Spinal instability neoplastic score: An analysis of reliability and validity from the spine Oncology Study Group

Daryl R. Fourney, Evan M. Frangou, Timothy C. Ryken, Christian P. DiPaola, Christopher I. Shaffrey, Sigurd H. Berven, Mark H. Bilsky, James S. Harrop, Michael G. Fehlings, Stefano Boriani, Dean Chou, Meic H. Schmidt, David W. Polly, Roberto Biagini, Shane Burch, Mark B. Dekutoski, Aruna Ganju, Peter C. Gerszten, Ziya L. Gokaslan, Michael W. GroffNorbert J. Liebsch, Ehud Mendel, Scott H. Okuno, Shreyaskumar Patel, Laurence D. Rhines, Peter S. Rose, Daniel M. Sciubba, Narayan Sundaresan, Katsuro Tomita, Peter P. Varga, Luiz R. Vialle, Frank D. Vrionis, Yoshiya Yamada, Charles G. Fisher

Research output: Contribution to journalArticle

226 Citations (Scopus)

Abstract

Purpose: Standardized indications for treatment of tumor-related spinal instability are hampered by the lack of a valid and reliable classification system. The objective of this study was to determine the interobserver reliability, intraobserver reliability, and predictive validity of the Spinal Instability Neoplastic Score (SINS). Methods: Clinical and radiographic data from 30 patients with spinal tumors were classified as stable, potentially unstable, and unstable by members of the Spine Oncology Study Group. The median category for each patient case (consensus opinion) was used as the gold standard for predictive validity testing. On two occasions at least 6 weeks apart, each rater also scored each patient using SINS. Each total score was converted into a three-category data field, with 0 to 6 as stable, 7 to 12 as potentially unstable, and 13 to 18 as unstable. Results: The ≲καππ α∀ statistics for interobserver reliability were 0.790, 0.841, 0.244, 0.456, 0.462, and 0.492 for the fields of location, pain, bone quality, alignment, vertebral body collapse, and posterolateral involvement, respectively. The ≲καππα∀ statistics for intraobserver reliability were 0.806, 0.859, 0.528, 0.614, 0.590, and 0.662 for the same respective fields. Intraclass correlation coefficients for inter- and intraobserver reliability of total SINS score were 0.846 (95% CI, 0.773 to 0.911) and 0.886 (95% CI, 0.868 to 0.902), respectively. The ≲καππα∀ statistic for predictive validity was 0.712 (95% CI, 0.676 to 0.766). Conclusion: SINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability. The sensitivity and specificity of SINS for potentially unstable or unstable lesions were 95.7% and 79.5%, respectively.

Original languageEnglish
Pages (from-to)3072-3077
Number of pages6
JournalJournal of Clinical Oncology
Volume29
Issue number22
DOIs
Publication statusPublished - Aug 1 2011

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Reproducibility of Results
Spine
Neoplasms
Consensus
Bone and Bones
Sensitivity and Specificity
Pain
Therapeutics

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

Fourney, D. R., Frangou, E. M., Ryken, T. C., DiPaola, C. P., Shaffrey, C. I., Berven, S. H., ... Fisher, C. G. (2011). Spinal instability neoplastic score: An analysis of reliability and validity from the spine Oncology Study Group. Journal of Clinical Oncology, 29(22), 3072-3077. https://doi.org/10.1200/JCO.2010.34.3897

Spinal instability neoplastic score : An analysis of reliability and validity from the spine Oncology Study Group. / Fourney, Daryl R.; Frangou, Evan M.; Ryken, Timothy C.; DiPaola, Christian P.; Shaffrey, Christopher I.; Berven, Sigurd H.; Bilsky, Mark H.; Harrop, James S.; Fehlings, Michael G.; Boriani, Stefano; Chou, Dean; Schmidt, Meic H.; Polly, David W.; Biagini, Roberto; Burch, Shane; Dekutoski, Mark B.; Ganju, Aruna; Gerszten, Peter C.; Gokaslan, Ziya L.; Groff, Michael W.; Liebsch, Norbert J.; Mendel, Ehud; Okuno, Scott H.; Patel, Shreyaskumar; Rhines, Laurence D.; Rose, Peter S.; Sciubba, Daniel M.; Sundaresan, Narayan; Tomita, Katsuro; Varga, Peter P.; Vialle, Luiz R.; Vrionis, Frank D.; Yamada, Yoshiya; Fisher, Charles G.

In: Journal of Clinical Oncology, Vol. 29, No. 22, 01.08.2011, p. 3072-3077.

