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Steiner D, Park JA, Singh S, Potter A, Scalera J, Beane J, Suzuki K, Lenburg ME, Burks EJ. A computed tomography-based score indicative of lung cancer aggression (SILA) predicts lung adenocarcinomas with low malignant potential or vascular invasion. Cancer Biomark 2024:CBM230456. [PMID: 39058440 DOI: 10.3233/cbm-230456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Histologic grading of lung adenocarcinoma (LUAD) is predictive of outcome but is only possible after surgical resection. A radiomic biomarker predictive of grade has the potential to improve preoperative management of early-stage LUAD. OBJECTIVE Validate a prognostic radiomic score indicative of lung cancer aggression (SILA) in surgically resected stage I LUAD (n= 161) histologically graded as indolent low malignant potential (LMP), intermediate, or aggressive vascular invasive (VI) subtypes. METHODS The SILA scores were generated from preoperative CT-scans using the previously validated Computer-Aided Nodule Assessment and Risk Yield (CANARY) software. RESULTS Cox proportional regression showed significant association between the SILA and 7-year recurrence-free survival (RFS) in a univariate (p< 0.05) and multivariate (p< 0.05) model incorporating age, gender, smoking status, pack years, and extent of resection. The SILA was positively correlated with invasive size (spearman r= 0.54, p= 8.0 × 10 - 14) and negatively correlated with percentage of lepidic histology (spearman r=-0.46, p= 7.1 × 10 - 10). The SILA predicted indolent LMP with an area under the receiver operating characteristic (ROC) curve (AUC) of 0.74 and aggressive VI with an AUC of 0.71, the latter remaining significant when invasive size was included as a covariate in a logistic regression model (p< 0.01). CONCLUSIONS The SILA scoring of preoperative CT scans was prognostic and predictive of resected pathologic grade.
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Affiliation(s)
- Dylan Steiner
- Department of Medicine, Section of Computational Biomedicine, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Ju Ae Park
- Thoracic Surgery, Inova Schar Cancer Institute, Fairfax, VA, USA
| | - Sarah Singh
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Austin Potter
- Department of Medicine, Section of Computational Biomedicine, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Jonathan Scalera
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Jennifer Beane
- Department of Medicine, Section of Computational Biomedicine, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Kei Suzuki
- Thoracic Surgery, Inova Schar Cancer Institute, Fairfax, VA, USA
| | - Marc E Lenburg
- Department of Medicine, Section of Computational Biomedicine, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- Department of Pathology, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- Department of Medicine, Section of Computational Biomedicine, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
| | - Eric J Burks
- Department of Pathology, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
- Department of Medicine, Section of Computational Biomedicine, Boston University Chobanian and Avedisian School of Medicine, Boston, USA
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Lee J, Chun J, Kim H, Kim JS, Park SY. Development and evaluation of an integrated model based on a deep segmentation network and demography-added radiomics algorithm for segmentation and diagnosis of early lung adenocarcinoma. Comput Med Imaging Graph 2023; 109:102299. [PMID: 37729827 DOI: 10.1016/j.compmedimag.2023.102299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/22/2023]
Abstract
Non-invasive early detection and differentiation grading of lung adenocarcinoma using computed tomography (CT) images are clinically important for both clinicians and patients, including determining the extent of lung resection. However, these are difficult to accomplish using preoperative images, with CT-based diagnoses often being different from postoperative pathologic diagnoses. In this study, we proposed an integrated detection and classification algorithm (IDCal) for diagnosing ground-glass opacity nodules (GGN) using CT images and other patient informatics, and compared its performance with that of other diagnostic modalities. All labeling was confirmed by a thoracic surgeon by referring to the patient's CT image and biopsy report. The detection phase was implemented via a modified FC-DenseNet to contour the lesions as elaborately as possible and secure the reliability of the classification phase for subsequent applications. Then, by integrating radiomics features and other patients' general information, the lesions were dichotomously reclassified into "non-invasive" (atypical adenomatous hyperplasia, adenocarcinoma in situ, and minimally invasive adenocarcinoma) and "invasive" (invasive adenocarcinoma). Data from 168 GGN cases were used to develop the IDCal, which was then validated in 31 independent CT scans. IDCal showed a high accuracy of GGN detection (sensitivity, 0.970; false discovery rate, 0.697) and classification (accuracy, 0.97; f1-score, 0.98; ROAUC, 0.96). In conclusion, the proposed IDCal detects and classifies GGN with excellent performance. Thus, it can be suggested that our multimodal prediction model has high potential as an auxiliary diagnostic tool of GGN to help clinicians.
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Affiliation(s)
- Juyoung Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06531, South Korea; Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | | | - Hojin Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea
| | - Jin Sung Kim
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, South Korea; Oncosoft Inc., Seoul, South Korea; Medical Physics and Biomedical Engineering Lab (MPBEL), Yonsei University College of Medicine, Seoul 03722, South Korea.
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06531, South Korea.
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Borghesi A, Coviello FL, Scrimieri A, Ciolli P, Ravanelli M, Farina D. Software-based quantitative CT analysis to predict the growth trend of persistent nonsolid pulmonary nodules: a retrospective study. LA RADIOLOGIA MEDICA 2023:10.1007/s11547-023-01648-z. [PMID: 37227661 DOI: 10.1007/s11547-023-01648-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
PURPOSE Persistent nonsolid nodules (NSNs) usually exhibit an indolent course and may remain stable for several years; however, some NSNs grow quickly and require surgical excision. Therefore, identifying quantitative features capable of early discrimination between growing and nongrowing NSNs is becoming a crucial aspect of radiological analysis. The main purpose of this study was to evaluate the performance of an open-source software (ImageJ) to predict the future growth of NSNs detected in a Caucasian (Italian) population. MATERIAL AND METHODS We retrospectively selected 60 NSNs with an axial diameter of 6-30 mm scanned with the same acquisition-reconstruction parameters and the same computed tomography (CT) scanner. Software-based analysis was performed on thin-section CT images using ImageJ. For each NSNs, several quantitative features were extracted from the baseline CT images. The relationships of NSN growth with quantitative CT features and other categorical variables were analyzed using univariate and multivariable logistic regression analyses. RESULTS In multivariable analysis, only the skewness and linear mass density (LMD) were significantly associated with NSN growth, and the skewness was the strongest predictor of growth. In receiver operating characteristic curve analyses, the optimal cutoff values of skewness and LMD were 0.90 and 19.16 mg/mm, respectively. The two predictive models that included the skewness, with or without LMD, exhibited an excellent power for predicting NSN growth. CONCLUSION According to our results, NSNs with a skewness value > 0.90, specifically those with a LMD > 19.16 mg/mm, should require closer follow-up due to their higher growth potential, and higher risk of becoming an active cancer.
