Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform

Delia Ciardo; Angela Argenone; Genoveva Ionela Boboc; Francesca Cucciarelli; Fiorenza De Rose; Maria Carmen De Santis; Alessandra Huscher; Edy Ippolito; Maria Rosa La Porta; Lorenza Marino; Ilaria Meaglia; Isabella Palumbo; Francesca Rossi; Paolo Alpi; Mario Bignardi; Alessio Bonanni; Domenico Cante; Tino Ceschia; Letizia Fabbietti; Marco Lupattelli; Elisa Donatella Mantero; Alessia Monaco; Patrizia Porcu; Vincenzo Ravo; Sonia Silipigni; Angelo Tozzi; Vincenza Umina; Dario Zerini; Luigi Bordonaro; Giorgia Capezzali; Elena Clerici; Sarah Pia Colangione; Michela Dispinzieri; Jessica Dognini; Laura Donadoni; Sara Falivene; Alessandra Fozza; Barbara Grilli; Roberta Guarnaccia; Eva Iannacone; Valentina Lancellotta; Agnese Prisco; Rosalinda Ricotti; Roberto Orecchia; Barbara Alicja Jereczek-Fossa; Maria Cristina Leonardi; on the behalf of the Breast Working Group of the Italian Association of Radiation Oncology (AIRO)

doi:10.1080/0284186X.2017.1325004

Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform

Delia Ciardo, Angela Argenone, Genoveva Ionela Boboc, Francesca Cucciarelli, Fiorenza De Rose, Maria Carmen De Santis, Alessandra Huscher, Edy Ippolito, Maria Rosa La Porta, Lorenza Marino, Ilaria Meaglia, Isabella Palumbo, Francesca Rossi, Paolo Alpi, Mario Bignardi, Alessio Bonanni, Domenico Cante, Tino Ceschia, Letizia Fabbietti, Marco LupattelliElisa Donatella Mantero, Alessia Monaco, Patrizia Porcu, Vincenzo Ravo, Sonia Silipigni, Angelo Tozzi, Vincenza Umina, Dario Zerini, Luigi Bordonaro, Giorgia Capezzali, Elena Clerici, Sarah Pia Colangione, Michela Dispinzieri, Jessica Dognini, Laura Donadoni, Sara Falivene, Alessandra Fozza, Barbara Grilli, Roberta Guarnaccia, Eva Iannacone, Valentina Lancellotta, Agnese Prisco, Rosalinda Ricotti, Roberto Orecchia, Barbara Alicja Jereczek-Fossa, Maria Cristina Leonardi, on the behalf of the Breast Working Group of the Italian Association of Radiation Oncology (AIRO)

Research output: Contribution to journal › Article › peer-review

Abstract

AIM: To quantify the variability between radiation oncologists (ROs) when outlining axillary nodes in breast cancer.

MATERIAL AND METHODS: For each participating center, three ROs with different levels of expertise, i.e., junior (J), senior (S) and expert (E), contoured axillary nodal levels (L1, L2, L3 and L4) on the CT images of three different patients (P) of an increasing degree of anatomical complexity (from P1 to P2 to P3), according to contouring guidelines. Consensus contours were generated using the simultaneous truth and performance level estimation (STAPLE) method.

RESULTS: Fifteen centers and 42 ROs participated. Overall, the median Dice similarity coefficient was 0.66. Statistically significant differences were observed according to the level of expertise (better agreement for J and E, worse for S); the axillary level (better agreement for L1 and L4, worse for L3); the patient (better agreement for P1, worse for P3). Statistically significant differences in contouring were found in 18% of the inter-center comparison. Less than a half of the centers could claim to have a good agreement between the internal ROs.

CONCLUSIONS: The overall intra-institute and inter-institute agreement was moderate. Central lymph-node levels were the most critical and variability increased as the complexity of the patient's anatomy increased. These findings might have an effect on the interpretation of results from multicenter and even mono-institute studies.

Original language	English
Pages (from-to)	1081-1088
Number of pages	8
Journal	Acta Oncologica
Volume	56
Issue number	8
DOIs	https://doi.org/10.1080/0284186X.2017.1325004
Publication status	Published - Aug 2017

Keywords

Axilla
Breast Neoplasms
Female
Humans
Lymph Nodes
Organs at Risk
Practice Guidelines as Topic
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Intensity-Modulated
Tumor Burden
Journal Article
Multicenter Study

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10.1080/0284186X.2017.1325004

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Ciardo, D., Argenone, A., Boboc, G. I., Cucciarelli, F., De Rose, F., De Santis, M. C., Huscher, A., Ippolito, E., La Porta, M. R., Marino, L., Meaglia, I., Palumbo, I., Rossi, F., Alpi, P., Bignardi, M., Bonanni, A., Cante, D., Ceschia, T., Fabbietti, L., ... on the behalf of the Breast Working Group of the Italian Association of Radiation Oncology (AIRO) (2017). Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform. Acta Oncologica, 56(8), 1081-1088. https://doi.org/10.1080/0284186X.2017.1325004