Research output: Contribution to journalArticle

Fourney, DR, Frangou, EM, Ryken, TC, DiPaola, CP, Shaffrey, CI, Berven, SH, Bilsky, MH, Harrop, JS, Fehlings, MG, Boriani, S, Chou, D, Schmidt, MH, Polly, DW, Biagini, R, Burch, S, Dekutoski, MB, Ganju, A, Gerszten, PC, Gokaslan, ZL, Groff, MW, Liebsch, NJ, Mendel, E, Okuno, SH, Patel, S, Rhines, LD, Rose, PS, Sciubba, DM, Sundaresan, N, Tomita, K, Varga, PP, Vialle, LR, Vrionis, FD, Yamada, Y & Fisher, CG 2011, 'Spinal instability neoplastic score: An analysis of reliability and validity from the spine Oncology Study Group', Journal of Clinical Oncology, vol. 29, no. 22, pp. 3072-3077. https://doi.org/10.1200/JCO.2010.34.3897
Fourney, Daryl R. ; Frangou, Evan M. ; Ryken, Timothy C. ; DiPaola, Christian P. ; Shaffrey, Christopher I. ; Berven, Sigurd H. ; Bilsky, Mark H. ; Harrop, James S. ; Fehlings, Michael G. ; Boriani, Stefano ; Chou, Dean ; Schmidt, Meic H. ; Polly, David W. ; Biagini, Roberto ; Burch, Shane ; Dekutoski, Mark B. ; Ganju, Aruna ; Gerszten, Peter C. ; Gokaslan, Ziya L. ; Groff, Michael W. ; Liebsch, Norbert J. ; Mendel, Ehud ; Okuno, Scott H. ; Patel, Shreyaskumar ; Rhines, Laurence D. ; Rose, Peter S. ; Sciubba, Daniel M. ; Sundaresan, Narayan ; Tomita, Katsuro ; Varga, Peter P. ; Vialle, Luiz R. ; Vrionis, Frank D. ; Yamada, Yoshiya ; Fisher, Charles G. / Spinal instability neoplastic score : An analysis of reliability and validity from the spine Oncology Study Group. In: Journal of Clinical Oncology. 2011 ; Vol. 29, No. 22. pp. 3072-3077.
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abstract = "Purpose: Standardized indications for treatment of tumor-related spinal instability are hampered by the lack of a valid and reliable classification system. The objective of this study was to determine the interobserver reliability, intraobserver reliability, and predictive validity of the Spinal Instability Neoplastic Score (SINS). Methods: Clinical and radiographic data from 30 patients with spinal tumors were classified as stable, potentially unstable, and unstable by members of the Spine Oncology Study Group. The median category for each patient case (consensus opinion) was used as the gold standard for predictive validity testing. On two occasions at least 6 weeks apart, each rater also scored each patient using SINS. Each total score was converted into a three-category data field, with 0 to 6 as stable, 7 to 12 as potentially unstable, and 13 to 18 as unstable. Results: The ≲καππ α∀ statistics for interobserver reliability were 0.790, 0.841, 0.244, 0.456, 0.462, and 0.492 for the fields of location, pain, bone quality, alignment, vertebral body collapse, and posterolateral involvement, respectively. The ≲καππα∀ statistics for intraobserver reliability were 0.806, 0.859, 0.528, 0.614, 0.590, and 0.662 for the same respective fields. Intraclass correlation coefficients for inter- and intraobserver reliability of total SINS score were 0.846 (95{\%} CI, 0.773 to 0.911) and 0.886 (95{\%} CI, 0.868 to 0.902), respectively. The ≲καππα∀ statistic for predictive validity was 0.712 (95{\%} CI, 0.676 to 0.766). Conclusion: SINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability. The sensitivity and specificity of SINS for potentially unstable or unstable lesions were 95.7{\%} and 79.5{\%}, respectively.",
author = "Fourney, {Daryl R.} and Frangou, {Evan M.} and Ryken, {Timothy C.} and DiPaola, {Christian P.} and Shaffrey, {Christopher I.} and Berven, {Sigurd H.} and Bilsky, {Mark H.} and Harrop, {James S.} and Fehlings, {Michael G.} and Stefano Boriani and Dean Chou and Schmidt, {Meic H.} and Polly, {David W.} and Roberto Biagini and Shane Burch and Dekutoski, {Mark B.} and Aruna Ganju and Gerszten, {Peter C.} and Gokaslan, {Ziya L.} and Groff, {Michael W.} and Liebsch, {Norbert J.} and Ehud Mendel and Okuno, {Scott H.} and Shreyaskumar Patel and Rhines, {Laurence D.} and Rose, {Peter S.} and Sciubba, {Daniel M.} and Narayan Sundaresan and Katsuro Tomita and Varga, {Peter P.} and Vialle, {Luiz R.} and Vrionis, {Frank D.} and Yoshiya Yamada and Fisher, {Charles G.}",
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TY - JOUR

T1 - Spinal instability neoplastic score

T2 - An analysis of reliability and validity from the spine Oncology Study Group

AU - Fourney, Daryl R.

