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Wang B, Wang W, Zhou W, Zhao Y, Liu W. Cervical cancer-specific long non-coding RNA landscape reveals the favorable prognosis predictive performance of an ion-channel-related signature model. Cancer Med 2024; 13:e7389. [PMID: 38864475 PMCID: PMC11167610 DOI: 10.1002/cam4.7389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 04/30/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Ion channels play an important role in tumorigenesis and progression of cervical cancer. Multiple long non-coding RNA genes are widely involved in ion channel-related signaling regulation. However, the association and potential clinical application of lncRNAs in the prognosis of cervical cancer are still poorly explored. METHODS Thirteen patients with cervical cancer were enrolled in current study. Whole transcriptome (involving both mRNAs and lncRNAs) sequencing was performed on fresh tumor and adjacent normal tissues that were surgically resected from patients. A comprehensive cervical cancer-specific lncRNA landscape was obtained by our custom pipeline. Then, a prognostic scoring model of ion-channel-related lncRNAs was established by regression algorithms. The performance of the predictive model as well as its association with the clinical characteristics and tumor microenvironment (TME) status were further evaluated. RESULTS To comprehensively identify cervical cancer-specific lncRNAs, we sequenced 26 samples of cervical cancer patients and integrated the transcriptomic results. We built a custom analysis pipeline to improve the accuracy of lncRNA identification and functional annotation and obtained 18,482 novel lncRNAs in cervical cancer. Then, 159 ion channel- and tumorigenesis-related (ICTR-) lncRNAs were identified. Based on nine ICTR-lncRNAs, we also established a prognostic scoring model and validated its accuracy and robustness in assessing the prognosis of patients with cervical cancer. Besides, the TME was characterized, and we found that B cells, activated CD8+ T, and tertiary lymphoid structures were significantly associated with ICTR-lncRNAs signature scores. CONCLUSION We provided a thorough landscape of cervical cancer-specific lncRNAs. Through integrative analyses, we identified ion-channel-related lncRNAs and established a predictive model for assessing the prognosis of patients with cervical cancer. Meanwhile, we characterized its association with TME status. This study improved our knowledge of the prominent roles of lncRNAs in regulating ion channel in cervical cancer.
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Affiliation(s)
- Bochang Wang
- Department of Gynecological OncologyTianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjinChina
- Tianjin Cancer Hospital Airport Hospital, National Clinical Research Center for CancerTianjinChina
| | - Wei Wang
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and TherapyYuceBio Technology Co., Ltd.ShenzhenChina
| | - Wenhao Zhou
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and TherapyYuceBio Technology Co., Ltd.ShenzhenChina
| | - Yujie Zhao
- Shenzhen Engineering Center for Translational Medicine of Precision Cancer Immunodiagnosis and TherapyYuceBio Technology Co., Ltd.ShenzhenChina
| | - Wenxin Liu
- Department of Gynecological OncologyTianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin's Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and TherapyTianjinChina
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Shu K, Wang K, Zhang R, Wang C, Cai Z, Liu K, Lin H, Zeng Y, Cao Z, Lai C, Yan Z, Lu Y. Pituitary MRI Radiomics Improves Diagnostic Performance of Growth Hormone Deficiency in Children Short Stature: A Multicenter Radiomics Study. Acad Radiol 2024:S1076-6332(24)00293-9. [PMID: 38796401 DOI: 10.1016/j.acra.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 05/28/2024]
Abstract
RATIONALE AND OBJECTIVES To develop an efficient machine-learning model using pituitary MRI radiomics and clinical data to differentiate growth hormone deficiency (GHD) from idiopathic short stature (ISS), making the diagnostic process more acceptable to patients and their families. MATERIALS AND METHODS A retrospective cohort of 297 GHD and 300 ISS children (4-12 years) were enrolled as training and validation cohorts (8:2 ratio). An external cohort from another institution (49 GHD and 51 ISS) was employed as the testing cohort. Radiomics features extracted from the anterior pituitary gland on sagittal T1-weighted image (1.5 T or 3.0 T) were used to develop a radiomics model after feature selection. Hematological biomarkers were selected to create a clinical model and combine with the optimal radiomics features to create a clinical-radiomics model. The area under the receive operating characteristic curve (AUC) and Delong test compared the diagnostic performance of the previously mentioned three models across different validation and testing cohorts. RESULTS 17 radiomics features were selected for the radiomics model, and total protein, total cholesterol, free triiodothyronine, and triglyceride were utilized for the clinical model. In the training and validation cohorts, the diagnostic performance of the clinical-radiomics model (AUC=0.820 and 0.801) was comparable to the radiomics model (AUC=0.812 and 0.779, both P >0.05), both outperforming the clinical model (AUC=0.575 and 0.593, P <0.001). In the testing cohort, the clinical-radiomics model exhibited the highest AUC of 0.762 than the clinical and radiomics model (AUC=0.604 and 0.741, respectively, P <0.05). In addition, the clinical and radiomics models demonstrated similar diagnostic performance in the testing cohort (P >0.05). CONCLUSION Integrating radiomics features from conventional pituitary MRI with clinical indicators offers a minimally invasive approach for identifying GHD and shows robustness in a multicenter setting.