Ciardo, D, Argenone, A, Boboc, GI, Cucciarelli, F, De Rose, F, De Santis, MC, Huscher, A, Ippolito, E, La Porta, MR, Marino, L, Meaglia, I, Palumbo, I, Rossi, F, Alpi, P, Bignardi, M, Bonanni, A, Cante, D, Ceschia, T, Fabbietti, L, Lupattelli, M, Mantero, ED, Monaco, A, Porcu, P, Ravo, V, Silipigni, S, Tozzi, A, Umina, V, Zerini, D, Bordonaro, L, Capezzali, G, Clerici, E, Colangione, SP, Dispinzieri, M, Dognini, J, Donadoni, L, Falivene, S, Fozza, A, Grilli, B, Guarnaccia, R, Iannacone, E, Lancellotta, V, Prisco, A, Ricotti, R, Orecchia, R, Jereczek-Fossa, BA, Leonardi, MC & on the behalf of the Breast Working Group of the Italian Association of Radiation Oncology (AIRO) 2017, 'Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform', Acta Oncologica, vol. 56, no. 8, pp. 1081-1088. https://doi.org/10.1080/0284186X.2017.1325004

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title = "Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform",

abstract = "AIM: To quantify the variability between radiation oncologists (ROs) when outlining axillary nodes in breast cancer.MATERIAL AND METHODS: For each participating center, three ROs with different levels of expertise, i.e., junior (J), senior (S) and expert (E), contoured axillary nodal levels (L1, L2, L3 and L4) on the CT images of three different patients (P) of an increasing degree of anatomical complexity (from P1 to P2 to P3), according to contouring guidelines. Consensus contours were generated using the simultaneous truth and performance level estimation (STAPLE) method.RESULTS: Fifteen centers and 42 ROs participated. Overall, the median Dice similarity coefficient was 0.66. Statistically significant differences were observed according to the level of expertise (better agreement for J and E, worse for S); the axillary level (better agreement for L1 and L4, worse for L3); the patient (better agreement for P1, worse for P3). Statistically significant differences in contouring were found in 18% of the inter-center comparison. Less than a half of the centers could claim to have a good agreement between the internal ROs.CONCLUSIONS: The overall intra-institute and inter-institute agreement was moderate. Central lymph-node levels were the most critical and variability increased as the complexity of the patient's anatomy increased. These findings might have an effect on the interpretation of results from multicenter and even mono-institute studies.",

keywords = "Axilla, Breast Neoplasms, Female, Humans, Lymph Nodes, Organs at Risk, Practice Guidelines as Topic, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Radiotherapy, Intensity-Modulated, Tumor Burden, Journal Article, Multicenter Study",

author = "Delia Ciardo and Angela Argenone and Boboc, {Genoveva Ionela} and Francesca Cucciarelli and {De Rose}, Fiorenza and {De Santis}, {Maria Carmen} and Alessandra Huscher and Edy Ippolito and {La Porta}, {Maria Rosa} and Lorenza Marino and Ilaria Meaglia and Isabella Palumbo and Francesca Rossi and Paolo Alpi and Mario Bignardi and Alessio Bonanni and Domenico Cante and Tino Ceschia and Letizia Fabbietti and Marco Lupattelli and Mantero, {Elisa Donatella} and Alessia Monaco and Patrizia Porcu and Vincenzo Ravo and Sonia Silipigni and Angelo Tozzi and Vincenza Umina and Dario Zerini and Luigi Bordonaro and Giorgia Capezzali and Elena Clerici and Colangione, {Sarah Pia} and Michela Dispinzieri and Jessica Dognini and Laura Donadoni and Sara Falivene and Alessandra Fozza and Barbara Grilli and Roberta Guarnaccia and Eva Iannacone and Valentina Lancellotta and Agnese Prisco and Rosalinda Ricotti and Roberto Orecchia and Jereczek-Fossa, {Barbara Alicja} and Leonardi, {Maria Cristina} and {on the behalf of the Breast Working Group of the Italian Association of Radiation Oncology (AIRO)}",