AU - Frangou, Evan M.

AU - Ryken, Timothy C.

AU - DiPaola, Christian P.

AU - Shaffrey, Christopher I.

AU - Berven, Sigurd H.

AU - Bilsky, Mark H.

AU - Harrop, James S.

AU - Fehlings, Michael G.

AU - Boriani, Stefano

AU - Chou, Dean

AU - Schmidt, Meic H.

AU - Polly, David W.

AU - Biagini, Roberto

AU - Burch, Shane

AU - Dekutoski, Mark B.

AU - Ganju, Aruna

AU - Gerszten, Peter C.

AU - Gokaslan, Ziya L.

AU - Groff, Michael W.

AU - Liebsch, Norbert J.

AU - Mendel, Ehud

AU - Okuno, Scott H.

AU - Patel, Shreyaskumar

AU - Rhines, Laurence D.

AU - Rose, Peter S.

AU - Sciubba, Daniel M.

AU - Sundaresan, Narayan

AU - Tomita, Katsuro

AU - Varga, Peter P.

AU - Vialle, Luiz R.

AU - Vrionis, Frank D.

AU - Yamada, Yoshiya

AU - Fisher, Charles G.

PY - 2011/8/1

Y1 - 2011/8/1

N2 - Purpose: Standardized indications for treatment of tumor-related spinal instability are hampered by the lack of a valid and reliable classification system. The objective of this study was to determine the interobserver reliability, intraobserver reliability, and predictive validity of the Spinal Instability Neoplastic Score (SINS). Methods: Clinical and radiographic data from 30 patients with spinal tumors were classified as stable, potentially unstable, and unstable by members of the Spine Oncology Study Group. The median category for each patient case (consensus opinion) was used as the gold standard for predictive validity testing. On two occasions at least 6 weeks apart, each rater also scored each patient using SINS. Each total score was converted into a three-category data field, with 0 to 6 as stable, 7 to 12 as potentially unstable, and 13 to 18 as unstable. Results: The ≲καππ α∀ statistics for interobserver reliability were 0.790, 0.841, 0.244, 0.456, 0.462, and 0.492 for the fields of location, pain, bone quality, alignment, vertebral body collapse, and posterolateral involvement, respectively. The ≲καππα∀ statistics for intraobserver reliability were 0.806, 0.859, 0.528, 0.614, 0.590, and 0.662 for the same respective fields. Intraclass correlation coefficients for inter- and intraobserver reliability of total SINS score were 0.846 (95% CI, 0.773 to 0.911) and 0.886 (95% CI, 0.868 to 0.902), respectively. The ≲καππα∀ statistic for predictive validity was 0.712 (95% CI, 0.676 to 0.766). Conclusion: SINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability. The sensitivity and specificity of SINS for potentially unstable or unstable lesions were 95.7% and 79.5%, respectively.

AB - Purpose: Standardized indications for treatment of tumor-related spinal instability are hampered by the lack of a valid and reliable classification system. The objective of this study was to determine the interobserver reliability, intraobserver reliability, and predictive validity of the Spinal Instability Neoplastic Score (SINS). Methods: Clinical and radiographic data from 30 patients with spinal tumors were classified as stable, potentially unstable, and unstable by members of the Spine Oncology Study Group. The median category for each patient case (consensus opinion) was used as the gold standard for predictive validity testing. On two occasions at least 6 weeks apart, each rater also scored each patient using SINS. Each total score was converted into a three-category data field, with 0 to 6 as stable, 7 to 12 as potentially unstable, and 13 to 18 as unstable. Results: The ≲καππ α∀ statistics for interobserver reliability were 0.790, 0.841, 0.244, 0.456, 0.462, and 0.492 for the fields of location, pain, bone quality, alignment, vertebral body collapse, and posterolateral involvement, respectively. The ≲καππα∀ statistics for intraobserver reliability were 0.806, 0.859, 0.528, 0.614, 0.590, and 0.662 for the same respective fields. Intraclass correlation coefficients for inter- and intraobserver reliability of total SINS score were 0.846 (95% CI, 0.773 to 0.911) and 0.886 (95% CI, 0.868 to 0.902), respectively. The ≲καππα∀ statistic for predictive validity was 0.712 (95% CI, 0.676 to 0.766). Conclusion: SINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability. The sensitivity and specificity of SINS for potentially unstable or unstable lesions were 95.7% and 79.5%, respectively.

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