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Zhao H, Wang Y, Sun Y, Wang Y, Shi B, Liu J, Zhang S. Hematological indicator-based machine learning models for preoperative prediction of lymph node metastasis in cervical cancer. Front Oncol 2024; 14:1400109. [PMID: 39193382 PMCID: PMC11347340 DOI: 10.3389/fonc.2024.1400109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/29/2024] [Indexed: 08/29/2024] Open
Abstract
Background Lymph node metastasis (LNM) is an important prognostic factor for cervical cancer (CC) and determines the treatment strategy. Hematological indicators have been reported as being useful biomarkers for the prognosis of a variety of cancers. This study aimed to evaluate the feasibility of machine learning models characterized by preoperative hematological indicators to predict the LNM status of CC patients before surgery. Methods The clinical data of 236 patients with pathologically confirmed CC were retrospectively analyzed at the Gynecology Oncology Department of the First Affiliated Hospital of Bengbu Medical University from November 2020 to August 2022. The least absolute shrinkage and selection operator (LASSO) was used to select 21 features from 35 hematological indicators and for the construction of 6 machine learning predictive models, including Adaptive Boosting (AdaBoost), Gaussian Naive Bayes (GNB), and Logistic Regression (LR), as well as Random Forest (RF), Support Vector Machines (SVM), and Extreme Gradient Boosting (XGBoost). Evaluation metrics of predictive models included the area under the receiver operating characteristic curve (AUC), accuracy, specificity, sensitivity, and F1-score. Results RF has the best overall predictive performance for ten-fold cross-validation in the training set. The specific performance indicators of RF were AUC (0.910, 95% confidence interval [CI]: 0.820-1.000), accuracy (0.831, 95% CI: 0.702-0.960), specificity (0.835, 95% CI: 0.708-0.962), sensitivity (0.831, 95% CI: 0.702-0.960), and F1-score (0.829, 95% CI: 0.696-0.962). RF had the highest AUC in the testing set (AUC = 0.854). Conclusion RF based on preoperative hematological indicators that are easily available in clinical practice showed superior performance in the preoperative prediction of CC LNM. However, investigations on larger external cohorts of patients are required for further validation of our findings.
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Affiliation(s)
- Huan Zhao
- School of Medical Imaging, Bengbu Medical University, Bengbu, Anhui, China
| | - Yuling Wang
- Department of Gynecology and Oncology, First Affiliated Hospital, Bengbu Medical University, Bengbu, Anhui, China
| | - Yilin Sun
- Department of Gynecology and Oncology, First Affiliated Hospital, Bengbu Medical University, Bengbu, Anhui, China
| | - Yongqiang Wang
- School of Medical Imaging, Bengbu Medical University, Bengbu, Anhui, China
| | - Bo Shi
- School of Medical Imaging, Bengbu Medical University, Bengbu, Anhui, China
| | - Jian Liu
- Department of Gynecology and Oncology, First Affiliated Hospital, Bengbu Medical University, Bengbu, Anhui, China
| | - Sai Zhang
- School of Medical Imaging, Bengbu Medical University, Bengbu, Anhui, China
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Zhou H, Zhao Q, Xie Q, Peng Y, Chen M, Huang Z, Lin Z, Yao T. Preoperative prediction model of lymph node metastasis in the inguinal and femoral region based on radiomics and artificial intelligence. Int J Gynecol Cancer 2024:ijgc-2024-005580. [PMID: 39089728 DOI: 10.1136/ijgc-2024-005580] [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: 08/04/2024] Open
Abstract
OBJECTIVE To predict preoperative inguinal lymph node metastasis in vulvar cancer patients using a machine learning model based on imaging features and clinical data from pelvic magnetic resonance imaging (MRI). METHODS 52 vulvar cancer patients were divided into a training set (n=37) and validation set (n=15). Clinical data and MRI images were collected, and regions of interest were delineated by experienced radiologists. A total of 1688 quantitative imaging features were extracted using the Radcloud platform. Dimensionality reduction and feature selection were applied, resulting in a radiomics signature. Clinical characteristics were screened, and a combined model integrating the radiomics signature and significant clinical features was constructed using logistic regression. Four machine learning classifiers (K nearest neighbor, random forest, adaptive boosting, and latent dirichlet allocation) were trained and validated. Model performance was evaluated using the receiver operating characteristic curve and the area under the curve (AUC), as well as decision curve analysis. RESULTS The radiomics score significantly differentiated between lymph node metastasis positive and negative patients in both the training and validation sets. The combined model demonstrated excellent discrimination, with AUC values of 0.941 and 0.933 in the training and validation sets, respectively. The calibration curve and decision curve analysis confirmed the model's high predictive accuracy and clinical utility. Among the machine learning classifiers, latent dirichlet allocation and random forest models achieved AUC values >0.7 in the validation set. Integrating all four classifiers resulted in a total model with an AUC of 0.717 in the validation set. CONCLUSION Radiomics combined with artificial intelligence can provide a new method for prediction of inguinal lymph node metastasis of vulvar cancer before surgery.