year = "2017",

month = aug,

doi = "10.1080/0284186X.2017.1325004",

language = "English",

volume = "56",

pages = "1081--1088",

journal = "Acta Oncologica",

issn = "0284-186X",

publisher = "Informa Healthcare",

number = "8",

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TY - JOUR

T1 - Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform

AU - Ciardo, Delia

AU - Argenone, Angela

AU - Boboc, Genoveva Ionela

AU - Cucciarelli, Francesca

AU - De Rose, Fiorenza

AU - De Santis, Maria Carmen

AU - Huscher, Alessandra

AU - Ippolito, Edy

AU - La Porta, Maria Rosa

AU - Marino, Lorenza

AU - Meaglia, Ilaria

AU - Palumbo, Isabella

AU - Rossi, Francesca

AU - Alpi, Paolo

AU - Bignardi, Mario

AU - Bonanni, Alessio

AU - Cante, Domenico

AU - Ceschia, Tino

AU - Fabbietti, Letizia

AU - Lupattelli, Marco

AU - Mantero, Elisa Donatella

AU - Monaco, Alessia

AU - Porcu, Patrizia

AU - Ravo, Vincenzo

AU - Silipigni, Sonia

AU - Tozzi, Angelo

AU - Umina, Vincenza

AU - Zerini, Dario

AU - Bordonaro, Luigi

AU - Capezzali, Giorgia

AU - Clerici, Elena

AU - Colangione, Sarah Pia

AU - Dispinzieri, Michela

AU - Dognini, Jessica

AU - Donadoni, Laura

AU - Falivene, Sara

AU - Fozza, Alessandra

AU - Grilli, Barbara

AU - Guarnaccia, Roberta

AU - Iannacone, Eva

AU - Lancellotta, Valentina

AU - Prisco, Agnese

AU - Ricotti, Rosalinda

AU - Orecchia, Roberto

AU - Jereczek-Fossa, Barbara Alicja

AU - Leonardi, Maria Cristina

AU - on the behalf of the Breast Working Group of the Italian Association of Radiation Oncology (AIRO)

PY - 2017/8

Y1 - 2017/8

N2 - AIM: To quantify the variability between radiation oncologists (ROs) when outlining axillary nodes in breast cancer.MATERIAL AND METHODS: For each participating center, three ROs with different levels of expertise, i.e., junior (J), senior (S) and expert (E), contoured axillary nodal levels (L1, L2, L3 and L4) on the CT images of three different patients (P) of an increasing degree of anatomical complexity (from P1 to P2 to P3), according to contouring guidelines. Consensus contours were generated using the simultaneous truth and performance level estimation (STAPLE) method.RESULTS: Fifteen centers and 42 ROs participated. Overall, the median Dice similarity coefficient was 0.66. Statistically significant differences were observed according to the level of expertise (better agreement for J and E, worse for S); the axillary level (better agreement for L1 and L4, worse for L3); the patient (better agreement for P1, worse for P3). Statistically significant differences in contouring were found in 18% of the inter-center comparison. Less than a half of the centers could claim to have a good agreement between the internal ROs.CONCLUSIONS: The overall intra-institute and inter-institute agreement was moderate. Central lymph-node levels were the most critical and variability increased as the complexity of the patient's anatomy increased. These findings might have an effect on the interpretation of results from multicenter and even mono-institute studies.

AB - AIM: To quantify the variability between radiation oncologists (ROs) when outlining axillary nodes in breast cancer.MATERIAL AND METHODS: For each participating center, three ROs with different levels of expertise, i.e., junior (J), senior (S) and expert (E), contoured axillary nodal levels (L1, L2, L3 and L4) on the CT images of three different patients (P) of an increasing degree of anatomical complexity (from P1 to P2 to P3), according to contouring guidelines. Consensus contours were generated using the simultaneous truth and performance level estimation (STAPLE) method.RESULTS: Fifteen centers and 42 ROs participated. Overall, the median Dice similarity coefficient was 0.66. Statistically significant differences were observed according to the level of expertise (better agreement for J and E, worse for S); the axillary level (better agreement for L1 and L4, worse for L3); the patient (better agreement for P1, worse for P3). Statistically significant differences in contouring were found in 18% of the inter-center comparison. Less than a half of the centers could claim to have a good agreement between the internal ROs.CONCLUSIONS: The overall intra-institute and inter-institute agreement was moderate. Central lymph-node levels were the most critical and variability increased as the complexity of the patient's anatomy increased. These findings might have an effect on the interpretation of results from multicenter and even mono-institute studies.

KW - Axilla

KW - Breast Neoplasms

KW - Female

KW - Humans

KW - Lymph Nodes

KW - Organs at Risk

KW - Practice Guidelines as Topic

KW - Radiotherapy Dosage

KW - Radiotherapy Planning, Computer-Assisted

KW - Radiotherapy, Intensity-Modulated

KW - Tumor Burden

KW - Journal Article

KW - Multicenter Study

U2 - 10.1080/0284186X.2017.1325004

DO - 10.1080/0284186X.2017.1325004

M3 - Article

C2 - 28534430

VL - 56

SP - 1081

EP - 1088

JO - Acta Oncologica

JF - Acta Oncologica

SN - 0284-186X

IS - 8

ER -

Variability in axillary lymph node delineation for breast cancer radiotherapy in presence of guidelines on a multi-institutional platform

Abstract

Keywords

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