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Affiliation(s)
- Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy.
| | - Felice Leopoldo Coviello
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Alessandra Scrimieri
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Pietro Ciolli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Marco Ravanelli
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
| | - Davide Farina
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, ASST Spedali Civili of Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy
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An P, Lin Y, Zhang J, Hu Y, Qin P, Ye Y, Li X, Feng G, Wang J. Prognostic Predicting Model of Pancreatic Body Tail Carcinoma Using Clinical and CT Radiomic Data. Technol Cancer Res Treat 2023; 22:15330338231186739. [PMID: 37464839 PMCID: PMC10363996 DOI: 10.1177/15330338231186739] [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: 01/18/2023] [Revised: 05/06/2023] [Accepted: 05/19/2023] [Indexed: 07/20/2023] Open
Abstract
Objective: To collect the clinical, pathological, and computed tomography (CT) data of 143 accepted surgical cases of pancreatic body tail cancer (PBTC) and to model and predict its prognosis. Methods: The clinical, pathological, and CT data of 143 PBTC patients who underwent surgical resection or endoscopic ultrasound biopsy and were pathologically diagnosed in Xiangyang No.1 People's Hospital Hospital from December 2012 to December 2022 were retrospectively analyzed. The Kaplan-Meier method was adopted to make survival curves based on the 1 to 5 years' follow-up data, and then the log-rank was employed to analyze the survival. According to the median survival of 6 months, the PBTC patients were divided into a group with a good prognosis (survival time ≥ 6 months) and a group with a poor prognosis (survival time < 6 months), and further the training set and test set were set at a ratio of 7/3. Then logistic regression was conducted to find independent risk factors, establish predictive models, and further the models were validated. Results: The Kaplan-Meier analysis showed that age, diabetes, tumor, node, and metastasis stage, CT enhancement mode, peripancreatic lymph node swelling, nerve invasion, surgery in a top hospital, tumor size, carbohydrate antigen 19-9, carcinoembryonic antigen, Radscore 1/2/3 were the influencing factors of PBTC recurrence. The overall average survival was 7.4 months in this study. The multivariate logistic analysis confirmed that nerve invasion, surgery in top hospital, dilation of the main pancreatic duct, and Radscore 2 were independent factors affecting the mortality of PBTC (P < .05). In the test set, the combined model achieved the best predictive performance [AUC 0.944, 95% CI (0.826-0.991)], significantly superior to the clinicopathological model [AUC 0.770, 95% CI (0.615-0.886), P = .0145], and the CT radiomics model [AUC 0.883, 95% CI (0.746-0.961), P = .1311], with a good clinical net benefit confirmed by decision curve. The same results were subsequently validated on the test set. Conclusion: The diagnosis and treatment of PBTC are challenging, and survival is poor. Nevertheless, the combined model benefits the clinical management and prognosis of PBTC.
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Affiliation(s)
- Peng An
- Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- Department of Internal Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
| | - Yong Lin
- Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- Department of Pancreatic Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Junyan Zhang
- Department of Internal Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Depatment of Radiology, Hubei Clinical Research Center of Parkinson’s disease, Xiangyang Key Laboratory of Movement Disorders, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, Hubei Province, P.R.C
| | - Yan Hu
- Department of Pancreatic Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- Department of Pharmacy and Laboratory, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Ping Qin
- Department of Pancreatic Surgery, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- Depatment of Radiology, Hubei Clinical Research Center of Parkinson’s disease, Xiangyang Key Laboratory of Movement Disorders, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, Hubei Province, P.R.C
- Department of internal medicine, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Yingjian Ye
- Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- Department of internal medicine, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Xiumei Li
- Depatment of Radiology, Hubei Clinical Research Center of Parkinson’s disease, Xiangyang Key Laboratory of Movement Disorders, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, Hubei Province, P.R.C
- Department of Pharmacy and Laboratory, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- Department of internal medicine, Xiangyang No. 1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Guoyan Feng
- Department of Radiology, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
- Department of Internal Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
- Department of Pharmacy and Laboratory, Xiangyang No.1 People’s Hospital, Hubei University of Medicine, Xiangyang, China
| | - Jinsong Wang
- Department of Internal Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, Hubei, China
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Huang H, Zheng D, Chen H, Wang Y, Chen C, Xu L, Li G, Wang Y, He X, Li W. Fusion of CT images and clinical variables based on deep learning for predicting invasiveness risk of stage I lung adenocarcinoma. Med Phys 2022; 49:6384-6394. [PMID: 35938604 DOI: 10.1002/mp.15903] [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: 05/25/2021] [Revised: 04/01/2022] [Accepted: 07/26/2022] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To develop a novel multimodal data fusion model by incorporating computed tomography (CT) images and clinical variables based on deep learning for predicting the invasiveness risk of stage I lung adenocarcinoma that manifests as ground-glass nodules (GGNs), and compare the diagnostic performance of it with that of radiologists. METHODS A total of 1946 patients with solitary and histopathologically confirmed GGNs with maximum diameter less than 3 cm were retrospectively enrolled. The training dataset containing 1704 GGNs was augmented by resampling, scaling, random cropping, etc., to generate new training data. A multimodal data fusion model based on residual learning architecture and two multilayer perceptron with attention mechanism combining CT images with patient general data and serum tumor markers was built. The distance-based confidence scores (DCS) were calculated and compared among multimodal data models with different combinations. An observer study was conducted and the prediction performance of the fusion algorithms was compared with that of the two radiologists by an independent testing dataset with 242 GGNs. RESULTS Among the whole GGNs, 606 GGNs are confirmed as invasive adenocarcinoma (IA) and 1340 are non-IA. The proposed novel multimodal data fusion model combining CT images, patient general data and serum tumor markers achieved the highest accuracy (88.5%), Area under a ROC curve (AUC) (0.957), F1 (81.5%), F1weighted (81.9%) and Matthews correlation coefficient (MCC) (73.2%) for classifying between IA and non-IA GGNs, which was even better than the senior radiologist's performance (accuracy, 86.1%). In addition, the DCSs for multimodal data suggested that CT image had a stronger influence (0.9540) quantitatively than general data (0.6726) or tumor marker (0.6971). CONCLUSION This study demonstrated that the feasibility of integrating different types of data including CT images and clinical variables, and the multimodal data fusion model yielded higher performance for distinguishing IA from non-IA GGNs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Haozhe Huang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Dezhong Zheng
- Laboratory for Medical Imaging Informatics, Shanghai Institute of Technical Physics, Chinese Academy of Science, 500 Yutian Road, Hongkou District, Shanghai, 200083, China.,University of Chinese Academy of Sciences, 19 Yuquan Road, Shijingshan District, Beijing, 100049, China
| | - Hong Chen
- Department of Medical Imaging, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Xuhui District, Shanghai, 200030, China
| | - Ying Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Chao Chen
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Lichao Xu
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Guodong Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Yaohui Wang
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Xinhong He
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
| | - Wentao Li
- Department of Interventional Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Xuhui District, Shanghai, 200032, China.,Department of Oncology, Shanghai Medical College, Fudan University, Xuhui District, 130 Dongan Road, Shanghai, 200032, China
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6
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Ren H, Liu F, Xu L, Sun F, Cai J, Yu L, Guan W, Xiao H, Li H, Yu H. Predicting the histological invasiveness of pulmonary adenocarcinoma manifesting as persistent pure ground-glass nodules by ultra-high-resolution CT target scanning in the lateral or oblique body position. Quant Imaging Med Surg 2021; 11:4042-4055. [PMID: 34476188 DOI: 10.21037/qims-20-1378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/30/2021] [Indexed: 12/18/2022]
Abstract
Background Ultra-high-resolution computed tomography (U-HRCT) has improved image quality for displaying the detailed characteristics of disease states and lung anatomy. The purpose of this study was to retrospectively examine whether U-HRCT target scanning in the lateral or oblique body position (protocol G scan) could predict histological invasiveness of pulmonary adenocarcinoma manifesting as pure ground-glass nodules (pGGNs). Methods From January 2015 to December 2016, 260 patients with 306 pathologically confirmed pGGNs who underwent preoperative protocol G scans were retrospectively reviewed and analyzed. The U-HRCT findings of preinvasive lesions [atypical adenomatous hyperplasias (AAH) and adenocarcinomas in situ (AIS)] and invasive pulmonary adenocarcinomas [minimally invasive adenocarcinomas (MIA) and invasive adenocarcinomas (IAC)] were manually compared and analyzed using orthogonal multiplanar reformation (MPR) images. The logistic regression model was established to determine variables that could predict the invasiveness of pGGNs. Receiver operating characteristic (ROC) curve analysis was performed to evaluate their diagnostic performance. Results There were 213 preinvasive lesions (59 AAHs and 154 AISs) and 93 invasive pulmonary adenocarcinomas (53 MIAs and 40 IACs). Compared with the preinvasive lesions, invasive adenocarcinomas exhibited a larger diameter (13.5 vs. 9.3 mm, P=0.000), higher mean attenuation (-571 vs. -613 HU, P=0.002), higher representative attenuation (-475 vs. -547 HU, P=0.000), lower relative attenuation (-339 vs. -292 HU, P=0.000) and greater frequencies of heterogeneity (P=0.001), air bronchogram (P=0.000), bubble lucency (P=0.000), and pleural indentation (P=0.000). Multiple logistic analysis revealed that larger diameter [odds ratio (OR), 1.328; 95% CI: 1.208-1.461; P=0.000] and higher representative attenuation (OR, 1.005; 95% CI: 1.003-1.007; P=0.000) were significant predictive factors of invasive pulmonary adenocarcinomas from preinvasive lesions. The optimal cut-off value of the maximum diameter for invasive pulmonary adenocarcinomas was larger than 10 mm (sensitivity, 66.7%; specificity, 72.8%). Conclusions The imaging features based on protocol G scanning can effectively help predict the histological invasiveness of pGGNs. The maximum diameter and representative attenuation are important parameters for predicting invasiveness.
