Radiologist experience and CT examination quality determine metastasis detection in patients with esophageal or gastric cardia cancer

European Radiology, Nov 2008

We aimed to separate the influence of radiologist experience from that of CT quality in the evaluation of CT examinations of patients with esophageal or gastric cardia cancer. Two radiologists from referral centers (‘expert radiologists’) and six radiologists from regional non-referral centers (‘non-expert radiologists’) performed 240 evaluations of 72 CT examinations of patients diagnosed with esophageal or gastric cardia cancer between 1994 and 2003. We used conditional logistic regression analysis to calculate odds ratios (OR) for the likelihood of a correct diagnosis. Expert radiologists made a correct diagnosis of the presence or absence of distant metastases according to the gold standard almost three times more frequently (OR 2.9; 95% CI 1.4–6.3) than non-expert radiologists. For the subgroup of CT examinations showing distant metastases, a statistically significant correlation (OR 3.5; 95% CI 1.4–9.1) was found between CT quality as judged by the radiologists and a correct diagnosis. Both radiologist experience and quality of the CT examination play a role in the detection of distant metastases in esophageal or gastric cardia cancer patients. Therefore, we suggest that staging procedures for esophageal and gastric cardia cancer should preferably be performed in centers with technically advanced equipment and experienced radiologists.

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Radiologist experience and CT examination quality determine metastasis detection in patients with esophageal or gastric cardia cancer

E. P. M. van Vliet J. J. Hermans W. De Wever M. J. C. Eijkemans E. W. Steyerberg C. Faasse E. P. M. van Helmond A. M. de Leeuw A. C. Sikkenk A. R. de Vries E. H. de Vries E. J. Kuipers P. D. Siersema 0 1 2 3 4 5 6 7 8 0 W. De Wever Department of Radiology, University Hospitals Gasthuisberg , Leuven, Belgium 1 J. J. Hermans Department of Radiology, Erasmus MC-University Medical Center Rotterdam , P.O. Box 2040, 3000 CA Rotterdam, The Netherlands 2 Present address: P. D. Siersema Department of Gastroenterology and Hepatology, University Medical Center Utrecht , Utrecht, The Netherlands 3 E. H. de Vries Department of Radiology, Vlietland Hospital , Vlaardingen, The Netherlands 4 A. R. de Vries Department of Radiology, Albert Schweitzer Hospital , Dordrecht, The Netherlands 5 A. C. Sikkenk Department of Radiology, Medical Centre Rijnmond-South , Rotterdam, The Netherlands 6 A. M. de Leeuw Department of Radiology, Beatrix Hospital , Gorinchem, The Netherlands 7 E. P. M. van Helmond Department of Radiology, Harbour Hospital , Rotterdam, The Netherlands 8 C. Faasse Department of Radiology, Franciscus Hospital , Roosendaal, The Netherlands We aimed to separate the influence of radiologist experience from that of CT quality in the evaluation of CT examinations of patients with esophageal or gastric cardia cancer. Two radiologists from referral centers ('expert radiologists') - and six radiologists from regional non-referral centers (non-expert radiologists) performed 240 evaluations of 72 CT examinations of patients diagnosed with esophageal or gastric cardia cancer between 1994 and 2003. We used conditional logistic regression analysis to calculate odds ratios (OR) for the likelihood of a correct diagnosis. Expert radiologists made a correct diagnosis of the presence or absence of distant metastases according to the gold standard almost three times more frequently (OR 2.9; 95% CI 1.46.3) than non-expert radiologists. For the subgroup of CT examinations showing distant metastases, a statistically significant correlation (OR 3.5; 95% CI 1.49.1) was found between CT quality as judged by the radiologists and a correct diagnosis. Both radiologist experience and quality of the CT examination play a role in the detection of distant metastases in esophageal or gastric cardia cancer patients. Therefore, we suggest that staging procedures for esophageal and gastric cardia cancer should preferably be performed in centers with technically advanced equipment and experienced radiologists. 72 CT examinations Fig. 1 Distribution of the CT examinations among the various radiologists 72 CTs evaluated, 37 (51%) had distant metastases, whereas the other 35 (49%) were without. Celiac lymph node metastases were considered as regional (N1) if the primary tumor was located in the gastric cardia and as distant metastases (M1) if the tumor was located in the esophagus. The gold standard was the postoperative pathological TNM stage, the result of fine-needle aspiration (FNA), or a radiological result with 6 months of follow-up. In patients with the gold standard postoperative pathological TNM stage or the result of FNA, no new metastases were found in the 6 months following resection or FNA, which suggests that the results of these gold standards were reliable. None of the patients received neoadjuvant therapy that could have changed the disease status. Table 1 Characteristics of CT examinations per group of 24 CTs The distribution of CT examinations among the participating radiologists is shown in Fig. 1. We made three groups of 24 CT examinations. The two expert radiologists evaluated 48 CTs, of which one set of 24 CT examinations was evaluated by both expert radiologists to determine the variability between these radiologists. The six non-expert radiologists each evaluated 24 CTs. In order to determine the variability between non-expert radiologists, the 24 CTs in each group were evaluated by two nonexpert radiologists. In summary, in group 1 and 3, 24 CTs were evaluated by one expert and two non-expert radiologists. In group 2, 24 CTs were evaluated by two expert and two non-expert radiologists. Each radiologist evaluated CT examinations from regional centers and the referral center (Table 1). In addition, each radiologist randomly evaluated two different CTs of the same patient, meaning that the CT from the regional center and that from the referral center were evaluated by the same radiologist. In group 1, four CTs from the regional center and four CTs from the referral center performed in the same patients were evaluated by the radiologists. In group 2, this number was 6 and in group 3, it was 5. Furthermore, each radiologist evaluated CTs with metastases as well as CTs without metastases according to the gold standard (Table 1). CT examination quality was determined with four criteria, which were given a score: (a) whether or not intravenous contrast medium was administered (bolus enhanced) (yes, 1; no, 2), (b) slice thic (...truncated)


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E. P. M. van Vliet, J. J. Hermans, W. De Wever, M. J. C. Eijkemans, E. W. Steyerberg, C. Faasse, E. P. M. van Helmond, A. M. de Leeuw, A. C. Sikkenk, A. R. de Vries, E. H. de Vries, E. J. Kuipers, P. D. Siersema. Radiologist experience and CT examination quality determine metastasis detection in patients with esophageal or gastric cardia cancer, European Radiology, 2008, pp. 2475, Volume 18, Issue 11, DOI: 10.1007/s00330-008-1052-4