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@ARTICLE{Mei:276244,
      author       = {R. Mei and L. Kessler$^*$ and K. M. Pabst$^*$ and M.
                      Weber$^*$ and C. Schimdkonz and C. Rischpler$^*$ and H. D.
                      Zacho and T. Hope and S. M. Schwarzenböck and M.
                      Allen-Auerbach and L. Emmett and J. Ferdinandus and M.
                      Unterrainer and B. M. Schaarschmidt and L. Umutlu and A.
                      Farolfi and P. Castellucci and C. Nanni and S. Telo and S.
                      Fanti and K. Herrmann$^*$ and W. P. Fendler$^*$},
      title        = {68{G}a-{FAPI} {PET}/{CT} {I}nterobserver {A}greement on
                      {T}umor {A}ssessment: {A}n {I}nternational {M}ulticenter
                      {P}rospective {S}tudy.},
      journal      = {Journal of nuclear medicine},
      volume       = {64},
      number       = {7},
      issn         = {0097-9058},
      address      = {New York, NY},
      publisher    = {Soc.},
      reportid     = {DKFZ-2023-01046},
      pages        = {1043-1048},
      year         = {2023},
      note         = {2023 Jul;64(7):1043-1048},
      abstract     = {68Ga-fibroblast activation protein inhibitors (FAPIs) are
                      promising radiotracers for cancer imaging, with emerging
                      data in the recent years. Nonetheless, the interobserver
                      agreement on 68Ga-FAPI PET/CT study interpretations in
                      cancer patients remains poorly understood. Methods:
                      68Ga-FAPI PET/CT was performed on 50 patients with various
                      tumor entities (sarcoma [n = 10], colorectal cancer [n =
                      10], pancreatic adenocarcinoma [n = 10], genitourinary
                      cancer [n = 10], and other types of cancer [n = 10]).
                      Fifteen masked observers reviewed and interpreted the images
                      using a standardized approach for local, local nodal, and
                      metastatic involvement. Observers were grouped by experience
                      as having a low (<30 prior 68Ga-FAPI PET/CT studies; n = 5),
                      intermediate (30-300 studies; n = 5), or high level of
                      experience (>300 studies; n = 5). Two independent readers
                      with a high level of experience and unmasked to clinical
                      information, histopathology, tumor markers, and follow-up
                      imaging (CT/MRI or PET/CT) served as the standard of
                      reference (SOR). Observer groups were compared by overall
                      agreement (percentage of patients matching SOR) and Fleiss
                      κ with mean and corresponding $95\%$ CI. We defined
                      acceptable agreement as a κ value of at least 0.6
                      (substantial or higher) and acceptable accuracy as at least
                      $80\%.$ Results: Highly experienced observers agreed
                      substantially on all categories (primary tumor: κ = 0.71;
                      $95\%$ CI, 0.71-0.71; local nodal involvement: κ = 0.62;
                      $95\%$ CI, 0.61-0.62; distant metastasis: κ = 0.75; $95\%$
                      CI, 0.75-0.75), whereas observers with intermediate
                      experience showed substantial agreement on primary tumor (κ
                      = 0.73; $95\%$ CI, 0.73-0.73) and distant metastasis (κ =
                      0.65; $95\%$ CI, 0.65-0.65) but moderate agreement on local
                      nodal stages (κ = 0.55; $95\%$ CI, 0.55-0.55). Observers
                      with low experience had moderate agreement on all categories
                      (primary tumor: κ = 0.57; $95\%$ CI, 0.57-0.58; local nodal
                      involvement: κ = 0.51; $95\%$ CI, 0.51-0.52; distant
                      metastasis: κ = 0.54; $95\%$ CI, 0.53-0.54). Compared with
                      SOR, the accuracy for readers with high, intermediate, and
                      low experience was $85\%,$ $83\%,$ and $78\%,$ respectively.
                      In summary, only highly experienced readers showed
                      substantial agreement and a diagnostic accuracy of at least
                      $80\%$ in all categories. Conclusion: The interpretation of
                      68Ga-FAPI PET/CT for cancer imaging had substantial
                      reproducibility and accuracy among highly experienced
                      observers only, especially for local nodal and metastatic
                      assessments. Therefore, for accurate interpretation of
                      different tumor entities and pitfalls, we recommend training
                      or experience with at least 300 representative scans for
                      future clinical readers.},
      keywords     = {FAPI (Other) / PET (Other) / cancer imaging (Other) /
                      fibroblast activation protein (Other) / interobserver
                      agreement (Other)},
      cin          = {ED01},
      ddc          = {610},
      cid          = {I:(DE-He78)ED01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:37230530},
      doi          = {10.2967/jnumed.122.265245},
      url          = {https://inrepo02.dkfz.de/record/276244},
}