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This month's editor's favorite is Serfling and colleagues “Interobserver Agreement Rates on Fibroblast Activation Protein Inhibitor–Directed Molecular Imaging and Therapy​". The investigators hypothesize that FAP inhibitor (FAPI)–directed molecular imaging may be useful in selecting patients for radiopharmaceutical therapy. Interobserver agreement rates for 4 blinded readers' interpretation of 68Ga-FAPI-4 PET/CT for radiopharmaceutical treatment was performed with in 49 randomized oncology patients. Per scan visual assessment was performed, including overall scan impression, number of organ and lymph node (LN) metastases, and number of affected organs and LN regions. A maximum of 3 target lesions, defined as largest in size or most intense, per organ compartment were identified.

To investigate potential reference tissues, quantification also included unaffected liver parenchyma and blood pool. Readers also indicated whether FAPI-directed radiopharmaceutical therapy should be considered. Interobserver agreement rates intraclass correlation coefficients (ICCs) were interpreted according to Cicchetti (with 0.4–0.59 indicating fair, and 0.6–0.74 good, agreement).

On a visual basis, the agreement rate for an overall scan impression was fair (ICC, 0.42; 95% confidence interval [CI], 0.27–0.57). The concordance rate for number of affected LN areas was also fair (ICC, 0.59; 95%CI, 0.45–0.72), whereas the number of LN metastases, number of affected organs, and number of organ metastases achieved good agreement rates (ICC, ≥0.63). In a quantitative analysis, concordance rates for LN were good (ICC, 0.70; 0.48–0.88), but only fair for organ lesions (ICC, 0.43; 0.26–0.60). In regard to background tissues, ICCs were good for unaffected liver parenchyma (0.68; 0.54–0.79) and fair for blood pool (0.43; 0.29– 0.58).When readers should decide on ERT, concordance rates were also fair (ICC, 0.59; 95% CI, 0.46–0.73).

The authors concluded that for FAPI-directed molecular imaging and therapy, a fair to good interobserver agreement rate was achieved, supporting the adoption of FAPI for clinical routine and multicenter treatment trials.

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