CT Evaluation of Lymph Nodes That Merge or Split During the Course of a Clinical Trial: Limitations of RECIST 1.1

Overview

Journal Radiol Imaging Cancer

Specialties Oncology
Radiology

Date 2021 Apr 20

PMID 33874734

Citations 4

Authors

Ahmad Shafiei

Mohammadhadi Bagheri

Faraz Farhadi

Andrea B Apolo

Nadia M Biassou

Les R Folio

Elizabeth C Jones

Ronald M Summers

Affiliations

Soon will be listed here.

Abstract

Purpose To compare Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 with volumetric measurement in the setting of target lymph nodes that split into two or more nodes or merge into one conglomerate node. Materials and Methods In this retrospective study, target lymph nodes were evaluated on CT scans from 166 patients with different types of cancer; 158 of the scans came from The Cancer Imaging Archive. Each target node was measured using RECIST 1.1 criteria before and after merging or splitting, followed by volumetric segmentation. To compare RECIST 1.1 with volume, a single-dimension hypothetical diameter (HD) was determined from the nodal volume. The nodes were divided into three groups: one-target merged (one target node merged with other nodes); two-target merged (two neighboring target nodes merged); and split node (a conglomerate node cleaved into smaller fragments). Bland-Altman analysis and test were applied to compare RECIST 1.1 with HD. On the basis of the RECIST 1.1 concept, we compared response category changes between RECIST 1.1 and HD. Results The data set consisted of 30 merged nodes (19 one-target merged and 11 two-target merged) and 20 split nodes (mean age for all 50 included patients, 50 years ± 7 [standard deviation]; 38 men). RECIST 1.1, volumetric, and HD measurements indicated an increase in size in all one-target merged nodes. While volume and HD indicated an increase in size for nodes in the two-target merged group, RECIST 1.1 showed a decrease in size in all two-target merged nodes. Although volume and HD demonstrated a decrease in size of all split nodes, RECIST 1.1 indicated an increase in size in 60% (12 of 20) of the nodes. Discrepancy of the response categories between RECIST 1.1 and HD was observed in 5% (one of 19) in one-target merged, 82% (nine of 11) in two-target merged, and 55% (11 of 20) in split nodes. Conclusion RECIST 1.1 does not optimally reflect size changes when lymph nodes merge or split. CT, Lymphatic, Tumor Response © RSNA, 2021.

Citing Articles

Phase I/II Study of the Aurora Kinase A Inhibitor Alisertib and Pembrolizumab in Refractory, Rb-Deficient Head and Neck Squamous Cell Carcinomas.

Johnson F, OHara M, Yapindi L, Jiang P, Tran H, Reuben A Clin Cancer Res. 2024; 31(3):479-490.

PMID: 39589337 PMC: 11790391. DOI: 10.1158/1078-0432.CCR-24-2290.

Follow-up of liver metastases: a comparison of deep learning and RECIST 1.1.

Joskowicz L, Szeskin A, Rochman S, Dodi A, Lederman R, Fruchtman-Brot H Eur Radiol. 2023; 33(12):9320-9327.

PMID: 37480549 DOI: 10.1007/s00330-023-09926-0.

Targeting MDSC Differentiation Using ATRA: A Phase I/II Clinical Trial Combining Pembrolizumab and All-Trans Retinoic Acid for Metastatic Melanoma.

Tobin R, Cogswell D, Cates V, Davis D, Borgers J, Van Gulick R Clin Cancer Res. 2022; 29(7):1209-1219.

PMID: 36378549 PMC: 10073240. DOI: 10.1158/1078-0432.CCR-22-2495.

Development and validation of a nomogram model for the prediction of 4L lymph node metastasis in thoracic esophageal squamous cell carcinoma.

Xu L, Guo J, Qi S, Xie H, Wei X, Yu Y Front Oncol. 2022; 12:887047.

PMID: 36263210 PMC: 9573997. DOI: 10.3389/fonc.2022.887047.

Development and validation of a longitudinal soft-tissue metastatic lesion matching algorithm.

Santoro-Fernandes V, Huff D, Scarpelli M, Perk T, Albertini M, Perlman S Phys Med Biol. 2021; 66(15).

PMID: 34261045 PMC: 11329192. DOI: 10.1088/1361-6560/ac1457.