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Affiliation(s)
- Kun Shu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Keren Wang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Ruifang Zhang
- Department of Radiology, Children's hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Chenyan Wang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Zheng Cai
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Kun Liu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Hu Lin
- Department of Endocrinology, Children's hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yan Zeng
- Department of Research Center, Shanghai United Imaging Intelligence Co., Ltd, China
| | - Zirui Cao
- Department of Research Center, Shanghai United Imaging Intelligence Co., Ltd, China
| | - Can Lai
- Department of Radiology, Children's hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Structural Malformations in Children of Zhejiang Province, Wenzhou, Zhejiang Province, China; Wenzhou Key Laboratory of Structural and Functional Imaging, Wenzhou, Zhejiang Province, China
| | - Yi Lu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China; Key Laboratory of Structural Malformations in Children of Zhejiang Province, Wenzhou, Zhejiang Province, China; Wenzhou Key Laboratory of Structural and Functional Imaging, Wenzhou, Zhejiang Province, China.
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Hinzpeter R, Mirshahvalad SA, Murad V, Avery L, Kulanthaivelu R, Kohan A, Ortega C, Elimova E, Yeung J, Hope A, Metser U, Veit-Haibach P. The [ 18F]F-FDG PET/CT Radiomics Classifier of Histologic Subtypes and Anatomical Disease Origins across Various Malignancies: A Proof-of-Principle Study. Cancers (Basel) 2024; 16:1873. [PMID: 38791955 PMCID: PMC11119256 DOI: 10.3390/cancers16101873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
We aimed to investigate whether [18F]F-FDG-PET/CT-derived radiomics can classify histologic subtypes and determine the anatomical origin of various malignancies. In this IRB-approved retrospective study, 391 patients (age = 66.7 ± 11.2) with pulmonary (n = 142), gastroesophageal (n = 128) and head and neck (n = 121) malignancies were included. Image segmentation and feature extraction were performed semi-automatically. Two models (all possible subset regression [APS] and recursive partitioning) were employed to predict histology (squamous cell carcinoma [SCC; n = 219] vs. adenocarcinoma [AC; n = 172]), the anatomical origin, and histology plus anatomical origin. The recursive partitioning algorithm outperformed APS to determine histology (sensitivity 0.90 vs. 0.73; specificity 0.77 vs. 0.65). The recursive partitioning algorithm also revealed good predictive ability regarding anatomical origin. Particularly, pulmonary malignancies were identified with high accuracy (sensitivity 0.93; specificity 0.98). Finally, a model for the synchronous prediction of histology and anatomical disease origin resulted in high accuracy in determining gastroesophageal AC (sensitivity 0.88; specificity 0.92), pulmonary AC (sensitivity 0.89; specificity 0.88) and head and neck SCC (sensitivity 0.91; specificity 0.92). Adding PET-features was associated with marginal incremental value for both the prediction of histology and origin in the APS model. Overall, our study demonstrated a good predictive ability to determine patients' histology and anatomical origin using [18F]F-FDG-PET/CT-derived radiomics features, mainly from CT.
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Affiliation(s)
- Ricarda Hinzpeter
- University Medical Imaging Toronto, Joint Department Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada; (S.A.M.); (V.M.); (R.K.); (A.K.); (C.O.); (U.M.); (P.V.-H.)
