Evaluation of Image-Defined Risk Factor (IDRF) Assessment in Patients With Intermediate-risk Neuroblastoma: A Report From the Children's Oncology Group Study ANBL0531

Erin G Brown; E Stanton Adkins; Peter Mattei; Fredric A Hoffer; Sandra L Wootton-Gorges; Wendy B London; Arlene Naranjo; Mary L Schmidt; Michael D Hogarty; Meredith S Irwin; Susan L Cohn; Julie R Park; John M Maris; Rochelle Bagatell; Clare J Twist; Jed G Nuchtern; Andrew M Davidoff; Erika A Newman; Dave R Lal

doi:10.1016/j.jpedsurg.2024.161896

Evaluation of Image-Defined Risk Factor (IDRF) Assessment in Patients With Intermediate-risk Neuroblastoma: A Report From the Children's Oncology Group Study ANBL0531

J Pediatr Surg. 2024 Sep 6:161896. doi: 10.1016/j.jpedsurg.2024.161896. Online ahead of print.

Authors

Erin G Brown¹, E Stanton Adkins², Peter Mattei³, Fredric A Hoffer⁴, Sandra L Wootton-Gorges⁵, Wendy B London⁶, Arlene Naranjo⁷, Mary L Schmidt⁸, Michael D Hogarty⁹, Meredith S Irwin¹⁰, Susan L Cohn¹¹, Julie R Park¹², John M Maris¹³, Rochelle Bagatell⁹, Clare J Twist¹⁴, Jed G Nuchtern¹⁵, Andrew M Davidoff¹⁶, Erika A Newman¹⁷, Dave R Lal¹⁸

Affiliations

¹ Division of Pediatric Surgery, Department of Surgery, University of California Davis Children's Hospital, Sacramento, CA, USA. Electronic address: egbrown@ucdavis.edu.
² Department of Pediatrics, University of South Carolina, Columbia, SC, USA.
³ Division of Pediatic Surgery, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁴ Department of Radiology, University of Washington, Seattle, WA, USA.
⁵ Department of Radiology, University of California Davis Children's Hospital, Sacramento, CA, USA.
⁶ Department of Pediatrics, Dana-Farber Cancer Institute and Boston Children's Hospital, Boston, MA, USA.
⁷ University of Florida Children's Oncology Group Statistics and Data Center, Gainesville, FL, USA.
⁸ Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Illinois Cancer Center, Chicago, IL, USA.
⁹ Division of Pediatric Hematology and Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁰ Division of Pediatric Hematology and Oncology, Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, USA.
¹¹ Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Chicago, Chicago, IL, USA.
¹² Division of Pediatric Hematology and Oncology, Department of Pediatrics, St. Jude Children's Research Center, Memphis, TN, USA.
¹³ Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁴ Division of Pediatric Hematology and Oncology, Department of Pediatrics, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA.
¹⁵ Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
¹⁶ Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA.
¹⁷ Division of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, Ann Arbor, MI, USA.
¹⁸ Division of Pediatric Surgery, Department of Surgery, Children's Wisconsin, Milwaukee, WI, USA.

PMID: 39317567
DOI: 10.1016/j.jpedsurg.2024.161896

Abstract

Background: The International Neuroblastoma Risk Group (INRG) classifier utilizes a staging system based on pretreatment imaging criteria in which image-defined risk factors (IDRFs) are used to evaluate the extent of locoregional disease. Children's Oncology Group (COG) study ANBL0531 prospectively examined institutional determination of IDRF status and compared that to a standardized central review.

Methods: Between 9/2009-6/2011, patients with intermediate-risk neuroblastoma were enrolled on ANBL0531 and had IDRF assessment at treating institutions. Paired COG pediatric surgeons and radiologists performed blinded central review of diagnostic imaging for the presence or absence of IDRFs. Second blinded review was performed in cases of discordance. Comparison of local and central review was performed using the Kappa coefficient to determine concordance in IDRF assessment.

Results: 211 patients enrolled in ANBL0531 underwent IDRF assessment; 3 patients were excluded due to poor image quality. Central reviewer pairs agreed on the presence or absence of any IDRF in 170/208 (81.7%; κ = 0.48) cases. Thirteen (6.3%) cases could not be adjudicated after second blinded review. Radiologists were more likely to identify IRDFs as present than surgeons (p < 0.001). Local and central reviewers agreed on the presence or absence of any IDRF in only108/208 (51.9%; κ = 0.06) cases.

Conclusions: Among experienced pediatric surgeons and radiologists participating in central review, concordance was moderate, with agreement in 81.7% of cases. On comparison of local and central assessment of IDRFs, concordance was poor. These data indicate that greater standardization, education, technology, and training are needed to improve the assessment of IDRFs in children with neuroblastoma.

Level of evidence: Treatment Study, Level III.

Keywords: Concordance; IDRF; Image-defined risk factor; Neuroblastoma.

Grants and funding

U10 CA180899/CA/NCI NIH HHS/United States