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Affiliation(s)
- Hua Ren
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.,Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fufu Liu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Xu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fan Sun
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jing Cai
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lingwei Yu
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenbin Guan
- Department of Pathology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haibo Xiao
- Department of Cardiothoracic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huimin Li
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Yu
- Department of Radiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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Gong J, Liu J, Li H, Zhu H, Wang T, Hu T, Li M, Xia X, Hu X, Peng W, Wang S, Tong T, Gu Y. Deep Learning-Based Stage-Wise Risk Stratification for Early Lung Adenocarcinoma in CT Images: A Multi-Center Study. Cancers (Basel) 2021; 13:cancers13133300. [PMID: 34209366 PMCID: PMC8269183 DOI: 10.3390/cancers13133300] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/28/2021] [Accepted: 06/28/2021] [Indexed: 12/21/2022] Open
Abstract
Simple Summary Prediction of the malignancy and invasiveness of ground glass nodules (GGNs) from computed tomography images is a crucial task for radiologists in risk stratification of early-stage lung adenocarcinoma. In order to solve this challenge, a two-stage deep neural network (DNN) was developed based on the images collected from four centers. A multi-reader multi-case observer study was conducted to evaluate the model capability. The performance of our model was comparable or even more accurate than that of senior radiologists, with average area under the curve values of 0.76 and 0.95 for two tasks, respectively. Findings suggest (1) a positive trend between the diagnostic performance and radiologist’s experience, (2) DNN yielded equivalent or even higher performance in comparison with senior radiologists, and (3) low image resolution reduced the model performance in predicting the risks of GGNs. Abstract This study aims to develop a deep neural network (DNN)-based two-stage risk stratification model for early lung adenocarcinomas in CT images, and investigate the performance compared with practicing radiologists. A total of 2393 GGNs were retrospectively collected from 2105 patients in four centers. All the pathologic results of GGNs were obtained from surgically resected specimens. A two-stage deep neural network was developed based on the 3D residual network and atrous convolution module to diagnose benign and malignant GGNs (Task1) and classify between invasive adenocarcinoma (IA) and non-IA for these malignant GGNs (Task2). A multi-reader multi-case observer study with six board-certified radiologists’ (average experience 11 years, range 2–28 years) participation was conducted to evaluate the model capability. DNN yielded area under the receiver operating characteristic curve (AUC) values of 0.76 ± 0.03 (95% confidence interval (CI): (0.69, 0.82)) and 0.96 ± 0.02 (95% CI: (0.92, 0.98)) for Task1 and Task2, which were equivalent to or higher than radiologists in the senior group with average AUC values of 0.76 and 0.95, respectively (p > 0.05). With the CT image slice thickness increasing from 1.15 mm ± 0.36 to 1.73 mm ± 0.64, DNN performance decreased 0.08 and 0.22 for the two tasks. The results demonstrated (1) a positive trend between the diagnostic performance and radiologist’s experience, (2) the DNN yielded equivalent or even higher performance in comparison with senior radiologists, and (3) low image resolution decreased model performance in predicting the risks of GGNs. Once tested prospectively in clinical practice, the DNN could have the potential to assist doctors in precision diagnosis and treatment of early lung adenocarcinoma.
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Affiliation(s)
- Jing Gong
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China; (J.G.); (H.L.); (H.Z.); (T.W.); (T.H.); (M.L.); (W.P.)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Jiyu Liu
- Department of Radiology, Shanghai Pulmonary Hospital, 507 Zheng Min Road, Shanghai 200433, China;
| | - Haiming Li
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China; (J.G.); (H.L.); (H.Z.); (T.W.); (T.H.); (M.L.); (W.P.)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Hui Zhu
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China; (J.G.); (H.L.); (H.Z.); (T.W.); (T.H.); (M.L.); (W.P.)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tingting Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China; (J.G.); (H.L.); (H.Z.); (T.W.); (T.H.); (M.L.); (W.P.)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Tingdan Hu
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China; (J.G.); (H.L.); (H.Z.); (T.W.); (T.H.); (M.L.); (W.P.)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Menglei Li
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China; (J.G.); (H.L.); (H.Z.); (T.W.); (T.H.); (M.L.); (W.P.)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Xianwu Xia
- Department of Radiology, Municipal Hospital Affiliated to Taizhou University, Taizhou 318000, China;
| | - Xianfang Hu
- Department of Radiology, Huzhou Central Hospital Affiliated Central Hospital of Huzhou University, 1558 Sanhuan North Road, Huzhou 313000, China;
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China; (J.G.); (H.L.); (H.Z.); (T.W.); (T.H.); (M.L.); (W.P.)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
| | - Shengping Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China; (J.G.); (H.L.); (H.Z.); (T.W.); (T.H.); (M.L.); (W.P.)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Correspondence: (S.W.); (T.T.); (Y.G.); Tel.: +86-13818521975 (S.W); +86-18017312912 (T.T.); +86-18017312040 (Y.G.)
| | - Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China; (J.G.); (H.L.); (H.Z.); (T.W.); (T.H.); (M.L.); (W.P.)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Correspondence: (S.W.); (T.T.); (Y.G.); Tel.: +86-13818521975 (S.W); +86-18017312912 (T.T.); +86-18017312040 (Y.G.)
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, China; (J.G.); (H.L.); (H.Z.); (T.W.); (T.H.); (M.L.); (W.P.)