- Institute for Diagnostic and Interventional Radiology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Seyed Ali Mirshahvalad
- University Medical Imaging Toronto, Joint Department Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada; (S.A.M.); (V.M.); (R.K.); (A.K.); (C.O.); (U.M.); (P.V.-H.)
| | - Vanessa Murad
- University Medical Imaging Toronto, Joint Department Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada; (S.A.M.); (V.M.); (R.K.); (A.K.); (C.O.); (U.M.); (P.V.-H.)
| | - Lisa Avery
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 1X6, Canada;
- Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada
| | - Roshini Kulanthaivelu
- University Medical Imaging Toronto, Joint Department Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada; (S.A.M.); (V.M.); (R.K.); (A.K.); (C.O.); (U.M.); (P.V.-H.)
| | - Andres Kohan
- University Medical Imaging Toronto, Joint Department Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada; (S.A.M.); (V.M.); (R.K.); (A.K.); (C.O.); (U.M.); (P.V.-H.)
| | - Claudia Ortega
- University Medical Imaging Toronto, Joint Department Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada; (S.A.M.); (V.M.); (R.K.); (A.K.); (C.O.); (U.M.); (P.V.-H.)
| | - Elena Elimova
- Department of Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada;
| | - Jonathan Yeung
- Division of Thoracic Surgery, Department of Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON M5G 2C4, Canada;
| | - Andrew Hope
- Department of Radiation Oncology, University Health Network, Toronto, ON M5G 2C4, Canada;
| | - Ur Metser
- University Medical Imaging Toronto, Joint Department Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada; (S.A.M.); (V.M.); (R.K.); (A.K.); (C.O.); (U.M.); (P.V.-H.)
| | - Patrick Veit-Haibach
- University Medical Imaging Toronto, Joint Department Medical Imaging, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada; (S.A.M.); (V.M.); (R.K.); (A.K.); (C.O.); (U.M.); (P.V.-H.)
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Leng Y, Kan A, Wang X, Li X, Xiao X, Wang Y, Liu L, Gong L. Contrast-enhanced CT radiomics for preoperative prediction of stage in epithelial ovarian cancer: a multicenter study. BMC Cancer 2024; 24:307. [PMID: 38448945 PMCID: PMC10916071 DOI: 10.1186/s12885-024-12037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Preoperative prediction of International Federation of Gynecology and Obstetrics (FIGO) stage in patients with epithelial ovarian cancer (EOC) is crucial for determining appropriate treatment strategy. This study aimed to explore the value of contrast-enhanced CT (CECT) radiomics in predicting preoperative FIGO staging of EOC, and to validate the stability of the model through an independent external dataset. METHODS A total of 201 EOC patients from three centers, divided into a training cohort (n = 106), internal (n = 46) and external (n = 49) validation cohorts. The least absolute shrinkage and selection operator (LASSO) regression algorithm was used for screening radiomics features. Five machine learning algorithms, namely logistic regression, support vector machine, random forest, light gradient boosting machine (LightGBM), and decision tree, were utilized in developing the radiomics model. The optimal performing algorithm was selected to establish the radiomics model, clinical model, and the combined model. The diagnostic performances of the models were evaluated through receiver operating characteristic analysis, and the comparison of the area under curves (AUCs) were conducted using the Delong test or F-test. RESULTS Seven optimal radiomics features were retained by the LASSO algorithm. The five radiomics models demonstrate that the LightGBM model exhibits notable prediction efficiency and robustness, as evidenced by AUCs of 0.83 in the training cohort, 0.80 in the internal validation cohort, and 0.68 in the external validation cohort. The multivariate logistic regression analysis indicated that carcinoma antigen 125 and tumor location were identified as independent predictors for the FIGO staging of EOC. The combined model exhibited best diagnostic efficiency, with AUCs of 0.95 in the training cohort, 0.83 in the internal validation cohort, and 0.79 in the external validation cohort. The F-test indicated that the combined model exhibited a significantly superior AUC value compared to the radiomics model in the training cohort (P < 0.001). CONCLUSIONS The combined model integrating clinical characteristics and radiomics features shows potential as a non-invasive adjunctive diagnostic modality for preoperative evaluation of the FIGO staging status of EOC, thereby facilitating clinical decision-making and enhancing patient outcomes.
