{"doi":"10.1101/2024.09.17.24313809","title":"Evaluating Observer Reliability and Diagnostic Accuracy of CT-LEFAT Criteria for Post-Treatment Head and Neck Lymphedema: A Prospective Blinded Comparative Analysis of Oncologist Human Inter-Rater Performance","abstract":"Background: Radiation-associated lymphedema and fibrosis (LEF) is a significant toxicity following radiation therapy (RT) for head and neck cancer (HNC) patients. Recently, the CT Lymphedema and Fibrosis Assessment Tool (CT-LEFAT) was developed to standardize LEF diagnosis through fat stranding visualized on CT. This study aims to evaluate the inter-observer reliability and diagnostic accuracy of the CT-LEFAT criteria. Materials and Methods: This study retrospectively evaluated 26 HNC patients treated with RT that received a minimum of two contrast-enhanced CT scans. Qualitative review was conducted by five physician raters to assess the fat stranding observed on CT according to the CT-LEFAT criteria. Fleiss' kappa analysis was used to assess the inter- and intra-rater reliability, and Receiver Operating Characteristic (ROC) Area Under the Curve (AUC) analysis was used to evaluate diagnostic accuracy. Results: The inter-rater reliability across the six CT-LEFAT regions generally indicated a slight to fair agreement across all raters (0.04 ≤ kappa ≤ 0.36). Intra-observer agreement was generally fair to moderate (overall kappa=0.44). The ROC AUC analysis varied based on aggregation method used (0.60 ≤ average AUC ≤ 0.70). Conclusion: This specific use-case evaluating CT-LEFAT criteria displays limited performance. This suggests that additional materials, such as further training, refinement of imaging methods, or other processes may be required before achieving clinically-ready diagnostic performance of LEF diagnosis.","journal":"medRxiv","year":2024,"id":503485,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.966,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1329744,"name":"Natalie West","orcid":"0009-0007-0211-8845","position":1,"is_corresponding":false},{"id":1353799,"name":"Serageldin K. Attia","orcid":null,"position":2,"is_corresponding":false},{"id":1218116,"name":"Zaphanlene Kaffey","orcid":"0009-0008-7999-5245","position":3,"is_corresponding":false},{"id":659027,"name":"Cem Dede","orcid":"0000-0002-0543-9325","position":4,"is_corresponding":false},{"id":689224,"name":"Samuel L. Mulder","orcid":"0000-0001-5185-4805","position":5,"is_corresponding":false},{"id":810496,"name":"Dina El-Habashy","orcid":"0000-0001-5182-9976","position":6,"is_corresponding":false},{"id":1353344,"name":"Roger Neuberger","orcid":"0009-0001-4514-1793","position":7,"is_corresponding":false},{"id":653657,"name":"Mohamed A. Naser","orcid":"0000-0003-1020-4966","position":8,"is_corresponding":false},{"id":348525,"name":"Steven J. Frank","orcid":"0000-0001-6517-7884","position":9,"is_corresponding":false},{"id":724570,"name":"Shitong Mao","orcid":"0000-0002-5122-7497","position":10,"is_corresponding":false},{"id":709121,"name":"Holly McMillan","orcid":"0000-0001-6875-7497","position":11,"is_corresponding":false},{"id":1353800,"name":"Brad G. Smith","orcid":null,"position":12,"is_corresponding":false},{"id":32353,"name":"David I. Rosenthal","orcid":"0000-0001-7124-7447","position":13,"is_corresponding":false},{"id":351185,"name":"Stephen Y. Lai","orcid":"0000-0001-8301-7286","position":14,"is_corresponding":false},{"id":447333,"name":"Katherine A. Hutcheson","orcid":"0000-0003-3710-5706","position":15,"is_corresponding":false},{"id":346829,"name":"Amy C. Moreno","orcid":"0000-0001-6762-6807","position":16,"is_corresponding":false},{"id":295555,"name":"Clifton D. Fuller","orcid":"0000-0002-5264-3994","position":17,"is_corresponding":false},{"id":1283605,"name":"MD Anderson Head and Neck Cancer Symptom Working Group","orcid":null,"position":0,"is_corresponding":true}],"reference_count":17,"raw_metadata":null,"created_at":"2026-07-19T02:10:31.826282Z","pmid":"39371132","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}