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The clinical impact of observer variability in lung nodule classification in children with Wilms Tumour
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  • Jesper Brok,
  • Susan Shelmerdine,
  • frederikke damsgaard,
  • Anne Smets,
  • Sabine IRTAN,
  • Sophie Swinson,
  • Venus Hedayati,
  • Joseph Jacob,
  • Arjun Nair,
  • Minou Oostveen,
  • Kathy Pritchard-Jones,
  • Øystein Olsen
Jesper Brok
University College London Institute of Child Health

Corresponding Author:jesper.sune.brok@regionh.dk

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Susan Shelmerdine
Great Ormond Street Hospital for Children
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frederikke damsgaard
Copenhagen University Hospital
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Anne Smets
Academic Medical Centre
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Sabine IRTAN
Hôpital Necker
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Sophie Swinson
Leeds Teaching Hospitals NHS Trust
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Venus Hedayati
King's College Hospital NHS Foundation Trust
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Joseph Jacob
University College London
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Arjun Nair
University College London Hospitals NHS Foundation Trust
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Minou Oostveen
UCL Great Ormond Street Institute of Child Health Library
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Kathy Pritchard-Jones
UCL Great Ormond Street Institute of Child Health Library
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Øystein Olsen
Great Ormond Street Hospital for Children
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Abstract

Objectives To investigate the extent to which observer variability of CT lung nodule assessment may affect clinical treatment stratification in Wilms Tumor (WT) patients, according to the recent SIOP-RTSG UMBRELLA protocol. Methods I: CT thoraces of children with WT submitted for central review, were used to estimate size distribution of lung metastases. II: Scans were selected for blinded review by five radiologists to determine intra and inter-observer variability. They assessed identical scans on two occasions six months apart. III: Monte Carlo simulation (MCMC) was used to predict the clinical impact of observer variation when applying the UMBRELLA protocol size criteria. Results Lung nodules were found in 84 out of 360 (23%) children with WT. For 21 identified lung nodules, inter-observer limits of agreement (LOA) for the five readers were ±2.4mm and ±1.4mm (AP diameter), ±1.9mm and ±1.8mm (TS diameter) and ±2.0mm and ±2.4mm (LS diameter) at assessments 1 and 2. Intra-observer LOA across the three dimensions were ±1.5mm, ±2.2mm, ±3.5mm, ±3.1mm and ± 2.6mm (readers 1-5). MCMC demonstrated that 17% of the patients with a ‘true’ nodule size of 3mm will be scored as <3 mm, and 21% of the patients with a ‘true’ nodule size of <3mm will be scored as being 3 mm. Conclusion A significant intra-inter observer-variation was found when measuring lung nodules on CT for patients with WT. This may have significant implications on treatment stratification, and thereby outcome, when applying a threshold of 3 mm for a lung nodule to dictate metastatic status.
26 Jan 2022Submitted to Pediatric Blood & Cancer
26 Jan 2022Submission Checks Completed
26 Jan 2022Assigned to Editor
09 Feb 2022Reviewer(s) Assigned
12 Mar 2022Review(s) Completed, Editorial Evaluation Pending
12 Mar 2022Editorial Decision: Revise Minor
10 Apr 20221st Revision Received
10 Apr 2022Submission Checks Completed
10 Apr 2022Assigned to Editor
11 Apr 2022Reviewer(s) Assigned
16 Apr 2022Review(s) Completed, Editorial Evaluation Pending
18 Apr 2022Editorial Decision: Accept
02 Jun 2022Published in Pediatric Blood & Cancer. 10.1002/pbc.29759