Alberts I, Hünermund JN, Sachpekidis C, Mingels C, Fech V, Bohn KP, Rominger A, Afshar-Oromieh A. The influence of digital PET/CT on diagnostic certainty and interrater reliability in [
68Ga]Ga-PSMA-11 PET/CT for recurrent prostate cancer.
Eur Radiol 2021;
31:8030-8039. [PMID:
33856522 PMCID:
PMC8452558 DOI:
10.1007/s00330-021-07870-5]
[Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/03/2021] [Accepted: 03/11/2021] [Indexed: 12/13/2022]
Abstract
Objective
To investigate the impact of digital PET/CT on diagnostic certainty, patient-based sensitivity and interrater reliability.
Methods
Four physicians retrospectively evaluated two matched cohorts of patients undergoing [68Ga]Ga-PSMA-11 PET/CT on a digital (dPET/CT n = 65) or an analogue scanner (aPET/CT n = 65) for recurrent prostate cancer between 11/2018 and 03/2019. The number of equivocal and pathological lesions as well as the frequency of discrepant findings and the interrater reliability for the two scanners were compared.
Results
dPET/CT detected more lesions than aPET/CT (p < 0.001). A higher number of pathological scans were observed for dPET/CT (83% vs. 57%, p < 0.001). The true-positive rate at follow-up was 100% for dPET/CT compared to 84% for aPET/CT (p < 0.001). The proportion of lesions rated as non-pathological as a total of all PSMA-avid lesions detected for dPET/CT was comparable to aPET/CT (61.8% vs. 57.0%, p = 0.99). Neither a higher rate of diagnostically uncertain lesions (11.5% dPET/CT vs. 13.7% aPET/CT, p = 0.95) nor discrepant scans (where one or more readers differed in opinion as to whether the scan is pathological) were observed (18% dPET/CT vs. 17% aPET/CT, p = 0.76). Interrater reliability for pathological lesions was excellent for both scanner types (Cronbach’s α = 0.923 dPET/CT; α = 0.948 aPET/CT) and interrater agreement was substantial for dPET/CT (Krippendorf’s α = 0.701) and almost perfect in aPET/CT (α = 0.802).
Conclusions
A higher detection rate for pathological lesions for dPET/CT compared with aPET/CT in multiple readers was observed. This improved sensitivity was coupled with an improved true-positive rate and was not associated with increased diagnostic uncertainty, rate of non-specific lesions, or reduced interrater reliability.
Key Points
• New generation digital scanners detect more cancer lesions in men with prostate cancer.
• When using digital scanners, the doctors are able to diagnose prostate cancer lesions with better certainty
• When using digital scanners, the doctors do not disagree with each other more than with other scanner types.
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