High Interobserver Agreement for the Standardized Reporting System SSTR-RADS 1.0 on Somatostatin Receptor PET/CT

Werner, Rudolf A.; Derlin, Thorsten; Rowe, Steven P.; Bundschuh, Lena; Sheikh, Gabriel T.; Pomper, Martin G.; Schulz, Sebastian; Higuchi, Takahiro; Buck, Andreas K.; Bengel, Frank M.; Bundschuh, Ralph A.; Lapa, Constantin

doi:10.2967/jnumed.120.245464

Cited by 12 publications

(19 citation statements)

References 38 publications

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“…As described in 12 , overall scan impression was assessed in a binary fashion. Scans were rated as positive when uptakes in disease sites were above background level.…”

Section: Methodsmentioning

confidence: 99%

Interobserver Agreement Rates on Fibroblast Activation Protein Inhibitor–Directed Molecular Imaging and Therapy

et al. 2022

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ObjectivesFibroblast activation protein (FAP) has emerged as a novel target for FAP inhibitor (FAPI)–directed molecular imaging and endoradiotherapy (ERT). We aimed to assess the interobserver agreement rates for interpretation of 68Ga-FAPI-4 PET/CT and decision for ERT.Patients and MethodsA random order of 68Ga-FAPI-4 PET/CTs from 49 oncology patients were independently interpreted by 4 blinded readers. Per scan, visual assessment was performed, including overall scan impression, number of organ/lymph node (LN) metastases, and number of affected organs/LN regions. Moreover, a maximum of 3 target lesions, defined as largest in size and/or most intense, per organ compartment were identified, which allowed for an additional quantitative interobserver assessment of LN and organ lesions. To investigate potential reference tissues, quantification also included unaffected liver parenchyma and blood pool. Readers also had to indicate whether FAPI-directed ERT should be considered (based on intensity of uptake and widespread disease). Interobserver agreement rates were evaluated using intraclass correlation coefficients (ICCs) and interpreted according to Cicchetti (with 0.4–0.59 indicating fair, and 0.6–0.74 good, agreement).ResultsOn a visual basis, the agreement rate for an overall scan impression was fair (ICC, 0.42; 95% confidence interval [CI], 0.27–0.57). The concordance rate for number of affected LN areas was also fair (ICC, 0.59; 95% CI, 0.45–0.72), whereas the number of LN metastases, number of affected organs, and number of organ metastases achieved good agreement rates (ICC, ≥0.63). In a quantitative analysis, concordance rates for LN were good (ICC, 0.70; 0.48–0.88), but only fair for organ lesions (ICC, 0.43; 0.26–0.60). In regards to background tissues, ICCs were good for unaffected liver parenchyma (0.68; 0.54–0.79) and fair for blood pool (0.43; 0.29–0.58). When readers should decide on ERT, concordance rates were also fair (ICC, 0.59; 95% CI, 0.46–0.73).ConclusionsFor FAPI-directed molecular imaging and therapy, a fair to good interobserver agreement rate was achieved, supporting the adoption of this radiotracer for clinical routine and multicenter trials.

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“…As described in 12 , overall scan impression was assessed in a binary fashion. Scans were rated as positive when uptakes in disease sites were above background level.…”

Section: Methodsmentioning

confidence: 99%

Interobserver Agreement Rates on Fibroblast Activation Protein Inhibitor–Directed Molecular Imaging and Therapy

et al. 2022

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“…A reporting system for SSTR PET imaging, known as SSTR-RADS, has been proposed to standardize diagnosis and treatment planning, where uptake of lesions is compared to background liver and correlated on CT, giving a per-lesion score of 1 (benign) to 5 (NET almost certainly present) [35]. It has shown high interobserver agreement and adoption for trials and clinical use is thus supported [36], although this has not yet translated into practice. The affinity profile of the three major PET radiotracers for SSTR imaging varies; 68 Ga-DOTATATE is most selective for SSTR2, 68 Ga-DOTATOC binds with greater affinity to both SSTR2 and SSTR5 and 68 Ga-DOTANOC with SSTR2, SSTR3 and SSTR5 [31].…”

