Head and neck PET/CT: Therapy response interpretation criteria (Hopkins criteria) - Interreader reliability, accuracy, and survival outcomes

Charles Marcus, Anthony Ciarallo, Abdel K. Tahari, Esther Mena, Wayne Koch, Richard L. Wahl, Ana P. Kiess, Hyunseok Kang, Rathan M. Subramaniam

Research output: Contribution to journalArticle

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Abstract

There has been no established qualitative system of interpretation for therapy response assessment using PET/CT for head and neck cancers. The objective of this study was to validate the Hopkins interpretation system to assess therapy response and survival outcome in head and neck squamous cell cancer patients (HNSCC). Methods: The study included 214 biopsy-proven HNSCC patients who underwent a posttherapy PET/CT study, between 5 and 24 wk after completion of treatment. The median follow-up was 27 mo. PET/CT studies were interpreted by 3 nuclear medicine physicians, independently. The studies were scored using a qualitative 5-point scale, for the primary tumor, for the right and left neck, and for overall assessment. Scores 1, 2, and 3 were considered negative for tumors, and scores 4 and 5 were considered positive for tumors. The Cohen ? coefficient (?) was calculated to measure interreader agreement. Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier plots with a Mantel-Cox log-rank test and Gehan Breslow Wilcoxon test for comparisons. Results: Of the 214 patients, 175 were men and 39 were women. There was 85.98%, 95.33%, 93.46%, and 87.38% agreement between the readers for overall, left neck, right neck, and primary tumor site response scores, respectively. The corresponding ? coefficients for interreader agreement between readers were, 0.69-0.79, 0.68- 0.83, 0.69-0.87, and 0.79-0.86 for overall, left neck, right neck, and primary tumor site response, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the therapy assessment were 68.1%, 92.2%, 71.1%, 91.1%, and 86.9%, respectively. Cox multivariate regression analysis showed human papillomavirus (HPV) status and PET/CT interpretation were the only factors associated with PFS and OS. Among the HPV-positive patients (n = 123), there was a significant difference in PFS (hazard ratio [HR], 0.14; 95% confidence interval, 0.03- 0.57; P = 0.0063) and OS (HR, 0.01; 95% confidence interval, 0.00- 0.13; P = 0.0006) between the patients who had a score negative for residual tumor versus positive for residual tumor. A similar significant difference was observed in PFS and OS for all patients. There was also a significant difference in the PFS of patients with PET-avid residual disease in one site versus multiple sites in the neck (HR, 0.23; log-rank P = 0.004). Conclusion: The Hopkins 5- point qualitative therapy response interpretation criteria for head and neck PET/CT has substantial interreader agreement and excellent negative predictive value and predicts OS and PFS in patients with HPV-positive HNSCC. COPYRIGHT

Original languageEnglish (US)
Pages (from-to)1411-1416
Number of pages6
JournalJournal of Nuclear Medicine
Volume55
Issue number9
DOIs
StatePublished - Jan 1 2014

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Neck
Head
Survival
Disease-Free Survival
Head and Neck Neoplasms
Squamous Cell Neoplasms
Therapeutics
Residual Neoplasm
Neoplasms
Confidence Intervals
Nuclear Medicine
Multivariate Analysis
Regression Analysis
Physicians
Biopsy
Sensitivity and Specificity

Keywords

  • Head and neck
  • Hopkins PET interpretation criteria
  • Therapy assessment

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

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Head and neck PET/CT : Therapy response interpretation criteria (Hopkins criteria) - Interreader reliability, accuracy, and survival outcomes. / Marcus, Charles; Ciarallo, Anthony; Tahari, Abdel K.; Mena, Esther; Koch, Wayne; Wahl, Richard L.; Kiess, Ana P.; Kang, Hyunseok; Subramaniam, Rathan M.

In: Journal of Nuclear Medicine, Vol. 55, No. 9, 01.01.2014, p. 1411-1416.

Research output: Contribution to journalArticle

Marcus, Charles ; Ciarallo, Anthony ; Tahari, Abdel K. ; Mena, Esther ; Koch, Wayne ; Wahl, Richard L. ; Kiess, Ana P. ; Kang, Hyunseok ; Subramaniam, Rathan M. / Head and neck PET/CT : Therapy response interpretation criteria (Hopkins criteria) - Interreader reliability, accuracy, and survival outcomes. In: Journal of Nuclear Medicine. 2014 ; Vol. 55, No. 9. pp. 1411-1416.
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AU - Marcus, Charles

AU - Ciarallo, Anthony

AU - Tahari, Abdel K.

AU - Mena, Esther

AU - Koch, Wayne

AU - Wahl, Richard L.

AU - Kiess, Ana P.

AU - Kang, Hyunseok

AU - Subramaniam, Rathan M.