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Affiliation(s)
- Haijian Zhou
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Zhao
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qingsheng Xie
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu Peng
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Mengjie Chen
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zixin Huang
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhongqiu Lin
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tingting Yao
- Department of Gynecological Oncology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Li C, Hu J, Zhang Z, Wei C, Chen T, Wang X, Dai Y, Shen J. Biparametric MRI of the prostate radiomics model for prediction of pelvic lymph node metastasis in prostate cancers : a two-centre study. BMC Med Imaging 2024; 24:185. [PMID: 39054441 PMCID: PMC11271060 DOI: 10.1186/s12880-024-01372-8] [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: 11/29/2023] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES Exploring the value of adding correlation analysis (radiomic features (RFs) of pelvic metastatic lymph nodes and primary lesions) to screen RFs of primary lesions in the feature selection process of establishing prediction model. METHODS A total of 394 prostate cancer (PCa) patients (263 in the training group, 74 in the internal validation group and 57 in the external validation group) from two tertiary hospitals were included in the study. The cases with pelvic lymph node metastasis (PLNM) positive in the training group were diagnosed by biopsy or MRI with a short-axis diameter ≥ 1.5 cm, PLNM-negative cases in the training group and all cases in validation group were underwent both radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND). The RFs of PLNM-negative lesion and PLNM-positive tissues including primary lesions and their metastatic lymph nodes (MLNs) in the training group were extracted from T2WI and apparent diffusion coefficient (ADC) map to build the following two models by fivefold cross-validation: the lesion model, established according to the primary lesion RFs selected by t tests and absolute shrinkage and selection operator (LASSO); the lesion-correlation model, established according to the primary lesion RFs selected by Pearson correlation analysis (RFs of primary lesions and their MLNs, correlation coefficient > 0.9), t test and LASSO. Finally, we compared the performance of these two models in predicting PLNM. RESULTS The AUC and the DeLong test of AUC in the lesion model and lesion-correlation model were as follows: training groups (0.8053, 0.8466, p = 0.0002), internal validation group (0.7321, 0.8268, p = 0.0429), and external validation group (0.6445, 0.7874, p = 0.0431), respectively. CONCLUSION The lesion-correlation model established by features of primary tumors correlated with MLNs has more advantages than the lesion model in predicting PLNM.
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Affiliation(s)
- Chunxing Li
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Department of MRI Room, Yancheng First Hospital Affiliated Hospital of NanJing University Medical School, Yancheng, China
| | - Jisu Hu
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Zhiyuan Zhang
- School of Medical Imaging, Biomedical Engineering, Xuzhou Medical University, Xuzhou, China
| | - Chaogang Wei
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Tong Chen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yakang Dai
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Junkang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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Cheng J, Zhao B, Liu Z, Huang D, Qin N, Yang A, Chen Y, Shu J. DMGM: deformable-mechanism based cervical cancer staging via MRI multi-sequence . Phys Med Biol 2024; 69:115044. [PMID: 38749463 DOI: 10.1088/1361-6560/ad4c50] [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: 07/31/2023] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
Objective.This study aims to leverage a deep learning approach, specifically a deformable convolutional layer, for staging cervical cancer using multi-sequence MRI images. This is in response to the challenges doctors face in simultaneously identifying multiple sequences, a task that computer-aided diagnosis systems can potentially improve due to their vast information storage capabilities.Approach.To address the challenge of limited sample sizes, we introduce a sequence enhancement strategy to diversify samples and mitigate overfitting. We propose a novel deformable ConvLSTM module that integrates a deformable mechanism with ConvLSTM, enabling the model to adapt to data with varying structures. Furthermore, we introduce the deformable multi-sequence guidance model (DMGM) as an auxiliary diagnostic tool for cervical cancer staging.Main results.Through extensive testing, including comparative and ablation studies, we validate the effectiveness of the deformable ConvLSTM module and the DMGM. Our findings highlight the model's ability to adapt to the deformation mechanism and address the challenges in cervical cancer tumor staging, thereby overcoming the overfitting issue and ensuring the synchronization of asynchronous scan sequences. The research also utilized the multi-modal data from BraTS 2019 as an external test dataset to validate the effectiveness of the proposed methodology presented in this study.Significance.The DMGM represents the first deep learning model to analyze multiple MRI sequences for cervical cancer, demonstrating strong generalization capabilities and effective staging in small dataset scenarios. This has significant implications for both deep learning applications and medical diagnostics. The source code will be made available subsequently.
