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Given the investigators\u2019 published clinical application more broadly in all oncology populations in a comprehensive cancer center, this study evaluated the validity of DIGEST\n                      <jats:sub>v2<\/jats:sub>\n                      across diverse non-HNC oncology populations. A retrospective analysis included 386 patients who underwent MBS studies at MD Anderson Cancer Center (2016\u20132021). Participants were randomly selected to represent a mix of the most common referrals for MBS (neuro-oncology, endocrine\/thyroid, thoracic cancers, mixed cancer etiologies in both inpatient and outpatient care). Two independent raters, clinical and research, assigned DIGEST overall, safety, and efficiency grades. Inter-rater reliability was assessed using weighted kappa (\u03ba\n                      <jats:sub>w<\/jats:sub>\n                      ). Criterion validity was evaluated against the MBSImP pharyngeal total score, and convergent construct validity against the MDADI physical score and the PSS-HN diet score, using Spearman\u2019s correlation coefficients (r\n                      <jats:sub>s<\/jats:sub>\n                      ) and Kruskal-Wallis tests. Analyses were stratified by disease and setting subgroups. Inter-rater reliability for the overall sample and subgroups was substantial for DIGEST overall, safety, and efficiency grades (\u03ba\n                      <jats:sub>w<\/jats:sub>\n                      \u2009=\u20090.68\u20130.71), with moderate agreement for efficiency in the endocrine\/thyroid subgroup (\u03ba\n                      <jats:sub>w<\/jats:sub>\n                      \u2009=\u20090.55). DIGEST effectively differentiated levels of pharyngeal pathophysiology for the overall sample and subgroups (MBSImP: r\n                      <jats:sub>s<\/jats:sub>\n                      =0.68\u20130.86,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05), demonstrating criterion validity. Associations with MDADI physical (r\n                      <jats:sub>s<\/jats:sub>\n                      =-0.12 to -0.47) and PSS-HN diet (r\n                      <jats:sub>s<\/jats:sub>\n                      =-0.23 to -0.49) indicated weak to moderate convergent construct validity. DIGEST demonstrated robust psychometric properties for assessing the severity of pharyngeal dysphagia across diverse non-HNC cancer populations, maintaining stable performance in common subgroups referred for MBS studies. This validation supports the broader use of DIGEST in oncology practice, addressing the need for reliable dysphagia assessment tools in oncology.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>- DIGESTv2 demonstrated substantial inter-rater reliability (\u03baw\u2009=\u20090.68\u20130.71) between clinicians in real-world practice and research laboratory image grading across neuro-oncology, endocrine\/thyroid, and thoracic cancer populations using routine clinical imaging data.<\/jats:p>\n                    <jats:p>- Criterion validity was confirmed by strong correlations with reference measures of swallowing function (rs\u2009=\u20090.68\u20130.86), validating DIGEST\u2019s ability to differentiate dysphagia severity.<\/jats:p>\n                    <jats:p>- DIGESTv2 performed consistently across subgroups commonly referred for videofluoroscopic-based swallowing evaluations, supporting its use as a standardized assessment method in oncology care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00455-025-10875-7","type":"journal-article","created":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T11:24:26Z","timestamp":1773833066000},"page":"307-315","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Expanding the Evidence-base for Clinician-Graded Dysphagia Using Dynamic Imaging Grade of Swallowing Toxicity (DIGEST): Validation Across Non-head and Neck Cancer Oncology Populations"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8953-8373","authenticated-orcid":false,"given":"Beatrice","family":"Manduchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla L.","family":"Warneke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaohui","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheila","family":"Buoy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carly E. A.","family":"Barbon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3710-5706","authenticated-orcid":false,"given":"Katherine A.","family":"Hutcheson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,18]]},"reference":[{"issue":"1","key":"10875_CR1","doi-asserted-by":"publisher","first-page":"62","DOI":"10.1002\/cncr.30283","volume":"123","author":"KA Hutcheson","year":"2017","unstructured":"Hutcheson KA, et al. Dynamic imaging grade of swallowing toxicity (DIGEST): scale development and validation. Cancer. 2017;123(1):62\u201370.","journal-title":"Cancer"},{"issue":"7","key":"10875_CR2","doi-asserted-by":"publisher","first-page":"1458","DOI":"10.1002\/cncr.34079","volume":"128","author":"KA Hutcheson","year":"2022","unstructured":"Hutcheson KA, et al. 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Hutcheson is the developer and principal investigator of DIGEST and reports funding support during the project period from the Patient-Centered Outcomes Research Institute, the National Institutes of Health, the THRIVE\/HESI Foundation, and Atos Medical outside the submitted work. She also reports funding from the ASH Foundation and the Stiefel Oropharyngeal Research Fund, royalties or licenses from MedBridge, Inc, payments or honoraria from Atos Medical, support for attending meetings and\/or travel from The University of Texas MD Anderson Cancer Center, and leadership with the Head and Neck Cancer Alliance Board and the American Board of Swallowing and Swallowing Disorders. The other authors made no disclosures.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The study was approved by the Institutional Review Board at The University of Texas MD Anderson Cancer Center (protocol PA19\u20130261); a waiver of informed consent was obtained for retrospective data-review.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"DIGESTv2 is a reliable and valid clinician-rated tool for grading the severity of pharyngeal swallowing impairment observed during video-based imaging of swallowing, with strong performance across diverse cancer populations.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Summary Statement"}}]}}