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Correspondence: (S.W.); (T.T.); (Y.G.); Tel.: +86-13818521975 (S.W); +86-18017312912 (T.T.); +86-18017312040 (Y.G.)
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Evaluation of Computer-Aided Nodule Assessment and Risk Yield (CANARY) in Korean patients for prediction of invasiveness of ground-glass opacity nodule. PLoS One 2021; 16:e0253204. [PMID: 34125856 PMCID: PMC8202915 DOI: 10.1371/journal.pone.0253204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/30/2021] [Indexed: 11/25/2022] Open
Abstract
Differentiating the invasiveness of ground-glass nodules (GGN) is clinically important, and several institutions have attempted to develop their own solutions by using computed tomography images. The purpose of this study is to evaluate Computer-Aided Analysis of Risk Yield (CANARY), a validated virtual biopsy and risk-stratification machine-learning tool for lung adenocarcinomas, in a Korean patient population. To this end, a total of 380 GGNs from 360 patients who underwent pulmonary resection in a single institution were reviewed. Based on the Score Indicative of Lung Cancer Aggression (SILA), a quantitative indicator of CANARY analysis results, all of the GGNs were classified as “indolent” (atypical adenomatous hyperplasia, adenocarcinomas in situ, or minimally invasive adenocarcinoma) or “invasive” (invasive adenocarcinoma) and compared with the pathology reports. By considering the possibility of uneven class distribution, statistical analysis was performed on the 1) entire cohort and 2) randomly extracted six sets of class-balanced samples. For each trial, the optimal cutoff SILA was obtained from the receiver operating characteristic curve. The classification results were evaluated using several binary classification metrics. Of a total of 380 GGNs, the mean SILA for 65 (17.1%) indolent and 315 (82.9%) invasive lesions were 0.195±0.124 and 0.391±0.208 (p < 0.0001). The area under the curve (AUC) of each trial was 0.814 and 0.809, with an optimal threshold SILA of 0.229 for both. The macro F1-score and geometric mean were found to be 0.675 and 0.745 for the entire cohort, while both scored 0.741 in the class-equalized dataset. From these results, CANARY could be confirmed acceptable in classifying GGN for Korean patients after the cutoff SILA was calibrated. We found that adjusting the cutoff SILA is needed to use CANARY in other countries or races, and geometric mean could be more objective than F1-score or AUC in the binary classification of imbalanced data.
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Silva M, Milanese G, Ledda RE, Pastorino U, Sverzellati N. Screen-detected solid nodules: from detection of nodule to structured reporting. Transl Lung Cancer Res 2021; 10:2335-2346. [PMID: 34164281 PMCID: PMC8182712 DOI: 10.21037/tlcr-20-296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer screening (LCS) is gaining some interest worldwide after positive results from International trials. Unlike other screening practices, LCS is performed by an extremely sensitive test, namely low-dose computed tomography (LDCT) that can detect the smallest nodules in lung parenchyma. Up-to-date detection approaches, such as computer aided detection systems, have been increasingly employed for lung nodule automatic identification and are largely used in most LCS programs as a complementary tool to visual reading. Solid nodules of any size are represented in the vast majority of subjects undergoing LDCT. However, less than 1% of solid nodules will be diagnosed lung cancer. This fact calls for specific characterization of nodules to avoid false positives, overinvestigation, and reduce the risks associated with nodule work up. Recent research has been exploring the potential of artificial intelligence, including deep learning techniques, to enhance the accuracy of both detection and characterisation of lung nodule. Computer aided detection and diagnosis algorithms based on artificial intelligence approaches have demonstrated the ability to accurately detect and characterize parenchymal nodules, reducing the number of false positives, and to outperform some of the currently used risk models for prediction of lung cancer risk, potentially reducing the proportion of surveillance CT scans. These forthcoming approaches will eventually integrate a new reasoning for development of future guidelines, which are expected to evolve into precision and personalized stratification of lung cancer risk stratification by continuous fashion, as opposed to the current format with a limited number of risk classes within fixed thresholds of nodule size. This review aims to detail the standard of reference for optimal management of solid nodules by low-dose computed and its projection into the fine selection of candidates for work up.
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Affiliation(s)
- Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Roberta E Ledda
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Ugo Pastorino
- Section of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milano, Italy
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
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de Margerie-Mellon C, Gill RR, Monteiro Filho AC, Heidinger BH, Onken A, VanderLaan PA, Bankier AA. Growth Assessment of Pulmonary Adenocarcinomas Manifesting as Subsolid Nodules on CT: Comparison of Diameter-Based and Volume Measurements. Acad Radiol 2020; 27:1385-1393. [PMID: 31732419 DOI: 10.1016/j.acra.2019.09.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 12/18/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the performances of diameter-based measurements, either using diameters, or by calculating diameter-based volumes, as compared to volume measurements in assessing growth of pulmonary adenocarcinomas manifesting as subsolid nodules on CT. MATERIALS AND METHODS In this IRB-approved, retrospective study, 74 pulmonary adenocarcinomas presenting as subsolid nodules and resected in 69 patients (21 men, 48 women, mean age 70 ± 9 years) were included. Three CTs were available for each patient. Nodule size on each CT was assessed with diameter measurements, calculated volume based on diameter measurements, and measured volume. Nodule growth was defined as an increase of measured volume ≥25% between two sequential CTs. Sensitivity, specificity, accuracy, positive and negative predictive values of diameter-based measurements for growth assessment were calculated. Nodule characteristics were compared with nonparametric tests and analysis of variance. RESULTS There were fewer growing nodules during CT1-CT2 interval (n = 22, 30%) than during CT2-CT3 interval (n = 33, 45%, p =.060). Specificity and negative predictive value of diameter-based measurements for growth assessment ranged respectively from 52 to 77% and 81 to 83% between CT1 and CT2, and from 66 to 76% and 79 to 90% between CT2 and CT3. Nongrowing nodules tended to be larger, regardless how size was measured, and some of these differences in size were statistically significant (p =.002 to .046). CONCLUSION For pulmonary adenocarcinomas presenting as subsolid nodules on CT, diameter-based assessment of nodule volume is reasonably accurate at confirming a lack of nodule growth but may overestimate actual growth, as compared to growth assessment based on measured volume.
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de Margerie-Mellon C, Gill RR, Salazar P, Oikonomou A, Nguyen ET, Heidinger BH, Medina MA, VanderLaan PA, Bankier AA. Assessing invasiveness of subsolid lung adenocarcinomas with combined attenuation and geometric feature models. Sci Rep 2020; 10:14585. [PMID: 32883973 PMCID: PMC7471897 DOI: 10.1038/s41598-020-70316-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/13/2020] [Indexed: 01/22/2023] Open
Abstract
The aim of this study was to develop and test multiclass predictive models for assessing the invasiveness of individual lung adenocarcinomas presenting as subsolid nodules on computed tomography (CT). 227 lung adenocarcinomas were included: 31 atypical adenomatous hyperplasia and adenocarcinomas in situ (class H1), 64 minimally invasive adenocarcinomas (class H2) and 132 invasive adenocarcinomas (class H3). Nodules were segmented, and geometric and CT attenuation features including functional principal component analysis features (FPC1 and FPC2) were extracted. After a feature selection step, two predictive models were built with ordinal regression: Model 1 based on volume (log) (logarithm of the nodule volume) and FPC1, and Model 2 based on volume (log) and Q.875 (CT attenuation value at the 87.5% percentile). Using the 200-repeats Monte-Carlo cross-validation method, these models provided a multiclass classification of invasiveness with discriminative power AUCs of 0.83 to 0.87 and predicted the class probabilities with less than a 10% average error. The predictive modelling approach adopted in this paper provides a detailed insight on how the value of the main predictors contribute to the probability of nodule invasiveness and underlines the role of nodule CT attenuation features in the nodule invasiveness classification.
