Spinal instability neoplastic score: An analysis of reliability and validity from the spine Oncology Study Group Journal Article
| Authors: | Fourney, D. R.; Frangou, E. M.; Ryken, T. C.; Dipaola, C. P.; Shaffrey, C. I.; Berven, S. H.; Bilsky, M. H.; Harrop, J. S.; Fehlings, M. G.; Boriani, S.; Chou, D.; Schmidt, M. H.; Polly, D. W.; Biagini, R.; Burch, S.; Dekutoski, M. B.; Ganju, A.; Gerszten, P. C.; Gokaslan, Z. L.; Groff, M. W.; Liebsch, N. J.; Mendel, E.; Okuno, S. H.; Patel, S.; Rhines, L. D.; Rose, P. S.; Sciubba, D. M.; Sundaresan, N.; Tomita, K.; Varga, P. P.; Vialle, L. R.; Vrionis, F. D.; Yamada, Y.; Fisher, C. G. |
| Article Title: | Spinal instability neoplastic score: An analysis of reliability and validity from the spine Oncology Study Group |
| Abstract: | Purpose: Standardized indications for treatment of tumor-related spinal instability are hampered by the lack of a valid and reliable classification system. The objective of this study was to determine the interobserver reliability, intraobserver reliability, and predictive validity of the Spinal Instability Neoplastic Score (SINS). Methods: Clinical and radiographic data from 30 patients with spinal tumors were classified as stable, potentially unstable, and unstable by members of the Spine Oncology Study Group. The median category for each patient case (consensus opinion) was used as the gold standard for predictive validity testing. On two occasions at least 6 weeks apart, each rater also scored each patient using SINS. Each total score was converted into a three-category data field, with 0 to 6 as stable, 7 to 12 as potentially unstable, and 13 to 18 as unstable. Results: The ≲καππ α∀ statistics for interobserver reliability were 0.790, 0.841, 0.244, 0.456, 0.462, and 0.492 for the fields of location, pain, bone quality, alignment, vertebral body collapse, and posterolateral involvement, respectively. The ≲καππα∀ statistics for intraobserver reliability were 0.806, 0.859, 0.528, 0.614, 0.590, and 0.662 for the same respective fields. Intraclass correlation coefficients for inter- and intraobserver reliability of total SINS score were 0.846 (95% CI, 0.773 to 0.911) and 0.886 (95% CI, 0.868 to 0.902), respectively. The ≲καππα∀ statistic for predictive validity was 0.712 (95% CI, 0.676 to 0.766). Conclusion: SINS demonstrated near-perfect inter- and intraobserver reliability in determining three clinically relevant categories of stability. The sensitivity and specificity of SINS for potentially unstable or unstable lesions were 95.7% and 79.5%, respectively. © 2011 by American Society of Clinical Oncology. |
| Keywords: | clinical article; disease classification; pathophysiology; sensitivity and specificity; reproducibility; reproducibility of results; tumor localization; observer variation; validation study; bone density; spinal cord tumor; spine; spinal neoplasms; predictive validity; scoring system; predictive value of tests; pain assessment; predictive value; joint instability; spine tumor; vertebra; lumbar vertebrae; interrater reliability; intrarater reliability; cervical vertebrae; thoracic vertebrae; spine instability; spine radiography; vertebra body; cervical spine; spinal instability neoplastic score; lumbar vertebra |
| Journal Title: | Journal of Clinical Oncology |
| Volume: | 29 |
| Issue: | 22 |
| ISSN: | 0732-183X |
| Publisher: | American Society of Clinical Oncology |
| Date Published: | 2011-08-01 |
| Start Page: | 3072 |
| End Page: | 3077 |
| Language: | English |
| DOI: | 10.1200/jco.2010.34.3897 |
| PUBMED: | 21709187 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Export Date: 3 October 2011" - "CODEN: JCOND" - "Source: Scopus" |
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