽  
Stage Iii ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma ◽  
Urinary Neopterin

Urinary neopterin levels were studied in 96 patients with malignant lymphomas. Twenty-eight had Hodgkin's disease and 68 non-Hodgkin's lymphoma. Neopterin excretion was significantly related to the clinical stage of the disease. Mean neopterin excretion in patients with active disease (634 ± 527 μmol neopterin/mol creatinine) was significantly higher (p = 0.000) than in patients in complete remission (198 ± 105 μmol neopterin/mol creatinine). Mean neopterin levels of patients in stage III-IV were higher than for patients in stage III. These findings were the same in patients with Hodgkin's disease and those with non-Hodgkin's lymphoma (659 ± 593 - 425 ± 316 μmol neopterin/mol creatinine), regardless of the histological subtype. A significant correlation was found between neopterin excretion, ESR (r=0.31; p=0.003) and hemoglobin (r=–0.40; p=0.000). Longitudinal analysis showed a trend towards a correlation between response to therapy and neopterin excretion. These findings suggest that neopterin may be a useful prognostic marker in non-Hodgkin's lymphoma.

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