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Affiliation(s)
| | - Ritu R Gill
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Anastasia Oikonomou
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Elsie T Nguyen
- Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Benedikt H Heidinger
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Mayra A Medina
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Alexander A Bankier
- Department of Radiology, UMass Memorial Medical Center, University of Massachusetts Medical School, Worcester, MA, USA
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de Margerie-Mellon C, Ngo LH, Gill RR, Monteiro Filho AC, Heidinger BH, Onken A, Medina MA, VanderLaan PA, Bankier AA. The Growth Rate of Subsolid Lung Adenocarcinoma Nodules at Chest CT. Radiology 2020; 297:189-198. [PMID: 32749206 DOI: 10.1148/radiol.2020192322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Confirming that subsolid adenocarcinomas show exponential growth is important because it would justify using volume doubling time to assess their growth. Purpose To test whether the growth of lung adenocarcinomas manifesting as subsolid nodules at chest CT is accurately represented by an exponential model. Materials and Methods Patients with lung adenocarcinomas manifesting as subsolid nodules surgically resected between January 2005 and May 2018, with three or more longitudinal CT examinations before resection, were retrospectively included. Overall volume (for all nodules) and solid component volume (for part-solid nodules) were measured over time. A linear mixed-effects model was used to identify the growth pattern (linear, exponential, quadratic, or power law) that best represented growth. The interactions between nodule growth and clinical, CT morphologic, and pathologic parameters were studied. Results Sixty-nine patients (mean age, 70 years ± 9 [standard deviation]; 48 women) with 74 lung adenocarcinomas were evaluated. Overall growth and solid component growth were better represented by an exponential model (adjusted R2 = 0.89 and 0.95, respectively) than by a quadratic model (r2 = 0.88 and 0.93, respectively), a linear model (r2 = 0.87 and 0.92, respectively), or a power law model (r2 = 0.82 and 0.93, respectively). Faster overall volume growth was associated with a history of lung cancer (P < .001), a baseline nodule volume less than 500 mm3 (P = .03), and histologic findings of invasive adenocarcinoma (P < .001). The median volume doubling time of noninvasive adenocarcinoma was significantly longer than that of invasive adenocarcinoma (939 days [interquartile range, 588-1563 days] vs 678 days [interquartile range, 392-916 days], respectively; P = .01). Conclusion The overall volume growth of adenocarcinomas manifesting as subsolid nodules at chest CT was best represented by an exponential model compared with the other tested models. This justifies the use of volume doubling time for the growth assessment of these nodules. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Kuriyama and Yanagawa in this issue.
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Affiliation(s)
- Constance de Margerie-Mellon
- From the Departments of Radiology (C.d.M.M., R.R.G., A.C.M.F., B.H.H., A.A.B.), General Medicine (L.H.N.), and Pathology (A.O., M.A.M., P.A.V.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (B.H.H.)
| | - Long H Ngo
- From the Departments of Radiology (C.d.M.M., R.R.G., A.C.M.F., B.H.H., A.A.B.), General Medicine (L.H.N.), and Pathology (A.O., M.A.M., P.A.V.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (B.H.H.)
| | - Ritu R Gill
- From the Departments of Radiology (C.d.M.M., R.R.G., A.C.M.F., B.H.H., A.A.B.), General Medicine (L.H.N.), and Pathology (A.O., M.A.M., P.A.V.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (B.H.H.)
| | - Antonio C Monteiro Filho
- From the Departments of Radiology (C.d.M.M., R.R.G., A.C.M.F., B.H.H., A.A.B.), General Medicine (L.H.N.), and Pathology (A.O., M.A.M., P.A.V.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (B.H.H.)
| | - Benedikt H Heidinger
- From the Departments of Radiology (C.d.M.M., R.R.G., A.C.M.F., B.H.H., A.A.B.), General Medicine (L.H.N.), and Pathology (A.O., M.A.M., P.A.V.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (B.H.H.)
| | - Allison Onken
- From the Departments of Radiology (C.d.M.M., R.R.G., A.C.M.F., B.H.H., A.A.B.), General Medicine (L.H.N.), and Pathology (A.O., M.A.M., P.A.V.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (B.H.H.)
| | - Mayra A Medina
- From the Departments of Radiology (C.d.M.M., R.R.G., A.C.M.F., B.H.H., A.A.B.), General Medicine (L.H.N.), and Pathology (A.O., M.A.M., P.A.V.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (B.H.H.)
| | - Paul A VanderLaan
- From the Departments of Radiology (C.d.M.M., R.R.G., A.C.M.F., B.H.H., A.A.B.), General Medicine (L.H.N.), and Pathology (A.O., M.A.M., P.A.V.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (B.H.H.)
| | - Alexander A Bankier
- From the Departments of Radiology (C.d.M.M., R.R.G., A.C.M.F., B.H.H., A.A.B.), General Medicine (L.H.N.), and Pathology (A.O., M.A.M., P.A.V.), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass (L.H.N.); and Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria (B.H.H.)
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Xia X, Gong J, Hao W, Yang T, Lin Y, Wang S, Peng W. Comparison and Fusion of Deep Learning and Radiomics Features of Ground-Glass Nodules to Predict the Invasiveness Risk of Stage-I Lung Adenocarcinomas in CT Scan. Front Oncol 2020; 10:418. [PMID: 32296645 PMCID: PMC7136522 DOI: 10.3389/fonc.2020.00418] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 03/10/2020] [Indexed: 01/15/2023] Open
Abstract
For stage-I lung adenocarcinoma, the 5-years disease-free survival (DFS) rates of non-invasive adenocarcinoma (non-IA) is different with invasive adenocarcinoma (IA). This study aims to develop CT image based artificial intelligence (AI) schemes to classify between non-IA and IA nodules, and incorporate deep learning (DL) and radiomics features to improve the classification performance. We collect 373 surgical pathological confirmed ground-glass nodules (GGNs) from 323 patients in two centers. It involves 205 non-IA (including 107 adenocarcinoma in situ and 98 minimally invasive adenocarcinoma), and 168 IA. We first propose a recurrent residual convolutional neural network based on U-Net to segment the GGNs. Then, we build two schemes to classify between non-IA and IA namely, DL scheme and radiomics scheme, respectively. Third, to improve the classification performance, we fuse the prediction scores of two schemes by applying an information fusion method. Finally, we conduct an observer study to compare our scheme performance with two radiologists by testing on an independent dataset. Comparing with DL scheme and radiomics scheme (the area under a receiver operating characteristic curve (AUC): 0.83 ± 0.05, 0.87 ± 0.04), our new fusion scheme (AUC: 0.90 ± 0.03) significant improves the risk classification performance (p < 0.05). In a comparison with two radiologists, our new model yields higher accuracy of 80.3%. The kappa value for inter-radiologist agreement is 0.6. It demonstrates that applying AI method is an effective way to improve the invasiveness risk prediction performance of GGNs. In future, fusion of DL and radiomics features may have a potential to handle the classification task with limited dataset in medical imaging.
