Evidence map›Paper›PMID 40174310›Full record

ArticleOral oncology2025

Evaluating observer reliability and diagnostic accuracy of CT-LEFAT criteria for post-treatment head and neck lymphedema: A prospective blinded comparative analysis.

Natalie A West, Serageldin K Attia, Zaphanlene Kaffey, Cem Dede, Samuel L Mulder, Dina M El-Habashy, Roger Neuberger, Mohamed A Naser, Steven J Frank, Shitong Mao and 8 more

Abstract readComparative Study
PubMed Full text at PMC Publisher
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Article in Oral oncology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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1 citing paper in PubMed.

  1. Article
4 · The record

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5 · Who and what money

Authors and funding

18 authors.

Natalie A WestDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; The University of Texas MD Anderson UT Health Houston Graduate School of Biomedical Sciences, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: nawest@mdanderson.org.
Serageldin K AttiaDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: serageddein@gmail.com.
Zaphanlene KaffeyDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; The University of Texas MD Anderson UT Health Houston Graduate School of Biomedical Sciences, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: zkaffey@mdanderson.org.
Cem DedeDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: cdede@mdanderson.org.
Samuel L MulderDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; The University of Texas MD Anderson UT Health Houston Graduate School of Biomedical Sciences, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: smulder@mdanderson.org.
Dina M El-HabashyDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: dina.elhabashy89@med.menofia.edu.eg.
Roger NeubergerDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: roger.neuberger@bcm.edu.
Mohamed A NaserDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: manaser@mdanderson.org.
Steven J FrankDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: sjfrank@mdanderson.org.
Shitong MaoDepartment of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: smao1@mdanderson.org.
Holly McMillanDepartment of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: hmcmillan@mdanderson.org.
Brad SmithDepartment of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: bgsmith1@mdanderson.org.
David RosenthalDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: dirosenthal@mdanderson.org.
Stephen Y LaiDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; The University of Texas MD Anderson UT Health Houston Graduate School of Biomedical Sciences, 1515 Holcombe Blvd, Houston, TX 77030, USA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; Department of Molecular and Cellular Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: sylai@mdanderson.org.
Katherine A HutchesonDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: karnold@mdanderson.org.
Amy C MorenoDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; The University of Texas MD Anderson UT Health Houston Graduate School of Biomedical Sciences, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: akmoreno@mdanderson.org.
Clifton D FullerDepartment of Radiation Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA; The University of Texas MD Anderson UT Health Houston Graduate School of Biomedical Sciences, 1515 Holcombe Blvd, Houston, TX 77030, USA. Electronic address: cdfuller@mdanderson.org.
MD Anderson Head and Neck Cancer Symptom Working Group

Funding

Tumor Evolution and Metastasis ProgramP30CA016672 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Scott Kopetz · 1985 to 2026
$290.8M
Paul Calabresi Clinical Oncology AwardK12CA088084 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI David S. Hong, Scott Kopetz · 2000 to 2026
$14.0M
Project 3: Inhibiting Oxidative Phosphorylation in Pancreatic CancerP50CA221707 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI KOPETZ, SCOTT, MAITRA, ANIRBAN · 2019 to 2023
$11.0M
Project 3: InHANCE: Fibrosis Imaging Biomarkers of Radiation: An Orphan Drug Study to Evaluate REduction of SeVERity of Symptoms in a Randomized Evaluative Trial (FIBRO2SE-REVERSE)P01CA278716 · NCI · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Kristy Brock · 2025 to 2026
$7.2M
Development of functional magnetic resonance imaging-guided adaptive radiotherapy for head and neck cancer patients using novel MR-Linac deviceR01DE028290 · NIDCR · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI CHRISTODOULEAS, JOHN PAUL, FULLER, CLIFTON DAVID · 2019 to 2023
$4.3M
NRSA Training CoreTL1TR003169 · NCATS · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · PI CHANDRA, JOYA, FROST, JEFFREY A. · 2019 to 2023
$3.7M
Longitudinal Spatial-Nonspatial Decision Support for Competing Outcomes in Head and Neck Cancer TherapyR01CA258827 · NCI · UNIVERSITY OF ILLINOIS AT CHICAGO · PI CANAHUATE, GUADALUPE, FULLER, CLIFTON DAVID · 2021 to 2025
$2.9M
Harvard MD Anderson Collaborative to Reduce LyMphatic MOrbidity in Head and Neck Cancer with Artificial Intelligence (HARMONiC-AI)R01DE034780 · NIDCR · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI Clifton David Fuller, Katherine Arnold Hutcheson · 2025 to 2026
$1.4M
CTSA Predoctoral T32 at the University of Texas Health Science Center at HoustonT32TR004905 · NCATS · UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON · PI Joya Chandra, Jeffrey A. Frost · 2024 to 2026
$811k
Provider and Patient-generated Remote Oro-Dental Health Electronic Data Capture for Algorithmic Longitudinal Evaluation and Risk-Assessment (PROHEALER)K01DE030524 · NIDCR · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI MORENO, AMY CATHERINE · 2022 to 2024
$479k
Radiation-specific Automated Dental Dose Distributions via Machine-learning based Mapping for Accurate Predictions of (Peri)odontal Problems (RADMAP)R21DE031082 · NIDCR · UNIVERSITY OF TX MD ANDERSON CAN CTR · PI MORENO, AMY CATHERINE · 2021 to 2022
$452k
ERK/MAP KINASE SIGNALLING PATHWAYSF32GM016926 · NIGMS · UNIVERSITY OF TEXAS SW MED CTR/DALLAS · PI FROST, JEFFREY A · 1994 to 1996
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NCATS NIH HHS T32 TR004905NCATS NIH HHS TL1 TR003169NCI NIH HHS K12 CA088084NCI NIH HHS P01 CA278716NCI NIH HHS P30 CA016672NCI NIH HHS P50 CA221707NCI NIH HHS R01 CA258827NIDCR NIH HHS K01 DE030524NIDCR NIH HHS R01 DE028290NIDCR NIH HHS R01 DE034780NIDCR NIH HHS R21 DE031082NIGMS NIH HHS F32 GM016926
6 · The paper itself

Abstract

backgroundRadiation-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

methodsThis 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.

resultsThe 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).

conclusionThis 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.

Indexed as

Head and Neck NeoplasmsLymphedemaTomography, X-Ray ComputedAdultAgedFemaleFibrosisHumansMaleMiddle AgedObserver VariationProspective StudiesReproducibility of ResultsRetrospective StudiesComputed tomographyCT imagingFibrosisHead and neck cancerLymphedemaObserver reliabilityObserver variationRadiation therapySoft tissue alterationToxicity

Identifiers

PMID40174310
PMCPMC12087970

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