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Chapter 4
limitation is the use of older generation PET/CT systems (Supplemental Table 4), which could influence the generalizability of our results.
Our findings, especially the suboptimal PA, have implications for trial design and clinical practice. A PA of 74% at I-PET clearly emphasizes the need for central review procedures in clinical trials investigating intensified therapy in I-PET– positive patients. The 76% PA at EoT-PET reinforces the recommendation to discuss patients during multidisciplinary tumor board meetings, allowing for a second read of the test result, aiming for optimal patient management (e.g., confirmatory scan or biopsy).
Our data indicate that reviewers are especially uncertain in cases of extranodal lymphoma involvement, which is common in DLBCL patients, with baseline frequencies of up to 20% depending on the site (Table 2 and Supplemental Table 3). These results could be helpful in focusing the training of nuclear medicine physicians, such as by using the harmonization approach of Ceriani et al. [25]. During the last 10–15 y, 18F-FDG PET/CT systems’ quality continued to evolve, and guidelines therefore need to be updated on a regular basis [26,27].
Conclusion
Interobserver agreement among experienced nuclear medicine physicians using DS for I-PET and EoT-PET response assessment in DLBCL has high percentages of OA (88%–92%) and NA (92%–95%). The lower (74%–76%) PA suggests that the accuracy of EoT-PET/CT treatment evaluation in daily practice and I-PET– adapted trials may benefit from dual reads and central review, respectively.
Disclosure
This work was financially supported by an Alpe d’HuZes/KWF fund, provided by the Dutch Cancer Society (VU 2012-5848). Pieternella Lugtenburg has received research funding from Roche, Servier, and Takeda and honoraria for advisory boards from Roche, Servier, Sandoz, BMS, Genmab, Takeda, and Celgene. No other potential conflict of interest relevant to this article was reported.
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