Perbandingan Akurasi Radiological Evaluation Score For Bone Tumors (REST) dan American College Of Radiology Bone Reporting And Data System (ACR Bone-RADS) pada Radiografi Konvensional Tumor Tulang Jinak dan Ganas

Ahmad Faiz, Prof. Dr. dr. Lina Choridah, Sp. Rad., Subsp. PRP (K).; dr. Hesti Gunarti, Sp.Rad.A Subsp. RA (K).

2025 | Tesis-Spesialis | S2 Radiologi

Latar Belakang: Interpretasi radiografi konvensional pada tumor tulang sering bersifat subjektif dan menimbulkan variasi antar pemeriksa. Sistem penilaian terstruktur seperti REST dan ACR Bone-RADS dikembangkan untuk meningkatkan objektivitas, namun perbandingan akurasi keduanya masih terbatas.

Tujuan: Menilai dan membandingkan akurasi diagnostik REST dan ACR Bone- RADS  dalam  membedakan  tumor  tulang  jinak  dan  ganas  pada  radiografi konvensional, serta mengidentifikasi parameter REST yang bermakna terhadap keganasan.

Metode: Penelitian uji diagnostik potong lintang retrospektif ini melibatkan 129 pasien dengan hasil histopatologi tumor tulang di RSUP Dr. Sardjito. Tiga radiolog independen menilai skor REST dan ACR Bone-RADS pada radiografi konvensional. Analisis meliputi uji reliabilitas Fleiss’ Kappa dan Intraclass Correlation Coefficient (ICC), kurva Receiver Operating Characteristic (ROC), perbandingan Area Under the Curve (AUC) dengan uji DeLong, cut-off skor dengan indeks Youden, akurasi, sensitivitas, spesifisitas, serta regresi logistik multivariat untuk menentukan parameter REST yang signifikan.

Hasil: Reliabilitas interobserver skor REST dan ACR Bone-RADS sangat baik (ICC > 0,9) dengan sebagian besar parameter menunjukkan tingkat kesepakatan hampir sempurna (Kappa > 0,8), kecuali erosi korteks (Kappa = 0,349), margin (Kappa =0,609), dan erosi endosteal (Kappa = 0,528). REST menunjukkan AUC 0,848 dan ACR Bone-RADS 0,808 tanpa perbedaan bermakna (p = 0,161). Cut-off skor REST ? 4 memberikan sensitivitas 72,2%, sedangkan cut-off optimal ACR Bone-RADS adalah skor 4. REST lebih spesifik (85,3%), sedangkan ACR Bone-RADS lebih sensitif (85,2%). Analisis multivariat mengidentifikasi reaksi periosteal sebagai parameter REST yang berhubungan signifikan dan independen dengan keganasan (p = 0,006; OR = 9,49).

Kesimpulan: REST dan ACR Bone-RADS memiliki akurasi diagnostik yang setara dalam membedakan tumor tulang jinak dan ganas. Reaksi periosteal merupakan prediktor independen terhadap keganasan.

Background: Interpretation of conventional radiographs in bone tumors often involves subjectivity and  interobserver  variability,  which may  affect diagnostic accuracy. Structured scoring systems such as the REST and the ACR Bone-RADS were developed to enhance objectivity and reproducibility; however, direct comparisons of their diagnostic accuracy remain limited.

Objective: To evaluate and compare the diagnostic accuracy of REST and ACR Bone- RADS in differentiating benign and malignant bone tumors on conventional radiographs, and to determine significant REST parameters associated with malignancy.

Methods: This retrospective cross-sectional diagnostic study involved 129 patients with histopathologically confirmed bone tumors at Dr. Sardjito General Hospital. Three independent  radiologists  assessed  REST  and  ACR  Bone-RADS  scores  using conventional radiographs. Analyses included interobserver reliability using Fleiss’ kappa and Intraclass Correlation Coefficient (ICC), Receiver Operating Characteristic (ROC) curves, Area Under the Curve (AUC) comparison with the DeLong test, score cut-off determination using Youden’s index, diagnostic accuracy, sensitivity, specificity, and multivariate logistic regression to determine significant REST predictors.

Results: Interobserver reliability for both REST and ACR Bone-RADS was excellent (ICC > 0.9), with most parameters showing almost perfect agreement (Kappa > 0.8) except for cortical erosion (Kappa = 0.349), margin (Kappa = 0,609) and endosteal erosion (Kappa = 0.528). REST achieved an AUC of 0.848 and ACR Bone-RADS 0.808, with no significant difference (p = 0.161). The optimal REST cut-off score ? 4 yielded 72.2% sensitivity, while the optimal ACR Bone-RADS cut-off score was 4. REST demonstrated higher specificity (85.3%), whereas ACR Bone-RADS was more sensitive (85.2%). Multivariate analysis identified periosteal reaction as the only REST parameter significantly and independently associated with malignancy (p = 0.006; OR = 9.49).

Conclusion: Both REST and ACR Bone-RADS demonstrated comparable diagnostic accuracy in differentiating benign and malignant bone tumors on conventional radiographs. Periosteal reaction was the only parameter significantly associated with tumor malignancy.

Kata Kunci : REST, ACR Bone-RADS, tumor tulang, radiografi konvensional, akurasi diagnostik