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Affiliation(s)
- Yinping Leng
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Ao Kan
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Xiwen Wang
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Xiaofen Li
- Department of Radiology, Jiangxi Provincial People's Hospital, Nanchang, Jiangxi, China
| | - Xuan Xiao
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China
| | - Yu Wang
- Clinical and Technical Support, Philips Healthcare, Shanghai, China
| | - Lan Liu
- Department of Radiology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China.
| | - Lianggeng Gong
- Department of Radiology, the Second Affiliated Hospital of Nanchang University, Minde Road No. 1, 330006, Nanchang, Jiangxi Province, China.
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Wang Y, Lin W, Zhuang X, Wang X, He Y, Li L, Lyu G. Advances in artificial intelligence for the diagnosis and treatment of ovarian cancer (Review). Oncol Rep 2024; 51:46. [PMID: 38240090 PMCID: PMC10828921 DOI: 10.3892/or.2024.8705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
Artificial intelligence (AI) has emerged as a crucial technique for extracting high‑throughput information from various sources, including medical images, pathological images, and genomics, transcriptomics, proteomics and metabolomics data. AI has been widely used in the field of diagnosis, for the differentiation of benign and malignant ovarian cancer (OC), and for prognostic assessment, with favorable results. Notably, AI‑based radiomics has proven to be a non‑invasive, convenient and economical approach, making it an essential asset in a gynecological setting. The present study reviews the application of AI in the diagnosis, differentiation and prognostic assessment of OC. It is suggested that AI‑based multi‑omics studies have the potential to improve the diagnostic and prognostic predictive ability in patients with OC, thereby facilitating the realization of precision medicine.
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Affiliation(s)
- Yanli Wang
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Weihong Lin
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Xiaoling Zhuang
- Department of Pathology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Xiali Wang
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, Fujian 362000, P.R. China
| | - Yifang He
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Luhong Li
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Guorong Lyu
- Department of Ultrasound, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, Fujian 362000, P.R. China
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Liu H, Wei Z, Xv Y, Tan H, Liao F, Lv F, Jiang Q, Chen T, Xiao M. Validity of a multiphase CT-based radiomics model in predicting the Leibovich risk groups for localized clear cell renal cell carcinoma: an exploratory study. Insights Imaging 2023; 14:167. [PMID: 37816901 PMCID: PMC10564697 DOI: 10.1186/s13244-023-01526-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/10/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVE To develop and validate a multiphase CT-based radiomics model for preoperative risk stratification of patients with localized clear cell renal cell carcinoma (ccRCC). METHODS A total of 425 patients with localized ccRCC were enrolled and divided into training, validation, and external testing cohorts. Radiomics features were extracted from three-phase CT images (unenhanced, arterial, and venous), and radiomics signatures were constructed by the least absolute shrinkage and selection operator (LASSO) regression algorithm. The radiomics score (Rad-score) for each patient was calculated. The radiomics model was established and visualized as a nomogram by incorporating significant clinical factors and Rad-score. The predictive performance of the radiomics model was evaluated by the receiver operating characteristic curve, calibration curve, and decision curve analysis (DCA). RESULTS The AUC of the triphasic radiomics signature reached 0.862 (95% CI: 0.809-0.914), 0.853 (95% CI: 0.785-0.921), and 0.837 (95% CI: 0.714-0.959) in three cohorts, respectively, which were higher than arterial, venous, and unenhanced radiomics signatures. Multivariate logistic regression analysis showed that Rad-score (OR: 4.066, 95% CI: 3.495-8.790) and renal vein invasion (OR: 12.914, 95% CI: 1.118-149.112) were independent predictors and used to develop the radiomics model. The radiomics model showed good calibration and discrimination and yielded an AUC of 0.872 (95% CI: 0.821-0.923), 0.865 (95% CI: 0.800-0.930), and 0.848 (95% CI: 0.728-0.967) in three cohorts, respectively. DCA showed the clinical usefulness of the radiomics model in predicting the Leibovich risk groups. CONCLUSIONS The radiomics model can be used as a non-invasive and useful tool to predict the Leibovich risk groups for localized ccRCC patients. CRITICAL RELEVANCE STATEMENT The triphasic CT-based radiomics model achieved favorable performance in preoperatively predicting the Leibovich risk groups in patients with localized ccRCC. Therefore, it can be used as a non-invasive and effective tool for preoperative risk stratification of patients with localized ccRCC. KEY POINTS • The triphasic CT-based radiomics signature achieves better performance than the single-phase radiomics signature. • Radiomics holds prospects in preoperatively predicting the Leibovich risk groups for ccRCC. • This study provides a non-invasive method to stratify patients with localized ccRCC.
