TY - JOUR
T1 - Inter-evaluator heterogeneity of clinical diagnosis for locally advanced esophageal squamous cell carcinoma
AU - Hamamoto, Yasuo
AU - Nojima, Masanori
AU - Aoki, Yu
AU - Suzuki, Takeshi
AU - Kawasaki, Kenta
AU - Hirata, Kenro
AU - Sukawa, Yasutaka
AU - Kasuga, Akira
AU - Kawakubo, Hirofumi
AU - Takeuchi, Hiroya
AU - Murakami, Koji
AU - Takaishi, Hiromasa
AU - Kanai, Takanori
AU - Kitagawa, Yuko
N1 - Funding Information:
Funding This work was supported by the Japan Society for the Promotion of Science (JSPS) Grant-in-Aid for Scientific Research (Grant No. 16K08880).
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background: Identifying clinical resectability of locally advanced esophageal squamous cell carcinoma (ESCC) is important, although inter-evaluator heterogeneity (IEH) could exist, especially in borderline resectable (BLR) cases. To investigate the extent of heterogeneity, we conducted clinical diagnostic imaging questionnaires. Materials and methods: Five cases with clinical T3 or T4 cases, which were treated with neo-adjuvant triplet chemotherapy followed by surgery, were selected as the model. These cases were divided into two groups: curative resected cases (#1–#3) and non-curative resected cases (#4 and #5). Only imaging slides were shown without any information about patient characteristics or clinical course. The evaluators consisted of surgeons (staff and non-staff), medical oncologists, and an imaging radiologist; a total of 25 medical staff answered the questionnaire. Two questions (1: clinical T stage before chemotherapy, 2: resectability after chemotherapy) were answered. Occupational differences were assessed by comparing the results to the imaging radiologist. Results: IEH was observed for clinical diagnosis before chemotherapy in one case (clinical T4: 52%, clinical T3: 48%). In the other cases, most evaluators diagnosed them as clinical T4, with 76–88% agreement. IEH for clinical resectability after chemotherapy was relatively small. Occupational IEH was observed in both before and after chemotherapy. Conclusion: IEH in decisions about treating BLR cases in ESCC should be considered in clinical practice. Multi-disciplinary teams are essential to overcome this problem.
AB - Background: Identifying clinical resectability of locally advanced esophageal squamous cell carcinoma (ESCC) is important, although inter-evaluator heterogeneity (IEH) could exist, especially in borderline resectable (BLR) cases. To investigate the extent of heterogeneity, we conducted clinical diagnostic imaging questionnaires. Materials and methods: Five cases with clinical T3 or T4 cases, which were treated with neo-adjuvant triplet chemotherapy followed by surgery, were selected as the model. These cases were divided into two groups: curative resected cases (#1–#3) and non-curative resected cases (#4 and #5). Only imaging slides were shown without any information about patient characteristics or clinical course. The evaluators consisted of surgeons (staff and non-staff), medical oncologists, and an imaging radiologist; a total of 25 medical staff answered the questionnaire. Two questions (1: clinical T stage before chemotherapy, 2: resectability after chemotherapy) were answered. Occupational differences were assessed by comparing the results to the imaging radiologist. Results: IEH was observed for clinical diagnosis before chemotherapy in one case (clinical T4: 52%, clinical T3: 48%). In the other cases, most evaluators diagnosed them as clinical T4, with 76–88% agreement. IEH for clinical resectability after chemotherapy was relatively small. Occupational IEH was observed in both before and after chemotherapy. Conclusion: IEH in decisions about treating BLR cases in ESCC should be considered in clinical practice. Multi-disciplinary teams are essential to overcome this problem.
KW - Esophageal cancer
KW - Heterogeneity
KW - Resectability
UR - http://www.scopus.com/inward/record.url?scp=85019851421&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85019851421&partnerID=8YFLogxK
U2 - 10.1007/s10388-017-0580-x
DO - 10.1007/s10388-017-0580-x
M3 - Article
C2 - 28983229
AN - SCOPUS:85019851421
VL - 14
SP - 324
EP - 332
JO - Esophagus
JF - Esophagus
SN - 1612-9059
IS - 4
ER -