Section: Somatostatin Receptor Imagingmentioning

confidence: 99%

Section: Somatostatin Receptor Imagingmentioning

confidence: 99%

Treatment of Neuroendocrine Neoplasms with Radiolabeled Peptides—Where Are We Now

Naik¹,

Al-Nahhas²,

Khan³

2022

Cancers

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Peptide receptor radionuclide therapy (PRRT) has been one of the most successful and exciting examples of theranostics in nuclear medicine in recent decades and is now firmly embedded in many treatment algorithms for unresectable or metastatic neuroendocrine neoplasms (NENs) worldwide. It is widely considered to be an effective treatment for well- or moderately differentiated neoplasms, which express high levels of somatostatin receptors that can be selectively targeted. This review article outlines the scientific basis of PRRT in treatment of NENs and describes its discovery dating back to the early 1990s. Early treatments utilizing Indium-111, a γ-emitter, showed promise in reduction in tumor size and improvement in biochemistry, but were also met with high radiation doses and myelotoxic and nephrotoxic effects. Subsequently, stable conjugation of DOTA-peptides with β-emitting radionuclides, such as Yttrium-90 and Lutetium-177, served as a breakthrough for PRRT and studies highlighted their potential in eliciting progression-free survival and quality of life benefits. This article will also elaborate on the key trials which paved the way for its approval and will discuss therapeutic considerations, such as patient selection and administration technique, to optimize its use.

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“…Recent advances in structural reporting of SSTR-PET by SSTR-RADS 1.0 [66] offer high interobserver reliability [67] necessary for reliable response assessment. These might pave the way for structured response assessment criteria including SSTR-PET.…”

Section: Molecular Imagingmentioning

confidence: 99%

Imaging and liquid biopsy in the prediction and evaluation of response to PRRT in neuroendocrine tumors: implications for patient management

Roll

Weckesser

Seifert

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose The aim of this narrative review is to give an overview on current and emerging imaging methods and liquid biopsy for prediction and evaluation of response to PRRT. Current limitations and new perspectives, including artificial intelligence, are discussed. Methods A literature review of PubMed/Medline was performed with representative keywords. The search included articles published online through August 31, 2020. All searches were restricted to English language manuscripts. Results Peptide radio receptor therapy (PRRT) is a prospectively evaluated and approved therapy option in neuroendocrine tumors (NETs). Different ligands targeting the somatostatin receptor (SSTR) are used as theranostic pairs for imaging NET and for PRRT. Response assessment in prospective trials often relies on the morphological RECIST 1.1 criteria, based on lesion size in CT or MRI. The role of SSTR-PET and quantitative uptake parameters and volumetric data is still not defined. Monoanalyte tumor marker chromogranin A has a limited value for response assessment after PRRT. New emerging liquid biopsy techniques are offering prediction of response to PRRT and prognostic value. Conclusions New response criteria for NET patients undergoing PRRT will comprise multiparametric hybrid imaging and blood-based multianalyte markers. This represents tumor biology and heterogeneity.

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High Interobserver Agreement for the Standardized Reporting System SSTR-RADS 1.0 on Somatostatin Receptor PET/CT

Cited by 12 publications

References 38 publications

Interobserver Agreement Rates on Fibroblast Activation Protein Inhibitor–Directed Molecular Imaging and Therapy

Interobserver Agreement Rates on Fibroblast Activation Protein Inhibitor–Directed Molecular Imaging and Therapy

Treatment of Neuroendocrine Neoplasms with Radiolabeled Peptides—Where Are We Now

Imaging and liquid biopsy in the prediction and evaluation of response to PRRT in neuroendocrine tumors: implications for patient management

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