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Affiliation(s)
- Xianwu Xia
- Department of Radiology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, China
| | - Jing Gong
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wen Hao
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ting Yang
- Department of Radiology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, China
| | - Yeqing Lin
- Department of Radiology, Municipal Hospital Affiliated to Medical School of Taizhou University, Taizhou, China
| | - Shengping Wang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Weijun Peng
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Borghesi A, Michelini S, Golemi S, Scrimieri A, Maroldi R. What's New on Quantitative CT Analysis as a Tool to Predict Growth in Persistent Pulmonary Subsolid Nodules? A Literature Review. Diagnostics (Basel) 2020; 10:E55. [PMID: 31973010 PMCID: PMC7168253 DOI: 10.3390/diagnostics10020055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 12/23/2022] Open
Abstract
Pulmonary subsolid nodules (SSNs) are observed not infrequently on thin-section chest computed tomography (CT) images. SSNs persisting after a follow-up period of three to six months have a high likelihood of being pre-malignant or malignant lesions. Malignant SSNs usually represent the histologic spectrum of pulmonary adenocarcinomas, and pulmonary adenocarcinomas presenting as SSNs exhibit quite heterogeneous behavior. In fact, while most lesions show an indolent course and may grow very slowly or remain stable for many years, others may exhibit significant growth in a relatively short time. Therefore, it is not yet clear which persistent SSNs should be surgically removed and for how many years stable SSNs should be monitored. In order to solve these two open issues, the use of quantitative analysis has been proposed to define the "tailored" management of persistent SSNs. The main purpose of this review was to summarize recent results about quantitative CT analysis as a diagnostic tool for predicting the behavior of persistent SSNs. Thus, a literature search was conducted in PubMed/MEDLINE, Scopus, and Web of Science databases to find original articles published from January 2014 to October 2019. The results of the selected studies are presented and compared in a narrative way.
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Affiliation(s)
- Andrea Borghesi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
| | - Silvia Michelini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Via Leonida Bissolati, 57, 25124 Brescia, Italy;
| | - Salvatore Golemi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
| | - Alessandra Scrimieri
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
| | - Roberto Maroldi
- Department of Radiology, University and ASST Spedali Civili of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (S.G.); (A.S.); (R.M.)
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Quantitative CT Analysis for Predicting the Behavior of Part-Solid Nodules with Solid Components Less than 6 mm: Size, Density and Shape Descriptors. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9163428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Persistent part-solid nodules (PSNs) with a solid component <6 mm usually represent minimally invasive adenocarcinomas and are significantly less aggressive than PSNs with a solid component ≥6 mm. However, not all PSNs with a small solid component behave in the same way: some nodules exhibit an indolent course, whereas others exhibit more aggressive behavior. Thus, predicting the future behavior of this subtype of PSN remains a complex and fascinating diagnostic challenge. The main purpose of this study was to apply open-source software to investigate which quantitative computed tomography (CT) features may be useful for predicting the behavior of a select group of PSNs. We retrospectively selected 50 patients with a single PSN with a solid component <6 mm and diameter <15 mm. Computerized analysis was performed using ImageJ software for each PSN and various quantitative features were calculated from the baseline CT images. The area, perimeter, mean Feret diameter, linear mass density, circularity and solidity were significantly related to nodule growth (p ≤ 0.031). Therefore, quantitative CT analysis was helpful for predicting the future behavior of a select group of PSNs with a solid component <6 mm and diameter <15 mm.
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Heidinger BH, Schwarz-Nemec U, Anderson KR, de Margerie-Mellon C, Monteiro Filho AC, Chen Y, Mayerhoefer ME, VanderLaan PA, Bankier AA. Visceral Pleural Invasion in Pulmonary Adenocarcinoma: Differences in CT Patterns between Solid and Subsolid Cancers. Radiol Cardiothorac Imaging 2019; 1:e190071. [PMID: 33778512 PMCID: PMC7977962 DOI: 10.1148/ryct.2019190071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 04/12/2023]
Abstract
PURPOSE To analyze the incidence and CT patterns of visceral pleural invasion (VPI) in adenocarcinomas on the basis of their CT presentation as solid or subsolid nodules. MATERIALS AND METHODS A total of 286 adenocarcinomas in direct contact with a pleural surface, resected at an institution between 2005 and 2016, were included in this retrospective, institutional review board-approved study. CT size and longest contact length with a pleural surface were measured and their ratios computed. Pleural deviation, pleural thickening, spiculations, different pleural tag types, pleural effusion, and the CT appearance of transgression into an adjacent lobe or infiltration of surrounding tissue were evaluated. Fisher exact tests and simple and multiple logistic regression models were used. RESULTS Of the 286 nodules, 179 of 286 (62.6%) were solid and 107 of 286 (37.4%) were subsolid. VPI was present in 49 of 286 (17.1%) nodules and was significantly more frequent in solid (44 of 179; 24.6%) than in subsolid nodules (five of 107; 4.7%; P < .001). In solid nodules, multiple regression analysis showed an association of higher contact length-to-size ratio (adjusted odds ratio [OR], 1.02; P = .007) and the presence of multiple pleural tag types (adjusted OR, 5.88; P = .002) with VPI. In subsolid nodules, longer pleural contact length of the solid nodular component (adjusted OR, 1.27; P = .017) and the CT appearance of transgression or infiltration (adjusted OR, 10.75; P = .037) were associated with VPI. CONCLUSION During preoperative evaluation of adenocarcinomas for the likelihood of VPI, whether a tumor manifests as a solid or a subsolid nodule is important to consider because the incidence of VPI is significantly higher in solid than in subsolid nodules. In addition, this study showed that the CT patterns associated with VPI differ between solid and subsolid nodules.© RSNA, 2019Supplemental material is available for this article.See also the commentary by Elicker in this issue.
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Gong J, Liu J, Hao W, Nie S, Wang S, Peng W. Computer-aided diagnosis of ground-glass opacity pulmonary nodules using radiomic features analysis. Phys Med Biol 2019; 64:135015. [PMID: 31167172 DOI: 10.1088/1361-6560/ab2757] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study aims to develop a CT-based radiomic features analysis approach for diagnosis of ground-glass opacity (GGO) pulmonary nodules, and also assess whether computer-aided diagnosis (CADx) performance changes in classifying between benign and malignant nodules associated with histopathological subtypes namely, adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC), respectively. The study involves 182 histopathology-confirmed GGO nodules collected from two cancer centers. Among them, 59 are benign, 50 are AIS, 32 are MIA, and 41 are IAC nodules. Four training/testing data sets-(1) all nodules, (2) benign and AIS nodules, (3) benign and MIA nodules, (4) benign and IAC nodules-are assembled based on their histopathological subtypes. We first segment pulmonary nodules depicted in CT images by using a 3D region growing and geodesic active contour level set algorithm. Then, we computed and extracted 1117 quantitative imaging features based on the 3D segmented nodules. After conducting radiomic features normalization process, we apply a leave-one-out cross-validation (LOOCV) method to build models by embedding with a Relief feature selection, synthetic minority oversampling technique (SMOTE) and three machine-learning classifiers namely, support vector machine classifier, logistic regression classifier and Gaussian Naïve Bayes classifier. When separately using four data sets to train and test three classifiers, the average areas under receiver operating characteristic curves (AUC) are 0.75, 0.55, 0.77 and 0.93, respectively. When testing on an independent data set, our scheme yields higher accuracy than two radiologists (61.3% versus radiologist 1: 53.1% and radiologist 2: 56.3%). This study demonstrates that: (1) the feasibility of using CT-based radiomic features analysis approach to distinguish between benign and malignant GGO nodules, (2) higher performance of CADx scheme in diagnosing GGO nodules comparing with radiologist, and (3) a consistently positive trend between classification performance and invasive grade of GGO nodules. Thus, to improve the CADx performance in diagnosing of GGO nodules, one should assemble an optimal training data set dominated with more nodules associated with non-invasive lung adenocarcinoma (i.e. AIS and MIA).
