International multispecialty expert physician preoperative identification of extranodal extension in patients with oropharyngeal cancer using computed tomography: Prospective blinded human inter-observer performance evaluation
Onur Sahin PhD, Serageldin Kamel MD, Kareem A. Wahid PhD, Cem Dede MD, Nicolette Taku MD, MPhil, MPH, Renjie He PhD, Mohamed A. Naser PhD, Christina S. Sharafi BS, Antti Mäkitie MD, PhD, Benjamin H. Kann MD, Kimmo Kaski PhD, Jaakko Sahlsten DSc, Joel Jaskari DSc, Moran Amit MD, PhD, Gregory M. Chronowski MD, Eduardo M. Diaz Jr. MD, Adam S. Garden MD, Ryan P. Goepfert MD, Jeffrey P. Guenette MD, MPH, G. Brandon Gunn MD, Jussi Hirvonen MD, PhD, Frank Hoebers MD, PhD, Katherine A. Hutcheson PhD, Nandita Guha-Thakurta MD, Jason Johnson MD, Diana Kaya MD, Shekhar D. Khanpara MD, Kristofer Nyman MD, Stephen Y. Lai MD, PhD, Miriam Lango MD, Kim O. Learned MD, Anna Lee MD, MPH, Carol M. Lewis MD, MPH, Anastasios Maniakas MD, PhD, Amy C. Moreno MD, MS, Jeffrey N. Myers MD, PhD, Jack Phan MD, PhD, Kristen B. Pytynia MD, MPH, David I. Rosenthal MD, Vlad C. Sandulache MD, PhD, Dawid Schellingerhout MBChB, MBA, Shalin J. Shah MD, Andrew G. Sikora MD, PhD, Abdallah S. R. Mohamed MD, PhD, Melissa M. Chen MD, Clifton D. Fuller MD, PhD, Multidisciplinary Oropharyngeal Cancer Extra-Nodal Extension (OPC ENE) Assessment Working Group
{"title":"International multispecialty expert physician preoperative identification of extranodal extension in patients with oropharyngeal cancer using computed tomography: Prospective blinded human inter-observer performance evaluation","authors":"Onur Sahin PhD, Serageldin Kamel MD, Kareem A. Wahid PhD, Cem Dede MD, Nicolette Taku MD, MPhil, MPH, Renjie He PhD, Mohamed A. Naser PhD, Christina S. Sharafi BS, Antti Mäkitie MD, PhD, Benjamin H. Kann MD, Kimmo Kaski PhD, Jaakko Sahlsten DSc, Joel Jaskari DSc, Moran Amit MD, PhD, Gregory M. Chronowski MD, Eduardo M. Diaz Jr. MD, Adam S. Garden MD, Ryan P. Goepfert MD, Jeffrey P. Guenette MD, MPH, G. Brandon Gunn MD, Jussi Hirvonen MD, PhD, Frank Hoebers MD, PhD, Katherine A. Hutcheson PhD, Nandita Guha-Thakurta MD, Jason Johnson MD, Diana Kaya MD, Shekhar D. Khanpara MD, Kristofer Nyman MD, Stephen Y. Lai MD, PhD, Miriam Lango MD, Kim O. Learned MD, Anna Lee MD, MPH, Carol M. Lewis MD, MPH, Anastasios Maniakas MD, PhD, Amy C. Moreno MD, MS, Jeffrey N. Myers MD, PhD, Jack Phan MD, PhD, Kristen B. Pytynia MD, MPH, David I. Rosenthal MD, Vlad C. Sandulache MD, PhD, Dawid Schellingerhout MBChB, MBA, Shalin J. Shah MD, Andrew G. Sikora MD, PhD, Abdallah S. R. Mohamed MD, PhD, Melissa M. Chen MD, Clifton D. Fuller MD, PhD, Multidisciplinary Oropharyngeal Cancer Extra-Nodal Extension (OPC ENE) Assessment Working Group","doi":"10.1002/cncr.35815","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Pathologic extranodal extension (pENE) is a crucial prognostic factor in oropharyngeal cancer (OPC), but determining pENE from imaging has high inter-observer variability. The role of clinician specialty in the accuracy of imaging-detected extranodal extension (iENE) remains unclear. The purpose of this study is to assess the influence of clinician specialty on the accuracy of preoperative iENE detection in human papillomavirus (HPV)-positive OPC using computed tomography (CT) imaging.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This prospective observational study evaluated pretherapy CT images from 24 HPV-positive OPC patients (30 scans, including duplicates). Thirty-four expert observers (11 radiologists, 12 surgeons, 11 radiation oncologists) assessed iENE and reported radiologic criteria and confidence. Ground-truth pENE status was confirmed pathologically. Accuracy, sensitivity, specificity, area under the receiver operating characteristic curve, and Brier scores were compared across specialties. Logistic regression determined significant predictors of pENE, whereas Fleiss’ kappa measured interobserver agreement.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Median accuracy was 0.57 (95% CI, 0.39–0.73), with no specialty showing performance beyond chance (median area under the receiver operating characteristic curve, 0.64). Minor differences were noted: surgeons had lower Brier scores (0.26 vs. 0.33, <i>p</i> < .01) and higher sensitivity (0.69 vs. 0.48) compared to radiologists and oncologists. Predictive signs included indistinct capsular contour and nodal necrosis. Interobserver agreement was weak (κ < 0.6).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Diagnostic performance for iENE on CT in HPV-positive OPC remains poor across specialties, with high variability and low accuracy. These findings highlight the need for automated systems or improved imaging methods to enhance iENE assessments.</p>\n </section>\n </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"131 7","pages":""},"PeriodicalIF":6.1000,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/cncr.35815","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Pathologic extranodal extension (pENE) is a crucial prognostic factor in oropharyngeal cancer (OPC), but determining pENE from imaging has high inter-observer variability. The role of clinician specialty in the accuracy of imaging-detected extranodal extension (iENE) remains unclear. The purpose of this study is to assess the influence of clinician specialty on the accuracy of preoperative iENE detection in human papillomavirus (HPV)-positive OPC using computed tomography (CT) imaging.
Methods
This prospective observational study evaluated pretherapy CT images from 24 HPV-positive OPC patients (30 scans, including duplicates). Thirty-four expert observers (11 radiologists, 12 surgeons, 11 radiation oncologists) assessed iENE and reported radiologic criteria and confidence. Ground-truth pENE status was confirmed pathologically. Accuracy, sensitivity, specificity, area under the receiver operating characteristic curve, and Brier scores were compared across specialties. Logistic regression determined significant predictors of pENE, whereas Fleiss’ kappa measured interobserver agreement.
Results
Median accuracy was 0.57 (95% CI, 0.39–0.73), with no specialty showing performance beyond chance (median area under the receiver operating characteristic curve, 0.64). Minor differences were noted: surgeons had lower Brier scores (0.26 vs. 0.33, p < .01) and higher sensitivity (0.69 vs. 0.48) compared to radiologists and oncologists. Predictive signs included indistinct capsular contour and nodal necrosis. Interobserver agreement was weak (κ < 0.6).
Conclusions
Diagnostic performance for iENE on CT in HPV-positive OPC remains poor across specialties, with high variability and low accuracy. These findings highlight the need for automated systems or improved imaging methods to enhance iENE assessments.
期刊介绍：
The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society.
CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