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Affiliation(s)
- Huayun Liu
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Zongjie Wei
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Yingjie Xv
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Hao Tan
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Fangtong Liao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China
| | - Fajin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qing Jiang
- Department of Urology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Chen
- Department of Pathology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Folsom SM, Berger J, Soong TR, Rangaswamy B. Comprehensive Review of Serous Tumors of Tubo-Ovarian Origin: Clinical Behavior, Pathological Correlation, Current Molecular Updates, and Imaging Manifestations. Curr Probl Diagn Radiol 2023; 52:425-438. [PMID: 37286440 DOI: 10.1067/j.cpradiol.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 03/28/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
Ovarian cancer is the eighth most common women's cancer worldwide, with the highest mortality rate of any gynecologic malignancy. On a global scale, the World Health Organization (WHO) reports that ovarian cancer has approximately 225,000 new cases every year with approximately 145,000 deaths. According to the National Institute of Health, Surveillance Epidemiology and End Results program (SEER) database, 5-year survival for women with ovarian cancer in the United States is 49.1%. High-grade serous ovarian carcinoma typically presents at an advanced stage and accounts for the majority of these cancer deaths. Given their prevalence and the lack of a reliable method for screening, early and reliable diagnosis of serous cancers is of paramount importance. Early differentiation of borderline, low and high-grade lesions can assist in surgical planning and support challenging intraoperative diagnoses. The objective of this article is to provide a review of the pathogenesis, diagnosis, and treatment of serous ovarian tumors, with a specific focus on the imaging characteristics that help to preoperatively differentiate borderline, low-grade, and high-grade serous ovarian lesions.
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Affiliation(s)
- Susan M Folsom
- Department of Gynecologic Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA..
| | - Jessica Berger
- Department of Gynecologic Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - T Rinda Soong
- Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA
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Gu R, Tan S, Xu Y, Pan D, Wang C, Zhao M, Wang J, Wu L, Zhao S, Wang F, Yang M. CT radiomics prediction of CXCL9 expression and survival in ovarian cancer. J Ovarian Res 2023; 16:180. [PMID: 37644593 PMCID: PMC10466849 DOI: 10.1186/s13048-023-01248-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND C-X-C motif chemokine ligand 9 (CXCL9), which is involved in the pathological processes of various human cancers, has become a hot topic in recent years. We developed a radiomic model to identify CXCL9 status in ovarian cancer (OC) and evaluated its prognostic significance. METHODS We analyzed enhanced CT scans, transcriptome sequencing data, and corresponding clinical characteristics of CXCL9 in OC using the TCIA and TCGA databases. We used the repeat least absolute shrinkage (LASSO) and recursive feature elimination(RFE) methods to determine radiomic features after extraction and normalization. We constructed a radiomic model for CXCL9 prediction based on logistic regression and internal tenfold cross-validation. Finally, a 60-month overall survival (OS) nomogram was established to analyze survival data based on Cox regression. RESULTS CXCL9 mRNA levels and several other genes involving in T-cell infiltration were significantly relevant to OS in OC patients. The radiomic score (rad_score) of our radiomic model was calculated based on the five features for CXCL9 prediction. The areas under receiver operating characteristic (ROC) curves (AUC-ROC) for the training cohort was 0.781, while that for the validation cohort was 0.743. Patients with a high rad_score had better overall survival (P < 0.001). In addition, calibration curves and decision curve analysis (DCA) showed good consistency between the prediction and actual observations, demonstrating the clinical utility of our model. CONCLUSION In patients with OC, the radiomics signature(RS) of CT scans can distinguish the level of CXCL9 expression and predict prognosis, potentially fulfilling the ultimate purpose of precision medicine.
