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Reliability of X-rays and bone scans for the assessment of changes in skeletal metastases from breast cancer

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Abstract Aims: 

To examine the level of agreement among observers regarding changes between serial images of bone metastases. Methods: 

Thirty-five pairs of bone X-rays and 30 pairs of bone scans were selected from the files of patients with breast cancer involving the skeleton. All images in a pair were of the same site and had been taken at least 12 weeks apart. Thirteen radiologists and 14 nuclear medicine physicians examined the X-ray and bone scan pairs, respectively. Each assessed whether the changes between sequential films represented improvement, stability or worsening. Inter-observer agreement was analysed using the kappa statistic (κ). Results: 

There was only fair overall agreement among radiologists regarding changes between X-rays (κ = 0.23), but there was substantial agreement among nuclear medicine physicians for bone scan assessments (κ = 0.62). Neither the experience of the observers nor the time between images had a significant effect on agreement. For X-rays, agreement was poorer if the response category was ‘improvement’ and if the type of bone lesion was mixed lytic/sclerotic. Conclusions: 

Evaluation of serial X-rays is unreliable for determining the response of bone metastases. Scintigraphic evaluation has a higher internal validity for the determination of response, but it should not be used in isolation from other clinical data. (Intern Med J 2004; 34: 615−620)

Keywords: X-ray; bone; breast neoplasm; observer variation; radionuclide imaging

Document Type: Research Article


Affiliations: 1: Walter and Eliza Hall Institute of Medical Research, 2: Statistical Centre, Peter MacCallum Cancer Centre and Departments of 3: Medical Imaging and 4: Oncology, St. Vincent's Hospital, Melbourne, Victoria, Australia

Publication date: November 1, 2004


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