Original Research

Inter-observer variability influences the Lugano classification when restaging lymphoma

Jacobus Möller, Tiaan Steyn, Nantes Combrinck, Gina Joubert, Alicia Sherriff, Jacques Janse van Rensburg
South African Journal of Radiology | Vol 22, No 1 | a1357 | DOI: https://doi.org/10.4102/sajr.v22i1.1357 | © 2018 Jacobus Moller, Tiaan Steyn, Nantes Combrinck, Gina Joubert, Alicia Sherriff, Jacques Janse van Rensburg | This work is licensed under CC Attribution 4.0
Submitted: 24 April 2018 | Published: 31 July 2018

About the author(s)

Jacobus Möller, Department of Clinical Imaging Sciences, Universitas Academic Hospital and University of the Free State, South Africa
Tiaan Steyn, Department of Clinical Imaging Sciences, Universitas Academic Hospital and University of the Free State, South Africa
Nantes Combrinck, Department of Clinical Imaging Sciences, Universitas Academic Hospital and University of the Free State, South Africa
Gina Joubert, Department of Biostatistics, University of the Free State, South Africa
Alicia Sherriff, Department of Oncology, Universitas Academic Hospital and University of the Free State, South Africa
Jacques Janse van Rensburg, Department of Radiology, Universitas Academic Hospital and University of the Free State, South Africa


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Abstract

Background: Lymphoma is an important and potentially curable oncological disease in South Africa. The staging and restaging of lymphoma have evolved over the years, with the latest international consensus guideline being the Lugano classification (LC). Prior to routine implementation of the LC, its robustness in the local setting should be determined.

 

Objectives: To determine the Inter-observer variability in response assignment when applying the LC in patients with lymphoma who were staged and restaged with computed tomography. In case of excessive discordance, specific mitigating measures will have to be taken before and during any proposed implementation of the LC.

 

Method: A total of 61 computed tomography scans in 21 patients were evaluated independently by four reviewers according to the LC, of which 21 scans were done at baseline, 21 at initial restaging and 19 at follow-up restaging. A retrospective comparative analysis was performed. Kappa values were calculated to determine agreement between observers.

 

Results: Only a moderate inter-observer agreement of 52% in the overall response classification was demonstrated. The most important sources of discrepancy were inconsistency in the assessment of target lesion regression to normal, determining the percentage change in the summed cross-sectional area of the target lesions and ascribing new lesions as either due to lymphoma or other causes.

 

Conclusion: Implementing the Lugano classification when restaging lymphoma is desirable to improve consistency and to conform to international guidelines. However, our study shows substantial inter-observer variability in response classification, potentially altering the treatment plan. Dedicated training and continuous quality control should, therefore, accompany the process.


Keywords

lymphoma; lugano classification; computed tomography; interobserver variability

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