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Affiliation(s)
- Rui Gu
- School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, 214063, China
- Department of Gynecology, Wuxi Maternity and Child Health Care Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, 214002, China
- Department of Gynecology, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214000, China
| | - Siyi Tan
- School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, 214063, China
| | - Yuping Xu
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, 214063, China
| | - Donghui Pan
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, 214063, China
| | - Ce Wang
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, 214063, China
| | - Min Zhao
- Department of Gynecology, Wuxi Maternity and Child Health Care Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, 214002, China
- Department of Gynecology, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214000, China
| | - Jiajun Wang
- Department of Gynecology, Wuxi Maternity and Child Health Care Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, 214002, China
- Department of Gynecology, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214000, China
| | - Liwei Wu
- Department of Gynecology, Wuxi Maternity and Child Health Care Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, 214002, China
- Department of Gynecology, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214000, China
| | - Shaojie Zhao
- Department of Gynecology, Wuxi Maternity and Child Health Care Hospital, Wuxi School of Medicine, Jiangnan University, Wuxi, 214002, China.
- Department of Gynecology, The Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University, Wuxi, 214000, China.
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210001, China.
| | - Min Yang
- School of Pharmacy, Nanjing Medical University, Nanjing, 211166, China.
- Key Laboratory of Nuclear Medicine, Ministry of Health, Jiangsu Key Laboratory of Molecular Nuclear Medicine, Jiangsu Institute of Nuclear Medicine, Wuxi, 214063, China.
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9
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Wang Y, Wang M, Cao P, Wong EMF, Ho G, Lam TPW, Han L, Lee EYP. CT-based deep learning segmentation of ovarian cancer and the stability of the extracted radiomics features. Quant Imaging Med Surg 2023; 13:5218-5229. [PMID: 37581064 PMCID: PMC10423396 DOI: 10.21037/qims-22-1135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 05/22/2023] [Indexed: 08/16/2023]
Abstract
Background Radiomics analysis could provide complementary tissue characterization in ovarian cancer (OC). However, OC segmentation required in radiomics analysis is time-consuming and labour-intensive. In this study, we aim to evaluate the performance of deep learning-based segmentation of OC on contrast-enhanced CT images and the stability of radiomics features extracted from the automated segmentation. Methods Staging abdominopelvic CT images of 367 patients with OC were retrospectively recruited. The training and cross-validation sets came from center A (n=283), and testing set (n=84) came from centers B and C. The tumours were manually delineated by a board-certified radiologist. Four model architectures provided by no-new-Net (nnU-Net) method were tested in this task. The segmentation performance evaluated by Dice score, Jaccard score, sensitivity and precision were compared among 4 architectures. The Pearson correlation coefficient (ρ), concordance correlation coefficient (ρc) and Bland-Altman plots were used to evaluate the volumetric assessment of OC between manual and automated segmentations. The stability of extracted radiomics features was evaluated by intraclass correlation coefficient (ICC). Results The 3D U-Net cascade architecture achieved highest median Dice score, Jaccard score, sensitivity and precision for OC segmentation in the testing set, 0.941, 0.890, 0.973 and 0.925, respectively. Tumour volumes of manual and automated segmentations were highly correlated (ρ=0.944 and ρc =0.933). 85.0% of radiomics features had high correlation with ICC >0.8. Conclusions The presented deep-learning segmentation could provide highly accurate automated segmentation of OC on CT images with high stability of the extracted radiomics features, showing the potential as a batch-processing segmentation tool.
