Nisanard Pisuchpen1,2, Sienna M Durbin3, Meghan J Mooradian3, Florian J Fintelmann1, Kerry L Reynolds3, Michael Dougan4, Avinash Kambadakone5. 1. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA. 2. Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand. 3. Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. 4. Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA. 5. Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA. akambadakone@mgh.harvard.edu.
Abstract
OBJECTIVE: This study aimed to assess MDCT as a diagnostic and prognostic tool in patients with suspected immune checkpoint inhibitor (ICI)-related colitis. MATERIALS AND METHODS: This retrospective cohort study included patients receiving ICIs at three hospitals between 2015 and 2019 who underwent both abdominopelvic MDCT and endoscopic biopsy to workup suspected ICI-related colitis. Two radiologists independently reviewed MDCT images for signs of colitis based on pre-defined features. Diagnostic performance of MDCT was calculated and categorical variables between treatment subgroups were compared. Logistic regression was used to develop proposed MDCT criteria for diagnosis and MDCT severity score based on a combination of MDCT features of colitis to predict the patient outcomes in ICI-related colitis. RESULTS: A total of 118 MDCT scans from 108 patients were evaluated for suspected colitis, with 72 confirmed ICI-related colitis cases. Sensitivity, specificity, PPV, and NPV of MDCT for diagnosis of ICI-related colitis was 81% (58/72), 52 % (24/46), 73% (58/80), and 63% (24/38), respectively. Small bowel involvement was visualized in 25% of cases with ICI-related colitis (18/72). In melanoma patients presenting with diarrhea grade ≥ 2 (n = 40), MDCT had the best diagnostic performance for ICI-related colitis (specificity = 80% [8/10], PPV = 92% [23/25]). MDCT severity scores predicted intravenous steroid use (OR 10.3, p = 0.004), length of stay > 7 days (OR 9.0, p < 0.001), and endoscopic mucosal ulceration (OR 4.7, p = 0.02). CONCLUSION: MDCT is a useful diagnostic and prognostic tool for evaluating patients with immune checkpoint inhibitor-related colitis. An MDCT-based severity score enables assessment of disease severity and predicts outcome. KEY POINTS: • MDCT is useful for the diagnosis of colitis in patients receiving immune checkpoint inhibitor (ICI) therapy, and an MDCT-based severity score allows for prognostication of patient outcomes. • MDCT yielded moderate sensitivity (81%) for diagnosis of ICI-related colitis but limited specificity (52%). However, in symptomatic melanoma patients (grade 2-4 diarrhea) with a high pretest probability, MDCT proved useful for diagnosis with a high PPV (92%). • For ICI-related colitis, our proposed MDCT severity score has prognostic value in predicting intravenous steroid use, prolonged length of stay during inpatient admission (> 7 days), and endoscopic mucosal ulceration.
OBJECTIVE: This study aimed to assess MDCT as a diagnostic and prognostic tool in patients with suspected immune checkpoint inhibitor (ICI)-related colitis. MATERIALS AND METHODS: This retrospective cohort study included patients receiving ICIs at three hospitals between 2015 and 2019 who underwent both abdominopelvic MDCT and endoscopic biopsy to workup suspected ICI-related colitis. Two radiologists independently reviewed MDCT images for signs of colitis based on pre-defined features. Diagnostic performance of MDCT was calculated and categorical variables between treatment subgroups were compared. Logistic regression was used to develop proposed MDCT criteria for diagnosis and MDCT severity score based on a combination of MDCT features of colitis to predict the patient outcomes in ICI-related colitis. RESULTS: A total of 118 MDCT scans from 108 patients were evaluated for suspected colitis, with 72 confirmed ICI-related colitis cases. Sensitivity, specificity, PPV, and NPV of MDCT for diagnosis of ICI-related colitis was 81% (58/72), 52 % (24/46), 73% (58/80), and 63% (24/38), respectively. Small bowel involvement was visualized in 25% of cases with ICI-related colitis (18/72). In melanomapatients presenting with diarrhea grade ≥ 2 (n = 40), MDCT had the best diagnostic performance for ICI-related colitis (specificity = 80% [8/10], PPV = 92% [23/25]). MDCT severity scores predicted intravenous steroid use (OR 10.3, p = 0.004), length of stay > 7 days (OR 9.0, p < 0.001), and endoscopic mucosal ulceration (OR 4.7, p = 0.02). CONCLUSION: MDCT is a useful diagnostic and prognostic tool for evaluating patients with immune checkpoint inhibitor-related colitis. An MDCT-based severity score enables assessment of disease severity and predicts outcome. KEY POINTS: • MDCT is useful for the diagnosis of colitis in patients receiving immune checkpoint inhibitor (ICI) therapy, and an MDCT-based severity score allows for prognostication of patient outcomes. • MDCT yielded moderate sensitivity (81%) for diagnosis of ICI-related colitis but limited specificity (52%). However, in symptomatic melanomapatients (grade 2-4 diarrhea) with a high pretest probability, MDCT proved useful for diagnosis with a high PPV (92%). • For ICI-related colitis, our proposed MDCT severity score has prognostic value in predicting intravenous steroid use, prolonged length of stay during inpatient admission (> 7 days), and endoscopic mucosal ulceration.
Authors: Marnix H Geukes Foppen; Elisa A Rozeman; Sandra van Wilpe; Cindy Postma; Petur Snaebjornsson; Johannes V van Thienen; Monique E van Leerdam; Michel van den Heuvel; Christian U Blank; Jolanda van Dieren; John B A G Haanen Journal: ESMO Open Date: 2018-01-13