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N2 - There has been no established qualitative system of interpretation for therapy response assessment using PET/CT for head and neck cancers. The objective of this study was to validate the Hopkins interpretation system to assess therapy response and survival outcome in head and neck squamous cell cancer patients (HNSCC). Methods: The study included 214 biopsy-proven HNSCC patients who underwent a posttherapy PET/CT study, between 5 and 24 wk after completion of treatment. The median follow-up was 27 mo. PET/CT studies were interpreted by 3 nuclear medicine physicians, independently. The studies were scored using a qualitative 5-point scale, for the primary tumor, for the right and left neck, and for overall assessment. Scores 1, 2, and 3 were considered negative for tumors, and scores 4 and 5 were considered positive for tumors. The Cohen ? coefficient (?) was calculated to measure interreader agreement. Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier plots with a Mantel-Cox log-rank test and Gehan Breslow Wilcoxon test for comparisons. Results: Of the 214 patients, 175 were men and 39 were women. There was 85.98%, 95.33%, 93.46%, and 87.38% agreement between the readers for overall, left neck, right neck, and primary tumor site response scores, respectively. The corresponding ? coefficients for interreader agreement between readers were, 0.69-0.79, 0.68- 0.83, 0.69-0.87, and 0.79-0.86 for overall, left neck, right neck, and primary tumor site response, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the therapy assessment were 68.1%, 92.2%, 71.1%, 91.1%, and 86.9%, respectively. Cox multivariate regression analysis showed human papillomavirus (HPV) status and PET/CT interpretation were the only factors associated with PFS and OS. Among the HPV-positive patients (n = 123), there was a significant difference in PFS (hazard ratio [HR], 0.14; 95% confidence interval, 0.03- 0.57; P = 0.0063) and OS (HR, 0.01; 95% confidence interval, 0.00- 0.13; P = 0.0006) between the patients who had a score negative for residual tumor versus positive for residual tumor. A similar significant difference was observed in PFS and OS for all patients. There was also a significant difference in the PFS of patients with PET-avid residual disease in one site versus multiple sites in the neck (HR, 0.23; log-rank P = 0.004). Conclusion: The Hopkins 5- point qualitative therapy response interpretation criteria for head and neck PET/CT has substantial interreader agreement and excellent negative predictive value and predicts OS and PFS in patients with HPV-positive HNSCC. COPYRIGHT

AB - There has been no established qualitative system of interpretation for therapy response assessment using PET/CT for head and neck cancers. The objective of this study was to validate the Hopkins interpretation system to assess therapy response and survival outcome in head and neck squamous cell cancer patients (HNSCC). Methods: The study included 214 biopsy-proven HNSCC patients who underwent a posttherapy PET/CT study, between 5 and 24 wk after completion of treatment. The median follow-up was 27 mo. PET/CT studies were interpreted by 3 nuclear medicine physicians, independently. The studies were scored using a qualitative 5-point scale, for the primary tumor, for the right and left neck, and for overall assessment. Scores 1, 2, and 3 were considered negative for tumors, and scores 4 and 5 were considered positive for tumors. The Cohen ? coefficient (?) was calculated to measure interreader agreement. Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier plots with a Mantel-Cox log-rank test and Gehan Breslow Wilcoxon test for comparisons. Results: Of the 214 patients, 175 were men and 39 were women. There was 85.98%, 95.33%, 93.46%, and 87.38% agreement between the readers for overall, left neck, right neck, and primary tumor site response scores, respectively. The corresponding ? coefficients for interreader agreement between readers were, 0.69-0.79, 0.68- 0.83, 0.69-0.87, and 0.79-0.86 for overall, left neck, right neck, and primary tumor site response, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of the therapy assessment were 68.1%, 92.2%, 71.1%, 91.1%, and 86.9%, respectively. Cox multivariate regression analysis showed human papillomavirus (HPV) status and PET/CT interpretation were the only factors associated with PFS and OS. Among the HPV-positive patients (n = 123), there was a significant difference in PFS (hazard ratio [HR], 0.14; 95% confidence interval, 0.03- 0.57; P = 0.0063) and OS (HR, 0.01; 95% confidence interval, 0.00- 0.13; P = 0.0006) between the patients who had a score negative for residual tumor versus positive for residual tumor. A similar significant difference was observed in PFS and OS for all patients. There was also a significant difference in the PFS of patients with PET-avid residual disease in one site versus multiple sites in the neck (HR, 0.23; log-rank P = 0.004). Conclusion: The Hopkins 5- point qualitative therapy response interpretation criteria for head and neck PET/CT has substantial interreader agreement and excellent negative predictive value and predicts OS and PFS in patients with HPV-positive HNSCC. COPYRIGHT

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