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Affiliation(s)
- Junqiang Cheng
- Institute of Systems Science and Technology, School of Electrical Engineering, Southwest Jiaotong University, Chengdu 611756, People's Republic of China
| | - Binnan Zhao
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, People's Republic of China
| | - Ziyi Liu
- State Key Laboratory of Air Traffic Management System, Nanjing 210022, People's Republic of China
| | - Deqing Huang
- Institute of Systems Science and Technology, School of Electrical Engineering, Southwest Jiaotong University, Chengdu 611756, People's Republic of China
| | - Na Qin
- Institute of Systems Science and Technology, School of Electrical Engineering, Southwest Jiaotong University, Chengdu 611756, People's Republic of China
| | - Aisen Yang
- Institute of Systems Science and Technology, School of Electrical Engineering, Southwest Jiaotong University, Chengdu 611756, People's Republic of China
| | - Yuan Chen
- Institute of Systems Science and Technology, School of Electrical Engineering, Southwest Jiaotong University, Chengdu 611756, People's Republic of China
| | - Jian Shu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, People's Republic of China
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Monthatip K, Boonnag C, Muangmool T, Charoenkwan K. A machine learning-based prediction model of pelvic lymph node metastasis in women with early-stage cervical cancer. J Gynecol Oncol 2024; 35:e17. [PMID: 37921601 PMCID: PMC10948976 DOI: 10.3802/jgo.2024.35.e17] [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: 05/11/2023] [Revised: 09/03/2023] [Accepted: 10/03/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVE To develop a novel machine learning-based preoperative prediction model for pelvic lymph node metastasis (PLNM) in early-stage cervical cancer by combining the clinical findings and preoperative computerized tomography (CT) of the whole abdomen and pelvis. METHODS Patients diagnosed with International Federation of Gynecology and Obstetrics stage IA2-IIA1 squamous cell carcinoma, adenocarcinoma, and adenosquamous carcinoma of the cervix who had primary radical surgery with bilateral pelvic lymphadenectomy from January 1, 2003 to December 31, 2020, were included. Seven supervised machine learning algorithms, including logistic regression, random forest, support vector machine, adaptive boosting, gradient boosting, extreme gradient boosting, and category boosting, were used to evaluate the risk of PLNM. RESULTS PLNM was found in 199 (23.9%) of 832 patients included. Younger age, larger tumor size, higher stage, no prior conization, tumor appearance, adenosquamous histology, and vaginal metastasis as well as the CT findings of larger tumor size, parametrial metastasis, pelvic lymph node enlargement, and vaginal metastasis, were significantly associated with PLNM. The models' predictive performance, including accuracy (89.1%-90.6%), area under the receiver operating characteristics curve (86.9%-91.0%), sensitivity (77.4%-82.4%), specificity (92.1%-94.3%), positive predictive value (77.0%-81.7%), and negative predictive value (93.0%-94.4%), appeared satisfactory and comparable among all the algorithms. After optimizing the model's decision threshold to enhance the sensitivity to at least 95%, the 'highly sensitive' model was obtained with a 2.5%-4.4% false-negative rate of PLNM prediction. CONCLUSION We developed prediction models for PLNM in early-stage cervical cancer with promising prediction performance in our setting. Further external validation in other populations is needed with potential clinical applications.