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Affiliation(s)
- Yiang Wang
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
| | - Mandi Wang
- Department of Radiology, Shenzhen People’s Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, China
| | - Peng Cao
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
| | - Esther M. F. Wong
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Grace Ho
- Department of Radiology, Queen Mary Hospital, Hong Kong, China
| | - Tina P. W. Lam
- Department of Radiology, Queen Mary Hospital, Hong Kong, China
| | - Lujun Han
- Department of Medical Imaging, State Key Laboratory of Oncology in South China, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Elaine Y. P. Lee
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong, China
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10
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Han X, Fan J, Zheng Y, Wu Y, Alwalid O, Ding C, Jia X, Li H, Zhang X, Zhang K, Li Y, Liu J, Guo T, Ren H, Shi H. Value of radiomics in differentiating synchronous double primary lung adenocarcinomas from intrapulmonary metastasis. J Thorac Dis 2023; 15:3685-3698. [PMID: 37559630 PMCID: PMC10407476 DOI: 10.21037/jtd-23-133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 06/12/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Distinguishing synchronous double primary lung adenocarcinoma (SDPLA) from intrapulmonary metastasis (IPM) of lung cancer has significant therapeutic and prognostic values. This study aimed to develop and validate a CT-based radiomics model to differentiate SDPLA from IPM. METHODS A total of 153 patients (93 SDPLA and 60 IPM) with 306 pathologically confirmed lesions were retrospectively studied. CT morphological features were also recorded. Region of interest (ROI) segmentation was performed semiautomatically, and 1,037 radiomics features were extracted from every segmented lesion The differences of radiomics features were defined as the relative net difference in radiomics features between the two lesions on CT. Those low reliable (ICC <0.75) and redundant (r>0.9) features were excluded by intraclass correlation coefficients (ICC) and Pearson's correlation. Multivariate logistic regression (LR) algorithm was used to establish the classification model according to the selected features. The radiomics model was based on the four most contributing differences of radiomics features. Clinical-CT model and MixModel were based on selected clinical and CT features only and the combination of clinical-CT and Rad-score, respectively. RESULTS In both the training and testing cohorts, the area under the curves (AUCs) of the radiomics model were larger than those of the clinical-CT model (0.944 vs. 0.793 and 0.886 vs. 0.735 on training and testing cohorts, respectively), and statistically significant differences between the two models in the testing set were found (P<0.001). Meanwhile, three radiologists had sensitivities of 84.2%, 63.9%, and 68.4%, and specificities of 76.9%, 69.2%, and 76.9% in differentiating 19 SDPLA cases from 13 cases of IPM in the testing set. Compared with the performance of the three radiologists, the radiomics model showed better accuracy to the patients in both the training and testing cohorts. Among the three models, the radiomics model showed the best net benefits. CONCLUSIONS The differences of radiomics features showed excellent diagnostic performance for preoperative differentiation between synchronous double primary lung adenocarcinoma from interpulmonary metastasis, superior to the clinical model and decisions made by radiologists.
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Affiliation(s)
- Xiaoyu Han
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jun Fan
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuting Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Ying Wu
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Osamah Alwalid
- Department of Diagnostic Imaging, Sidra Medicine, Doha, Qatar
| | - Chengyu Ding
- ShuKun (Beijing) Technology Co., Ltd., Beijing, China
| | - Xi Jia
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Hanting Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiaohui Zhang
- Clinical Solution, Philips Healthcare, Shanghai, China
| | - Kailu Zhang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yumin Li
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Jia Liu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Tingting Guo
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Hongwei Ren
- Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China
| | - Heshui Shi
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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11
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Huang ML, Ren J, Jin ZY, Liu XY, He YL, Li Y, Xue HD. A systematic review and meta-analysis of CT and MRI radiomics in ovarian cancer: methodological issues and clinical utility. Insights Imaging 2023; 14:117. [PMID: 37395888 DOI: 10.1186/s13244-023-01464-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/11/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES We aimed to present the state of the art of CT- and MRI-based radiomics in the context of ovarian cancer (OC), with a focus on the methodological quality of these studies and the clinical utility of these proposed radiomics models. METHODS Original articles investigating radiomics in OC published in PubMed, Embase, Web of Science, and the Cochrane Library between January 1, 2002, and January 6, 2023, were extracted. The methodological quality was evaluated using the radiomics quality score (RQS) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). Pairwise correlation analyses were performed to compare the methodological quality, baseline information, and performance metrics. Additional meta-analyses of studies exploring differential diagnoses and prognostic prediction in patients with OC were performed separately. RESULTS Fifty-seven studies encompassing 11,693 patients were included. The mean RQS was 30.7% (range - 4 to 22); less than 25% of studies had a high risk of bias and applicability concerns in each domain of QUADAS-2. A high RQS was significantly associated with a low QUADAS-2 risk and recent publication year. Significantly higher performance metrics were observed in studies examining differential diagnosis; 16 such studies as well as 13 exploring prognostic prediction were included in a separate meta-analysis, which revealed diagnostic odds ratios of 25.76 (95% confidence interval (CI) 13.50-49.13) and 12.55 (95% CI 8.38-18.77), respectively. CONCLUSION Current evidence suggests that the methodological quality of OC-related radiomics studies is unsatisfactory. Radiomics analysis based on CT and MRI showed promising results in terms of differential diagnosis and prognostic prediction. CRITICAL RELEVANCE STATEMENT Radiomics analysis has potential clinical utility; however, shortcomings persist in existing studies in terms of reproducibility. We suggest that future radiomics studies should be more standardized to better bridge the gap between concepts and clinical applications.