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Affiliation(s)
- Jing Gong
- Department of Radiology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, People's Republic of China. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, People's Republic of China. Jing Gong and Jiyu Liu contributed equally to this work
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18
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Ledda RE, Milanese G, Gnetti L, Borghesi A, Sverzellati N, Silva M. Spread through air spaces in lung adenocarcinoma: is radiology reliable yet? J Thorac Dis 2019; 11:S256-S261. [PMID: 30997191 DOI: 10.21037/jtd.2019.01.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Roberta E Ledda
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Gianluca Milanese
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Letizia Gnetti
- Pathology Unit, University Hospital of Parma, Parma, Italy
| | - Andrea Borghesi
- Department of Radiology, University and Spedali Civili of Brescia, Brescia, Italy
| | - Nicola Sverzellati
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Mario Silva
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
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19
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CT Manifestations of Tumor Spread Through Airspaces in Pulmonary Adenocarcinomas Presenting as Subsolid Nodules. J Thorac Imaging 2019; 33:402-408. [PMID: 30067571 DOI: 10.1097/rti.0000000000000344] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE The aim of this study was to identify potential computed tomography manifestations of pulmonary adenocarcinomas presenting as subsolid nodules and associated with the histologic evidence of spread of tumor through air spaces (STAS). MATERIALS AND METHODS From a radiologic-pathologic repository of resected pulmonary adenocarcinomas including 203 subsolid nodules, 40 STAS-positive nodules were randomly selected and matched to 40 STAS-negative nodules. Total average diameter, as well as average and long-axis diameters of the solid component, was measured. The proportion of solid component diameter to total average diameter was calculated. Measurements and proportions between STAS-positive and STAS-negative nodules were compared with paired samples t test, χ test, or the Fisher exact test. RESULTS The total average diameter in STAS-positive nodules was significantly larger than in STAS-negative nodules (P=0.024). The average and long-axis diameters of the solid component of STAS-positive nodules were significantly larger than that of STAS-negative nodules (P=0.001 and 0.003). The proportion of solid component to total average diameter was significantly larger in STAS-positive than in STAS-negative nodules (P=0.041). At a threshold of ≥10 mm for the average and the solid component long-axis diameters, significantly more nodules were STAS-positive than STAS-negative (P=0.015 and 0.001). CONCLUSIONS Total average diameter, average and long-axis diameters of the solid component, and a high proportion of solid component diameter compared with total average diameter are computed tomography manifestations of subsolid pulmonary adenocarcinomas with STAS. These findings could serve as an in-vivo tool for the likelihood estimation of STAS, and consequently influence management of subsolid adenocarcinomas.
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20
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Anderson KR, Onken A, Heidinger BH, Chen Y, Bankier AA, VanderLaan PA. Pathologic T Descriptor of Nonmucinous Lung Adenocarcinomas Now Based on Invasive Tumor Size: How Should Pathologists Measure Invasion? Am J Clin Pathol 2018; 150:499-506. [PMID: 30084917 DOI: 10.1093/ajcp/aqy080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The eighth edition of the American Joint Committee on Cancer staging manual now stratifies nonmucinous lung adenocarcinomas (nmLACAs) by the size of the invasive component only. This is determined by direct gross or microscopic measurement; however, a calculated invasive size based on the percentage of invasive growth patterns has been proposed as an alternative option. METHODS To compare radiologic with different pathologic assessments of invasive tumor size, we retrospectively reviewed a cohort of resected nmLACAs with a part-solid appearance on computed tomography (CT) scan (n = 112). RESULTS The median direct microscopic pathologic invasive measurements were not significantly different from the median calculated pathologic invasive measurements; however, the median CT invasive measurements were 0.26 cm larger than the median direct pathologic measurements (P < .001). CONCLUSIONS Our results show that pathologic calculated invasive tumor measurements are comparable to direct microscopic measurements of invasive tumor, thereby supporting the recommendation for use of calculated invasive tumor size by the pathologist if necessary.
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Affiliation(s)
- Kevin R Anderson
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Allison Onken
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Benedikt H Heidinger
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Yigu Chen
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Alexander A Bankier
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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21
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Borghesi A, Michelini S, Bertagna F, Scrimieri A, Pezzotti S, Maroldi R. Hilly or mountainous surface: a new CT feature to predict the behavior of pure ground glass nodules? Eur J Radiol Open 2018; 5:177-182. [PMID: 30294620 PMCID: PMC6170928 DOI: 10.1016/j.ejro.2018.09.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/19/2018] [Indexed: 02/02/2023] Open
Abstract
pGGNs typically show an indolent course with very slow growth rates. pGGNs exhibit different patterns of growth regardless of their initial CT features. Predicting the behavior of pGGNs on initial CT remains a diagnostic challenge. Diameter greater than 10 mm increases the risk of aggressive behavior in pGGNs. The analysis of surface morphology may help predict the behavior of pGGNs ≥ 10 mm.
Persistent pure ground-glass nodules (pGGNs) typically show an indolent course with very slow growth rates. These slow-growing lesions exhibit different growth patterns regardless of their initial computed tomography (CT) features. Therefore, predicting the aggressive behavior of pGGNs on initial CT remains a diagnostic challenge. The literature reports that computerized analysis and various quantitative features have been tested to improve the risk stratification for pGGNs. The present article describes the long-term follow-up of two pGGNs with different behavior and introduces, for the first time, a new computerized method of analysis that could be helpful for predicting the future behavior of pGGNs.
