{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T01:35:00Z","timestamp":1785893700618,"version":"3.56.0"},"reference-count":32,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T00:00:00Z","timestamp":1654128000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the extent to which observer variability of computed tomography (CT) lung nodule assessment may affect clinical treatment stratification in Wilms tumour (WT) patients, according to the recent Soci\u00e9t\u00e9 Internationale d'Oncologie P\u00e9diatrique Renal Tumour Study Group (SIOP\u2010RTSG) UMBRELLA protocol.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>I: CT thoraces of children with WT submitted for central review were used to estimate size distribution of lung metastases. II: Scans were selected for blinded review by five radiologists to determine intra\u2010 and inter\u2010observer variability. They assessed identical scans on two occasions 6\u00a0months apart. III: Monte Carlo simulation (MCMC) was used to predict the clinical impact of observer variation when applying the UMBRELLA protocol size criteria.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Lung nodules were found in 84 out of 360 (23%) children with WT. For 21 identified lung nodules, inter\u2010observer limits of agreement (LOA) for the five readers were \u00b12.4 and \u00b11.4\u00a0mm (AP diameter), \u00b11.9 and \u00b11.8\u00a0mm (TS diameter) and \u00b12.0 and \u00b12.4\u00a0mm (LS diameter) at assessments 1 and 2. Intra\u2010observer LOA across the three dimensions were \u00b11.5, \u00b12.2, \u00b13.5, \u00b13.1 and \u00b12.6\u00a0mm (readers 1\u20135). MCMC demonstrated that 17% of the patients with a \u2018true\u2019 nodule size of \u22653\u00a0mm will be scored as &lt;3\u00a0mm, and 21% of the patients with a \u2018true\u2019 nodule size of &lt;3\u00a0mm will be scored as being \u22653\u00a0mm.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>A significant intra\u2013inter observer variation was found when measuring lung nodules on CT for patients with WT. This may have significant implications on treatment stratification, and thereby outcome, when applying a threshold of \u22653\u00a0mm for a lung nodule to dictate metastatic status.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.29759","type":"journal-article","created":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T12:39:28Z","timestamp":1654173568000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["The clinical impact of observer variability in lung nodule classification in children with Wilms tumour"],"prefix":"10.1002","volume":"69","author":[{"given":"Jesper Sune","family":"Brok","sequence":"first","affiliation":[{"name":"Department of Paediatric Haematology and Oncology, Rigshospitalet Copenhagen University Hospital  Copenhagen Denmark"},{"name":"UCL Great Ormond Street Institute of Child Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Shelmerdine","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology Great Ormond Street Hospital for Children NHS foundation Trust  London UK"},{"name":"UCL Great Ormond Street Institute of Child Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9480-9147","authenticated-orcid":false,"given":"Frederikke","family":"Damsgaard","sequence":"additional","affiliation":[{"name":"Department of Paediatric Haematology and Oncology, Rigshospitalet Copenhagen University Hospital  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne","family":"Smets","sequence":"additional","affiliation":[{"name":"Department of Radiology Amsterdam University Medical Centre  Amsterdam The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5596-9570","authenticated-orcid":false,"given":"Sabine","family":"Irtan","sequence":"additional","affiliation":[{"name":"Department of Visceral and Neonatal Paediatric Surgery Sorbonne University, Armand Trousseau Hospital \u2010 APHP  Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Swinson","sequence":"additional","affiliation":[{"name":"The Leeds Teaching Hospitals  Leeds UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Venus","family":"Hedayati","sequence":"additional","affiliation":[{"name":"King's College Hospital NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Jacob","sequence":"additional","affiliation":[{"name":"Centre for Medical Image Computing University College London  London UK"},{"name":"Department of Respiratory Medicine University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjun","family":"Nair","sequence":"additional","affiliation":[{"name":"University College London Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minou","family":"Oostveen","sequence":"additional","affiliation":[{"name":"UCL Great Ormond Street Institute of Child Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2384-9475","authenticated-orcid":false,"given":"Kathy","family":"Pritchard\u2010Jones","sequence":"additional","affiliation":[{"name":"UCL Great Ormond Street Institute of Child Health  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8ystein","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology Great Ormond Street Hospital for Children NHS foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,6,2]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.2950210305"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(13)70548-5"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2016.09.005"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2012.06.007"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.18.00101"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(06)70724-0"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.04.7852"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.23090"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2011.05.025"},{"key":"e_1_2_8_11_1","unstructured":"WinBUGS.MRC Biostatistics Unit University of Cambridge.https:\/\/www.mrc\u2010bsu.cam.ac.uk\/software\/bugs\/the\u2010bugs\u2010project\u2010winbugs\/. 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