TY - JOUR
T1 - Reliability and Agreement of Radiological and Pathological Tumor Size in Patients with Multiple Endocrine Neoplasia Type 1-Related Pancreatic Neuroendocrine Tumors
T2 - Results from a Population-Based Cohort
AU - van Beek, Dirk-Jan
AU - Verkooijen, Helena M.
AU - Nell, Sjoerd
AU - Bonsing, Bert A.
AU - van Eijck, Casper H.
AU - van Goor, Harry
AU - Hoogwater, Frederik J. H.
AU - van Dijkum, Elisabeth J. M. Nieveen
AU - Kazemier, Geert
AU - Dejong, Cornelis H. C.
AU - Brosens, Lodewijk A. A.
AU - Wessels, Frank J.
AU - Rinkes, Inne H. M. Borel
AU - Valk, Gerlof D.
AU - Vriens, Menno R.
N1 - Funding Information:
This work was supported by an unrestricted grant from Ipsen Pharmaceutical. The funding source had no influence on the study question, design, data acquisition, statistical analysis, and interpretation of data.
Publisher Copyright:
© 2020
PY - 2021/7
Y1 - 2021/7
N2 - Background: Pancreatic neuroendocrine tumors (pNETs) have a high prevalence in patients with multiple endocrine neoplasia type 1 (MEN1) and are the leading cause of death. Tumor size is still regarded as the main prognostic factor and therefore used for surgical decision-making. We assessed reliability and agreement of radiological and pathological tumor size in a population-based cohort of patients with MEN1-related pNETs. Methods: Patients were selected from the Dutch MEN1 database if they had undergone a resection for a pNET between 2003 and 2018. Radiological (MRI, CT, and endoscopic ultrasonography [EUS]) and pathological tumor size were collected from patient records. Measures of agreement (Bland-Altman plots with limits of agreement [LoA] and absolute agreement) and reliability (intraclass correlation coefficients [ICC] and unweighted kappa) were calculated for continuous and categorized (< or >= 2 cm) pNET size. Results: In 73 included patients, the median radiological and pathological tumor sizes measured were 22 (3-160) and 21 (4-200) mm, respectively. Mean bias between radiological and pathological tumor size was -0.2 mm and LoA ranged from -12.9 to 12.6 mm. For the subgroups of MRI, CT, and EUS, LoA of radiological and pathological tumor size ranged from -9.6 to 10.9, -15.9 to 15.8, and -13.9 to 11.0, respectively. ICCs for the overall cohort, MRI, CT, and EUS were 0.80, 0.86, 0.75, and 0.76, respectively. Based on the 2 cm criterion, agreement was 81.5%; hence, 12 patients (18.5%) were classified differently between imaging and pathology. Absolute agreement and kappa values of MRI, CT, and EUS were 88.6, 85.7, and 75.0%, and 0.77, 0.71, and 0.50, respectively. Conclusion: Within a population-based cohort, MEN1-related pNET size was not systematically over- or underestimated on preoperative imaging. Based on agreement and reliability measures, MRI is the preferred imaging modality.
AB - Background: Pancreatic neuroendocrine tumors (pNETs) have a high prevalence in patients with multiple endocrine neoplasia type 1 (MEN1) and are the leading cause of death. Tumor size is still regarded as the main prognostic factor and therefore used for surgical decision-making. We assessed reliability and agreement of radiological and pathological tumor size in a population-based cohort of patients with MEN1-related pNETs. Methods: Patients were selected from the Dutch MEN1 database if they had undergone a resection for a pNET between 2003 and 2018. Radiological (MRI, CT, and endoscopic ultrasonography [EUS]) and pathological tumor size were collected from patient records. Measures of agreement (Bland-Altman plots with limits of agreement [LoA] and absolute agreement) and reliability (intraclass correlation coefficients [ICC] and unweighted kappa) were calculated for continuous and categorized (< or >= 2 cm) pNET size. Results: In 73 included patients, the median radiological and pathological tumor sizes measured were 22 (3-160) and 21 (4-200) mm, respectively. Mean bias between radiological and pathological tumor size was -0.2 mm and LoA ranged from -12.9 to 12.6 mm. For the subgroups of MRI, CT, and EUS, LoA of radiological and pathological tumor size ranged from -9.6 to 10.9, -15.9 to 15.8, and -13.9 to 11.0, respectively. ICCs for the overall cohort, MRI, CT, and EUS were 0.80, 0.86, 0.75, and 0.76, respectively. Based on the 2 cm criterion, agreement was 81.5%; hence, 12 patients (18.5%) were classified differently between imaging and pathology. Absolute agreement and kappa values of MRI, CT, and EUS were 88.6, 85.7, and 75.0%, and 0.77, 0.71, and 0.50, respectively. Conclusion: Within a population-based cohort, MEN1-related pNET size was not systematically over- or underestimated on preoperative imaging. Based on agreement and reliability measures, MRI is the preferred imaging modality.
KW - Magnetic resonance imaging
KW - Endoscopic ultrasonography
KW - Multiple endocrine neoplasia type 1
KW - Pancreatic neuroendocrine tumor
KW - Reliability
KW - Agreement
KW - Computed tomography
KW - ENDOSCOPIC ULTRASONOGRAPHY
KW - FORMALIN FIXATION
KW - LIVER METASTASES
KW - GUIDELINES
KW - MEN1
KW - EUS
KW - MANAGEMENT
KW - SURGERY
KW - CANCER
KW - DEATH
U2 - 10.1159/000510514
DO - 10.1159/000510514
M3 - Article
C2 - 32721974
SN - 0028-3835
VL - 111
SP - 705
EP - 717
JO - Neuroendocrinology
JF - Neuroendocrinology
IS - 8
ER -