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Affiliation(s)
- Meng-Lin Huang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Jing Ren
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Zheng-Yu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Xin-Yu Liu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Yong-Lan He
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
| | - Yuan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, People's Republic of China.
| | - Hua-Dan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China.
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12
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Ren J, Mao L, Zhao J, Li XL, Wang C, Liu XY, Jin ZY, He YL, Li Y, Xue HD. Seeing beyond the tumor: computed tomography image-based radiomic analysis helps identify ovarian clear cell carcinoma subtype in epithelial ovarian cancer. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01666-x. [PMID: 37368228 DOI: 10.1007/s11547-023-01666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To develop and validate a model that can preoperatively identify the ovarian clear cell carcinoma (OCCC) subtype in epithelial ovarian cancer (EOC) using CT imaging radiomics and clinical data. MATERIAL AND METHODS We retrospectively analyzed data from 282 patients with EOC (training set = 225, testing set = 57) who underwent pre-surgery CT examinations. Patients were categorized into OCCC or other EOC subtypes based on postoperative pathology. Seven clinical characteristics (age, cancer antigen [CA]-125, CA-199, endometriosis, venous thromboembolism, hypercalcemia, stage) were collected. Primary tumors were manually delineated on portal venous-phase images, and 1218 radiomic features were extracted. The F-test-based feature selection method and logistic regression algorithm were used to build the radiomic signature, clinical model, and integrated model. To explore the effects of integrated model-assisted diagnosis, five radiologists independently interpreted images in the testing set and reevaluated cases two weeks later with knowledge of the integrated model's output. The diagnostic performances of the predictive models, radiologists, and radiologists aided by the integrated model were evaluated. RESULTS The integrated model containing the radiomic signature (constructed by four wavelet radiomic features) and three clinical characteristics (CA-125, endometriosis, and hypercalcinemia), showed better diagnostic performance (AUC = 0.863 [0.762-0.964]) than the clinical model (AUC = 0.792 [0.630-0.953], p = 0.295) and the radiomic signature alone (AUC = 0.781 [0.636-0.926], p = 0.185). The diagnostic sensitivities of the radiologists were significantly improved when using the integrated model (p = 0.023-0.041), while the specificities and accuracies were maintained (p = 0.074-1.000). CONCLUSION Our integrated model shows great potential to facilitate the early identification of the OCCC subtype in EOC, which may enhance subtype-specific therapy and clinical management.
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Affiliation(s)
- Jing Ren
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Shuai Fu Yuan 1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Li Mao
- AI Lab, Deepwise Healthcare, Beijing, People's Republic of China
| | - Jia Zhao
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Shuai Fu Yuan 1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xiu-Li Li
- AI Lab, Deepwise Healthcare, Beijing, People's Republic of China
| | - Chen Wang
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Shuai Fu Yuan 1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Xin-Yu Liu
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Shuai Fu Yuan 1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Zheng-Yu Jin
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Shuai Fu Yuan 1, Dongcheng District, Beijing, 100730, People's Republic of China
| | - Yong-Lan He
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Shuai Fu Yuan 1, Dongcheng District, Beijing, 100730, People's Republic of China.
| | - Yuan Li
- Department of Obstetrics and Gynecology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Peking Union Medical College Hospital, Beijing, People's Republic of China.
| | - Hua-Dan Xue
- Department of Radiology, Chinese Academy of Medical Sciences & Peking Union Medical College, Peking Union Medical College Hospital, Shuai Fu Yuan 1, Dongcheng District, Beijing, 100730, People's Republic of China.
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