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Affiliation(s)
- Kamonrat Monthatip
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chiraphat Boonnag
- Biomedical Informatics Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tanarat Muangmool
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittipat Charoenkwan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Qin F, Sun X, Tian M, Jin S, Yu J, Song J, Wen F, Xu H, Yu T, Dong Y. Prediction of lymph node metastasis in operable cervical cancer using clinical parameters and deep learning with MRI data: a multicentre study. Insights Imaging 2024; 15:56. [PMID: 38411729 PMCID: PMC10899556 DOI: 10.1186/s13244-024-01618-7] [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: 06/13/2023] [Accepted: 12/09/2023] [Indexed: 02/28/2024] Open
Abstract
OBJECTIVES To develop and validate a magnetic resonance imaging-based (MRI) deep multiple instance learning (D-MIL) model and combine it with clinical parameters for preoperative prediction of lymph node metastasis (LNM) in operable cervical cancer. METHODS A total of 392 patients with cervical cancer were retrospectively enrolled. Clinical parameters were analysed by logistical regression to construct a clinical model (M1). A ResNet50 structure is applied to extract features at the instance level without using manual annotations about the tumour region and then construct a D-MIL model (M2). A hybrid model (M3) was constructed by M1 and M2 scores. The diagnostic performance of each model was evaluated by the area under the receiver operating characteristic curve (AUC) and compared using the Delong method. Disease-free survival (DFS) was evaluated by the Kaplan‒Meier method. RESULTS SCC-Ag, maximum lymph node short diameter (LNmax), and tumour volume were found to be independent predictors of M1 model. For the diagnosis of LNM, the AUC of the training/internal/external cohort of M1 was 0.736/0.690/0.732, the AUC of the training/internal/external cohort of M2 was 0.757/0.714/0.765, and the AUC of the training/internal/external cohort of M3 was 0.838/0.764/0.835. M3 showed better performance than M1 and M2. Through the survival analysis, patients with higher hybrid model scores had a shorter time to reach DFS. CONCLUSION The proposed hybrid model could be used as a personalised non-invasive tool, which is helpful for predicting LNM in operable cervical cancer. The score of the hybrid model could also reflect the DFS of operable cervical cancer. CRITICAL RELEVANCE STATEMENT Lymph node metastasis is an important factor affecting the prognosis of cervical cancer. Preoperative prediction of lymph node status is helpful to make treatment decisions, improve prognosis, and prolong survival time. KEY POINTS • The MRI-based deep-learning model can predict the LNM in operable cervical cancer. • The hybrid model has the highest diagnostic efficiency for the LNM prediction. • The score of the hybrid model can reflect the DFS of operable cervical cancer.
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Affiliation(s)
- Fengying Qin
- Department of Radiology, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang, Liaoning, 110042, China
| | - Xinyan Sun
- Department of Radiology, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang, Liaoning, 110042, China
| | - Mingke Tian
- Department of Radiology, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang, Liaoning, 110042, China
| | - Shan Jin
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, 116081, China
| | - Jian Yu
- Department of Radiology, Huludao Center Hospital, Huludao, 125001, China
| | - Jing Song
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110801, China
| | - Feng Wen
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, 110801, China
| | - Hongming Xu
- School of Biomedical Engineering, Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, 116081, China
| | - Tao Yu
- Department of Radiology, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang, Liaoning, 110042, China
| | - Yue Dong
- Department of Radiology, Cancer Hospital of Dalian University of Technology (Liaoning Cancer Hospital & Institute), Shenyang, Liaoning, 110042, China.
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Wang T, Li YY, Ma NN, Wang PA, Zhang B. A MRI radiomics-based model for prediction of pelvic lymph node metastasis in cervical cancer. World J Surg Oncol 2024; 22:55. [PMID: 38365759 PMCID: PMC10873981 DOI: 10.1186/s12957-024-03333-5] [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: 10/12/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Cervical cancer (CC) is a common malignancy of the female reproductive tract, and preoperative prediction of lymph node metastasis (LNM) is essential. This study aims to design and validate a magnetic resonance imaging (MRI) radiomics-based predictive model capable of detecting LNM in patients diagnosed with CC. METHODS This retrospective analysis incorporated 86 and 38 CC patients into the training and testing groups, respectively. Radiomics features were extracted from MRI T2WI, T2WI-SPAIR, and axial apparent diffusion coefficient (ADC) sequences. Selected features identified in the training group were then used to construct a radiomics scoring model, with relevant LNM-related risk factors having been identified through univariate and multivariate logistic regression analyses. The resultant predictive model was then validated in the testing cohort. RESULTS In total, 16 features were selected for the construction of a radiomics scoring model. LNM-related risk factors included worse differentiation (P < 0.001), more advanced International Federation of Gynecology and Obstetrics (FIGO) stages (P = 0.03), and a higher radiomics score from the combined MRI sequences (P = 0.01). The equation for the predictive model was as follows: -0.0493-2.1410 × differentiation level + 7.7203 × radiomics score of combined sequences + 1.6752 × FIGO stage. The respective area under the curve (AUC) values for the T2WI radiomics score, T2WI-SPAIR radiomics score, ADC radiomics score, combined sequence radiomics score, and predictive model were 0.656, 0.664, 0.658, 0.835, and 0.923 in the training cohort, while these corresponding AUC values were 0.643, 0.525, 0.513, 0.826, and 0.82 in the testing cohort. CONCLUSIONS This MRI radiomics-based model exhibited favorable accuracy when used to predict LNM in patients with CC. Relative to the use of any individual MRI sequence-based radiomics score, this predictive model yielded superior diagnostic accuracy.
