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 -