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Affiliation(s)
- Andrea Borghesi
- Department of Radiology, University and Spedali Civili of Brescia, Brescia, Italy
| | - Silvia Michelini
- Department of Radiology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University and Spedali Civili of Brescia, Brescia, Italy
| | - Alessandra Scrimieri
- Department of Radiology, University and Spedali Civili of Brescia, Brescia, Italy
| | - Stefania Pezzotti
- Department of Radiology, University and Spedali Civili of Brescia, Brescia, Italy
| | - Roberto Maroldi
- Department of Radiology, University and Spedali Civili of Brescia, Brescia, Italy
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22
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CT diagnosis of pleural and stromal invasion in malignant subpleural pure ground-glass nodules: an exploratory study. Eur Radiol 2018; 29:279-286. [DOI: 10.1007/s00330-018-5558-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/23/2018] [Accepted: 05/23/2018] [Indexed: 12/19/2022]
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Clay R, Rajagopalan S, Karwoski R, Maldonado F, Peikert T, Bartholmai B. Computer Aided Nodule Analysis and Risk Yield (CANARY) characterization of adenocarcinoma: radiologic biopsy, risk stratification and future directions. Transl Lung Cancer Res 2018; 7:313-326. [PMID: 30050769 DOI: 10.21037/tlcr.2018.05.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The majority of incidentally and screen-detected lung cancers are adenocarcinomas. Optimal management of these tumors is clinically challenging due to variability in tumor histopathology and behavior. Invasive adenocarcinoma (IA) is generally aggressive while adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) may be extremely indolent. Computer Aided Nodule Analysis and Risk Yield (CANARY) is a quantitative computed tomography (CT) analysis tool that allows non-invasive assessment of tumor characteristics. This analysis may obviate the need for tissue biopsy and facilitate the risk stratification of adenocarcinoma of the lung. CANARY was developed by unsupervised machine learning techniques using CT data of histopathologically-characterized adenocarcinomas of the lung. This technique identified 9 distinct exemplars that constitute the spectrum of CT features found in adenocarcinoma of the lung. The distributions of these features in a nodule correlate with histopathology. Further automated clustering of CANARY nodules defined three distinct groups that have distinctly different post-resection disease free survival (DFS). CANARY has been validated within the NLST cohort and multiple other cohorts. Using semi-automated segmentation as input to CANARY, there is excellent repeatability and interoperator correlation of results. Confirmation and longitudinal tracking of indolent adenocarcinoma with CANARY may ultimately add decision support in nuanced cases where surgery may not be in the best interest of the patient due to competing comorbidity. Currently under investigation is CANARY's role in detecting differing driver mutations and tumor response to targeted chemotherapeutics. Combining the results from CANARY analysis with clinical information and other quantitative techniques such as analysis of the tumor-free surrounding lung may aid in building more powerful predictive models. The next step in CANARY investigation will be its prospective application, both in selecting low-risk stage 1 adenocarcinoma for active surveillance and investigation in selecting high-risk early stage adenocarcinoma for adjuvant therapy.
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Affiliation(s)
- Ryan Clay
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Ronald Karwoski
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Fabien Maldonado
- Department of Internal Medicine, Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tobias Peikert
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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24
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Silva M, Milanese G, Seletti V, Ariani A, Sverzellati N. Pulmonary quantitative CT imaging in focal and diffuse disease: current research and clinical applications. Br J Radiol 2018; 91:20170644. [PMID: 29172671 PMCID: PMC5965469 DOI: 10.1259/bjr.20170644] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/14/2017] [Accepted: 11/23/2017] [Indexed: 12/14/2022] Open
Abstract
The frenetic development of imaging technology-both hardware and software-provides exceptional potential for investigation of the lung. In the last two decades, CT was exploited for detailed characterization of pulmonary structures and description of respiratory disease. The introduction of volumetric acquisition allowed increasingly sophisticated analysis of CT data by means of computerized algorithm, namely quantitative CT (QCT). Hundreds of thousands of CTs have been analysed for characterization of focal and diffuse disease of the lung. Several QCT metrics were developed and tested against clinical, functional and prognostic descriptors. Computer-aided detection of nodules, textural analysis of focal lesions, densitometric analysis and airway segmentation in obstructive pulmonary disease and textural analysis in interstitial lung disease are the major chapters of this discipline. The validation of QCT metrics for specific clinical and investigational needs prompted the translation of such metrics from research field to patient care. The present review summarizes the state of the art of QCT in both focal and diffuse lung disease, including a dedicated discussion about application of QCT metrics as parameters for clinical care and outcomes in clinical trials.
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Affiliation(s)
- Mario Silva
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Gianluca Milanese
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Valeria Seletti
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Parma, Italy
| | - Alarico Ariani
- Department of Medicine, Internal Medicine and Rheumatology Unit, University Hospital of Parma, Parma, Italy
| | - Nicola Sverzellati
- Department of Medicine and Surgery (DiMeC), Section of Radiology, Unit of Surgical Sciences, University of Parma, Parma, Italy
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25
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Heidinger BH, Anderson KR, Nemec U, Costa DB, Gangadharan SP, VanderLaan PA, Bankier AA. Morphologic characteristics of pulmonary adenocarcinomas manifesting as pure ground-glass nodules on CT. J Thorac Dis 2017; 9:E1148-E1150. [PMID: 29313855 DOI: 10.21037/jtd.2017.11.25] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Benedikt H Heidinger
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Kevin R Anderson
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ursula Nemec
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Daniel B Costa
- Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Sidhu P Gangadharan
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Paul A VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Alexander A Bankier
- Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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26
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Heidinger BH, Nemec U, Anderson KR, Costa DB, Gangadharan SP, VanderLaan PA, Bankier AA. "Rounding" the Size of Pulmonary Nodules: Impact of Rounding Methods on Nodule Management, as Defined by the 2017 Fleischner Society Guidelines. Acad Radiol 2017; 24:1422-1427. [PMID: 28666724 DOI: 10.1016/j.acra.2017.05.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 05/18/2017] [Accepted: 05/20/2017] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to quantify the impact of different rounding methods on size measurements of pulmonary nodules and to determine the number of nodules that change management categories as a result of rounding. MATERIALS AND METHODS For this retrospective institutional review board-approved study, we included 503 incidental pulmonary nodules (308 solid and 195 subsolid) from a data repository. Long and short axes were measured. Average diameters were calculated using four different rounding methods (method 1: no rounding; method 2: rounding only the average diameter to the closest millimeter; method 3: rounding only short and long axes; and method 4: rounding short and long axes and the average diameter to the closest millimeter). Nodules were classified for each rounding method according to the 2017 Fleischner Society guideline management categories. Measurements were compared among the four rounding methods using analysis of variance. RESULTS Without rounding, the average nodule diameter was 15.67 ± 5.97 mm. This increased between 0.03 and 0.29 mm using rounding methods 2-4 (range: P < 0.001-0.017). The nodule size was more frequently rounded up (range: 52.1%-77.5%) than rounded down (range: 17.7%-42.5%) using rounding methods 2-4, as compared to no rounding. In the 308 solid nodules, up to 2.9% of the nodules changed management category, whereas none of the 195 subsolid nodules changed category. CONCLUSIONS Rounding methods have a small absolute but statically significant effect on nodule size, impacting management category in less than 3% of the nodules. This suggests that, in clinical practice, any rounding method can be used for determining nodule size without substantially biasing individual nodules toward given management categories.
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Affiliation(s)
- Benedikt H Heidinger
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215.
| | - Ursula Nemec
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Kevin R Anderson
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Daniel B Costa
- Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Sidhu P Gangadharan
- Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Paul A VanderLaan
- Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Alexander A Bankier
- Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
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27
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Peikert T, Rajagopalan S, Bartholmai B, Maldonado F. While size matters-advanced "Radiomics" remain promising for the clinical management of ground glass opacities. J Thorac Dis 2017; 9:3568-3571. [PMID: 29268343 DOI: 10.21037/jtd.2017.09.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Tobias Peikert
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University, Nashville, TN, USA
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28
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Milanese G, Sverzellati N, Pastorino U, Silva M. Adenocarcinoma in pure ground glass nodules: histological evidence of invasion and open debate on optimal management. J Thorac Dis 2017; 9:2862-2867. [PMID: 29221257 DOI: 10.21037/jtd.2017.08.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Gianluca Milanese
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Nicola Sverzellati
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Ugo Pastorino
- Department of Thoracic Surgery, IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mario Silva
- Section of Radiology, Unit of Surgical Sciences, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
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