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Affiliation(s)
- Tao Wang
- Suzhou Medical College of Soochow University, Suzhou, China
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Yan-Yu Li
- Department of Gynaecology and Obstetrics, Xuzhou Central Hospital, Xuzhou, China
| | - Nan-Nan Ma
- Department of Radiology, Xuzhou Central Hospital, Xuzhou, China
| | - Pei-An Wang
- Hospital Administration Office, Xuzhou Central Hospital, Xuzhou, China.
| | - Bei Zhang
- Suzhou Medical College of Soochow University, Suzhou, China.
- Department of Gynaecology and Obstetrics, Xuzhou Central Hospital, Xuzhou, China.
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Zhang Y, Wu C, Du J, Xiao Z, Lv F, Liu Y. Prediction of recurrence risk factors in patients with early-stage cervical cancers by nomogram based on MRI handcrafted radiomics features and deep learning features: a dual-center study. Abdom Radiol (NY) 2024; 49:258-270. [PMID: 37987856 DOI: 10.1007/s00261-023-04125-3] [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: 01/02/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE To establish and validate a deep learning radiomics nomogram (DLRN) based on intratumoral and peritumoral regions of MR images and clinical characteristics to predict recurrence risk factors in early-stage cervical cancer and to clarify whether DLRN could be applied for risk stratification. METHODS Two hundred and twenty five pathologically confirmed early-stage cervical cancers were enrolled and made up the training cohort and internal validation cohort, and 40 patients from another center were enrolled into the external validation cohort. On the basis of region of interest (ROI) of intratumoral and different peritumoral regions, two sets of features representing deep learning and handcrafted radiomics features were created using combined images of T2-weighted MRI (T2WI) and diffusion-weighted imaging (DWI). The signature subset with the best discriminant features was chosen, and deep learning and handcrafted signatures were created using logistic regression. Integrated with independent clinical factors, a DLRN was built. The discrimination and calibration of DLNR were applied to assess its therapeutic utility. RESULTS The DLRN demonstrated satisfactory performance for predicting recurrence risk factors, with AUCs of 0.944 (95% confidence interval 0.896-0.992) and 0.885 (95% confidence interval 0.834-0.937) in the internal and external validation cohorts. Furthermore, decision curve analysis revealed that the DLRN outperformed the clinical model, deep learning signature, and radiomics signature in terms of net benefit. CONCLUSION A DLRN based on intratumoral and peritumoral regions had the potential to predict and stratify recurrence risk factors for early-stage cervical cancers and enhance the value of individualized precision treatment.
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Affiliation(s)
- Yajiao Zhang
- College of Medical Informatics, Chongqing Medical University, No.1 Medical College Road, Chongqing, China
| | - Chao Wu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinglong Du
- College of Medical Informatics, Chongqing Medical University, No.1 Medical College Road, Chongqing, China
| | - Zhibo Xiao
- College of Medical Informatics, Chongqing Medical University, No.1 Medical College Road, Chongqing, China
| | - Furong Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanbing Liu
- College of Medical Informatics, Chongqing Medical University, No.1 Medical College Road, Chongqing, China.