References

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2008; 45(2):228-47. DOI: 10.1016/j.ejca.2008.10.026. View

Yaghmai V, Miller F, Rezai P, Benson 3rd A, Salem R . Response to treatment series: part 2, tumor response assessment--using new and conventional criteria. AJR Am J Roentgenol. 2011; 197(1):18-27. DOI: 10.2214/AJR.11.6581. View

Goldmacher G, Conklin J . The use of tumour volumetrics to assess response to therapy in anticancer clinical trials. Br J Clin Pharmacol. 2012; 73(6):846-54. PMC: 3391506. DOI: 10.1111/j.1365-2125.2012.04179.x. View

Tran L, Brown M, Goldin J, Yan X, Pais R, McNitt-Gray M . Comparison of treatment response classifications between unidimensional, bidimensional, and volumetric measurements of metastatic lung lesions on chest computed tomography. Acad Radiol. 2004; 11(12):1355-60. DOI: 10.1016/j.acra.2004.09.004. View

Schiavon G, Ruggiero A, Schoffski P, van der Holt B, Bekers D, Eechoute K . Tumor volume as an alternative response measurement for imatinib treated GIST patients. PLoS One. 2012; 7(11):e48372. PMC: 3487791. DOI: 10.1371/journal.pone.0048372. View

Mozley P, Bendtsen C, Zhao B, Schwartz L, Thorn M, Rong Y . Measurement of tumor volumes improves RECIST-based response assessments in advanced lung cancer. Transl Oncol. 2012; 5(1):19-25. PMC: 3281412. DOI: 10.1593/tlo.11232. View

Roth H, Lu L, Seff A, Cherry K, Hoffman J, Wang S . A new 2.5D representation for lymph node detection using random sets of deep convolutional neural network observations. Med Image Comput Comput Assist Interv. 2014; 17(Pt 1):520-7. PMC: 4295635. DOI: 10.1007/978-3-319-10404-1_65. View

Fournier L, Ammari S, Thiam R, Cuenod C . Imaging criteria for assessing tumour response: RECIST, mRECIST, Cheson. Diagn Interv Imaging. 2014; 95(7-8):689-703. DOI: 10.1016/j.diii.2014.05.002. View

10.

Nishino M, Jackman D, DiPiro P, Hatabu H, Janne P, Johnson B . Revisiting the relationship between tumour volume and diameter in advanced NSCLC patients: An exercise to maximize the utility of each measure to assess response to therapy. Clin Radiol. 2014; 69(8):841-8. PMC: 4105980. DOI: 10.1016/j.crad.2014.03.020. View

11.

Lubner M, Stabo N, Lubner S, Rio A, Song C, Pickhardt P . Volumetric Versus Unidimensional Measures of Metastatic Colorectal Cancer in Assessing Disease Response. Clin Colorectal Cancer. 2017; 16(4):324-333.e1. DOI: 10.1016/j.clcc.2017.03.009. View

12.

Welsh J, Bodeker K, Fallon E, Bhatia S, Buatti J, Cullen J . Comparison of response evaluation criteria in solid tumors with volumetric measurements for estimation of tumor burden in pancreatic adenocarcinoma and hepatocellular carcinoma. Am J Surg. 2012; 204(5):580-5. PMC: 3496005. DOI: 10.1016/j.amjsurg.2012.07.007. View

13.

Fenerty K, Patronas N, Heery C, Gulley J, Folio L . Resources Required for Semi-Automatic Volumetric Measurements in Metastatic Chordoma: Is Potentially Improved Tumor Burden Assessment Worth the Time Burden?. J Digit Imaging. 2015; 29(3):357-64. PMC: 4879033. DOI: 10.1007/s10278-015-9846-9. View

14.

Shah G, Kesari S, Xu R, Batchelor T, ONeill A, Hochberg F . Comparison of linear and volumetric criteria in assessing tumor response in adult high-grade gliomas. Neuro Oncol. 2006; 8(1):38-46. PMC: 1871928. DOI: 10.1215/S1522851705000529. View

15.

Padhani A, Ollivier L . The RECIST (Response Evaluation Criteria in Solid Tumors) criteria: implications for diagnostic radiologists. Br J Radiol. 2001; 74(887):983-6. DOI: 10.1259/bjr.74.887.740983. View

16.

Chalian H, Tore H, Horowitz J, Salem R, Miller F, Yaghmai V . Radiologic assessment of response to therapy: comparison of RECIST Versions 1.1 and 1.0. Radiographics. 2011; 31(7):2093-105. DOI: 10.1148/rg.317115050. View

17.

Mozley P, Schwartz L, Bendtsen C, Zhao B, Petrick N, Buckler A . Change in lung tumor volume as a biomarker of treatment response: a critical review of the evidence. Ann Oncol. 2010; 21(9):1751-1755. DOI: 10.1093/annonc/mdq051. View

18.

Force J, Rajan A, Dombi E, Steinberg S, Giaccone G . Assessment of objective responses using volumetric evaluation in advanced thymic malignancies and metastatic non-small cell lung cancer. J Thorac Oncol. 2011; 6(7):1267-73. PMC: 3157582. DOI: 10.1097/JTO.0b013e3182199be2. View

19.

Nishino M . Tumor Response Assessment for Precision Cancer Therapy: Response Evaluation Criteria in Solid Tumors and Beyond. Am Soc Clin Oncol Educ Book. 2018; 38:1019-1029. DOI: 10.1200/EDBK_201441. View

20.

JAMES K, Eisenhauer E, Christian M, Terenziani M, Vena D, Muldal A . Measuring response in solid tumors: unidimensional versus bidimensional measurement. J Natl Cancer Inst. 1999; 91(6):523-8. DOI: 10.1093/jnci/91.6.523. View