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9
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Li J, Zhou H, Lu X, Wang Y, Pang H, Cesar D, Liu A, Zhou P. Preoperative prediction of cervical cancer survival using a high-resolution MRI-based radiomics nomogram. BMC Med Imaging 2023; 23:153. [PMID: 37821840 PMCID: PMC10568765 DOI: 10.1186/s12880-023-01111-5] [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: 05/12/2023] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Cervical cancer patients receiving radiotherapy and chemotherapy require accurate survival prediction methods. The objective of this study was to develop a prognostic analysis model based on a radiomics score to predict overall survival (OS) in cervical cancer patients. METHODS Predictive models were developed using data from 62 cervical cancer patients who underwent radical hysterectomy between June 2020 and June 2021. Radiological features were extracted from T2-weighted (T2W), T1-weighted (T1W), and diffusion-weighted (DW) magnetic resonance images prior to treatment. We obtained the radiomics score (rad-score) using least absolute shrinkage and selection operator (LASSO) regression and Cox's proportional hazard model. We divided the patients into low- and high-risk groups according to the critical rad-score value, and generated a nomogram incorporating radiological features. We evaluated the model's prediction performance using area under the receiver operating characteristic (ROC) curve (AUC) and classified the participants into high- and low-risk groups based on radiological characteristics. RESULTS The 62 patients were divided into high-risk (n = 43) and low-risk (n = 19) groups based on the rad-score. Four feature parameters were selected via dimensionality reduction, and the scores were calculated after modeling. The AUC values of ROC curves for prediction of 3- and 5-year OS using the model were 0.84 and 0.93, respectively. CONCLUSION Our nomogram incorporating a combination of radiological features demonstrated good performance in predicting cervical cancer OS. This study highlights the potential of radiomics analysis in improving survival prediction for cervical cancer patients. However, further studies on a larger scale and external validation cohorts are necessary to validate its potential clinical utility.
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Affiliation(s)
- Jia Li
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Hao Zhou
- Department of Cardiology, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaofei Lu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yiren Wang
- School of Nursing, Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Daniel Cesar
- Department of Gynecology Oncology, National Cancer Institute, Rio de Janeiro, Brazil
| | - Aiai Liu
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Ping Zhou
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Bizzarri N, Russo L, Dolciami M, Zormpas-Petridis K, Boldrini L, Querleu D, Ferrandina G, Pedone Anchora L, Gui B, Sala E, Scambia G. Radiomics systematic review in cervical cancer: gynecological oncologists' perspective. Int J Gynecol Cancer 2023; 33:1522-1541. [PMID: 37714669 DOI: 10.1136/ijgc-2023-004589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVE Radiomics is the process of extracting quantitative features from radiological images, and represents a relatively new field in gynecological cancers. Cervical cancer has been the most studied gynecological tumor for what concerns radiomics analysis. The aim of this study was to report on the clinical applications of radiomics combined and/or compared with clinical-pathological variables in patients with cervical cancer. METHODS A systematic review of the literature from inception to February 2023 was performed, including studies on cervical cancer analysing a predictive/prognostic radiomics model, which was combined and/or compared with a radiological or a clinical-pathological model. RESULTS A total of 57 of 334 (17.1%) screened studies met inclusion criteria. The majority of studies used magnetic resonance imaging (MRI), but positron emission tomography (PET)/computed tomography (CT) scan, CT scan, and ultrasound scan also underwent radiomics analysis. In apparent early-stage disease, the majority of studies (16/27, 59.3%) analysed the role of radiomics signature in predicting lymph node metastasis; six (22.2%) investigated the prediction of radiomics to detect lymphovascular space involvement, one (3.7%) investigated depth of stromal infiltration, and one investigated (3.7%) parametrial infiltration. Survival prediction was evaluated both in early-stage and locally advanced settings. No study focused on the application of radiomics in metastatic or recurrent disease. CONCLUSION Radiomics signatures were predictive of pathological and oncological outcomes, particularly if combined with clinical variables. These may be integrated in a model using different clinical-pathological and translational characteristics, with the aim to tailor and personalize the treatment of each patient with cervical cancer.
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Affiliation(s)
- Nicolò Bizzarri
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Russo
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Miriam Dolciami
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Konstantinos Zormpas-Petridis
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Boldrini
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Denis Querleu
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gabriella Ferrandina
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Pedone Anchora
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Benedetta Gui
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Evis Sala
- Department of Bioimaging, Radiation Oncology and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Scambia
- UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Wagner‐Larsen KS, Hodneland E, Fasmer KE, Lura N, Woie K, Bertelsen BI, Salvesen Ø, Halle MK, Smit N, Krakstad C, Haldorsen IS. MRI-based radiomic signatures for pretreatment prognostication in cervical cancer. Cancer Med 2023; 12:20251-20265. [PMID: 37840437 PMCID: PMC10652318 DOI: 10.1002/cam4.6526] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Accurate pretherapeutic prognostication is important for tailoring treatment in cervical cancer (CC). PURPOSE To investigate whether pretreatment MRI-based radiomic signatures predict disease-specific survival (DSS) in CC. STUDY TYPE Retrospective. POPULATION CC patients (n = 133) allocated into training(T) (nT = 89)/validation(V) (nV = 44) cohorts. FIELD STRENGTH/SEQUENCE T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) at 1.5T or 3.0T. ASSESSMENT Radiomic features from segmented tumors were extracted from T2WI and DWI (high b-value DWI and apparent diffusion coefficient (ADC) maps). STATISTICAL TESTS Radiomic signatures for prediction of DSS from T2WI (T2rad ) and T2WI with DWI (T2 + DWIrad ) were constructed by least absolute shrinkage and selection operator (LASSO) Cox regression. Area under time-dependent receiver operating characteristics curves (AUC) were used to evaluate and compare the prognostic performance of the radiomic signatures, MRI-derived maximum tumor size ≤/> 4 cm (MAXsize ), and 2018 International Federation of Gynecology and Obstetrics (FIGO) stage (I-II/III-IV). Survival was analyzed using Cox model estimating hazard ratios (HR) and Kaplan-Meier method with log-rank tests. RESULTS The radiomic signatures T2rad and T2 + DWIrad yielded AUCT /AUCV of 0.80/0.62 and 0.81/0.75, respectively, for predicting 5-year DSS. Both signatures yielded better or equal prognostic performance to that of MAXsize (AUCT /AUCV : 0.69/0.65) and FIGO (AUCT /AUCV : 0.77/0.64) and were significant predictors of DSS after adjusting for FIGO (HRT /HRV for T2rad : 4.0/2.5 and T2 + DWIrad : 4.8/2.1). Adding T2rad and T2 + DWIrad to FIGO significantly improved DSS prediction compared to FIGO alone in cohort(T) (AUCT 0.86 and 0.88 vs. 0.77), and FIGO with T2 + DWIrad tended to the same in cohort(V) (AUCV 0.75 vs. 0.64, p = 0.07). High radiomic score for T2 + DWIrad was significantly associated with reduced DSS in both cohorts. DATA CONCLUSION Radiomic signatures from T2WI and T2WI with DWI may provide added value for pretreatment risk assessment and for guiding tailored treatment strategies in CC.
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Affiliation(s)
- Kari S. Wagner‐Larsen
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of RadiologyHaukeland University HospitalBergenNorway
- Section for Radiology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Erlend Hodneland
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of RadiologyHaukeland University HospitalBergenNorway
- Department of MathematicsUniversity of BergenBergenNorway
| | - Kristine E. Fasmer
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of RadiologyHaukeland University HospitalBergenNorway
- Section for Radiology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Njål Lura
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of RadiologyHaukeland University HospitalBergenNorway
- Section for Radiology, Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Kathrine Woie
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
| | | | - Øyvind Salvesen
- Clinical Research Unit, Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | - Mari K. Halle
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
- Centre for Cancer Biomarkers (CCBIO), Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Noeska Smit
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of RadiologyHaukeland University HospitalBergenNorway
- Department of InformaticsUniversity of BergenBergenNorway
| | - Camilla Krakstad
- Department of Obstetrics and GynecologyHaukeland University HospitalBergenNorway
- Centre for Cancer Biomarkers (CCBIO), Department of Clinical ScienceUniversity of BergenBergenNorway
| | - Ingfrid S. Haldorsen
- Mohn Medical Imaging and Visualization Centre (MMIV), Department of RadiologyHaukeland University HospitalBergenNorway
- Section for Radiology, Department of Clinical MedicineUniversity of BergenBergenNorway
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Zhou Y, Song L, Xia J, Liu H, Xing J, Gao J. Radiomics model based on contrast-enhanced CT texture features for pretreatment prediction of overall survival in esophageal neuroendocrine carcinoma. Front Oncol 2023; 13:1225180. [PMID: 37664013 PMCID: PMC10473874 DOI: 10.3389/fonc.2023.1225180] [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: 05/18/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Background Limited studies have observed the prognostic value of CT images for esophageal neuroendocrine carcinoma (NEC) due to rare incidence and low treatment experience in clinical. In this study, the pretreatment enhanced CT texture features and clinical characteristics were investigated to predict the overall survival of esophageal NEC. Methods This retrospective study included 89 patients with esophageal NEC. The training and testing cohorts comprised 61 (70%) and 28 (30%) patients, respectively. A total of 402 radiomics features were extracted from the tumor region that segmented pretreatment venous phase CT images. The least absolute shrinkage and selection operator (LASSO) Cox regression was applied to feature dimension reduction, feature selection, and radiomics signature construction. A radiomics nomogram was constructed based on the radiomics signature and clinical risk factors using a multivariable Cox proportional regression. The performance of the nomogram for the pretreatment prediction of overall survival (OS) was evaluated for discrimination and calibration. Results Only the enhancement degree was an independent factor in clinical variable influenced OS. The radiomics signatures demonstrated good predictability for prognostic status discrimination. The radiomics nomogram integrating texture signatures was slightly superior to the nomogram derived from the combined model with a C-index of 0.844 (95%CI: 0.783-0.905) and 0.847 (95% CI: 0.782-0.912) in the training set, and 0.805 (95%CI: 0.707-0.903) and 0.745 (95% CI: 0.639-0.851) in the testing set, respectively. Conclusion The radiomics nomogram based on pretreatment CT radiomics signature had better prognostic power and predictability of the overall survival in patients with esophageal NEC than the model using combined variables.
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Affiliation(s)
- Yue Zhou
- Department of Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijie Song
- Department of Oncology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Xia
- Department of Oncology, Anyang Tumor Hospital, Anyang, China
| | - Huan Liu
- Advanced Analytics Team, GE Healthcare, Shanghai, China
| | - Jingjing Xing
- Department of Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianbo Gao
- Department of Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Liu S, Zhou Y, Wang C, Shen J, Zheng Y. Prediction of lymph node status in patients with early-stage cervical cancer based on radiomic features of magnetic resonance imaging (MRI) images. BMC Med Imaging 2023; 23:101. [PMID: 37528338 PMCID: PMC10392004 DOI: 10.1186/s12880-023-01059-6] [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: 01/18/2023] [Accepted: 07/19/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Lymph node metastasis is an important factor affecting the treatment and prognosis of patients with cervical cancer. However, the comparison of different algorithms and features to predict lymph node metastasis is not well understood. This study aimed to construct a non-invasive model for predicting lymph node metastasis in patients with cervical cancer based on clinical features combined with the radiomic features of magnetic resonance imaging (MRI) images. METHODS A total of 180 cervical cancer patients were divided into the training set (n = 126) and testing set (n = 54). In this cross-sectional study, radiomic features of MRI images and clinical features of patients were collected. The least absolute shrinkage and selection operator (LASSO) regression was used to filter the features. Seven machine learning methods, including eXtreme Gradient Boosting (XGBoost), Logistic Regression, Multinomial Naive Bayes (MNB), Support Vector Machine (SVM), Decision Tree, Random Forest, and Gradient Boosting Decision Tree (GBDT) are used to build the models. Receiver operating characteristics (ROC) curve and area under the curve (AUC), accuracy, sensitivity, and specificity were calculated to assess the performance of the models. RESULTS Of these 180 patients, 49 (27.22%) patients had lymph node metastases. Five of the 122 radiomic features and 3 clinical features were used to build predictive models. Compared with other models, the MNB model was the most robust, with its AUC, specificity, and accuracy on the testing set of 0.745 (95%CI: 0.740-0.750), 0.900 (95%CI: 0.807-0.993), and 0.778 (95%CI: 0.667-0.889), respectively. Furthermore, the AUCs of the MNB models with clinical features only, radiomic features only, and combined features were 0.698 (95%CI: 0.692-0.704), 0.632 (95%CI: 0.627-0.637), and 0.745 (95%CI: 0.740-0.750), respectively. CONCLUSION The MNB model, which combines the radiomic features of MRI images with the clinical features of the patient, can be used as a non-invasive tool for the preoperative assessment of lymph node metastasis.
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Affiliation(s)
- Shuyu Liu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Bengbu Medical College, No.287 Changhuai Road, Longzihu District, Bengbu, Anhui, 233004, China
| | - Yu Zhou
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Bengbu Medical College, No.287 Changhuai Road, Longzihu District, Bengbu, Anhui, 233004, China
| | - Caizhi Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Bengbu Medical College, No.287 Changhuai Road, Longzihu District, Bengbu, Anhui, 233004, China
| | - Junjie Shen
- Department of Radiology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, 233004, China
| | - Yi Zheng
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Bengbu Medical College, No.287 Changhuai Road, Longzihu District, Bengbu, Anhui, 233004, China.
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Jha AK, Mithun S, Sherkhane UB, Jaiswar V, Osong B, Purandare N, Kannan S, Prabhash K, Gupta S, Vanneste B, Rangarajan V, Dekker A, Wee L. Systematic review and meta-analysis of prediction models used in cervical cancer. Artif Intell Med 2023; 139:102549. [PMID: 37100501 DOI: 10.1016/j.artmed.2023.102549] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 11/18/2022] [Accepted: 04/04/2023] [Indexed: 04/28/2023]
Abstract
BACKGROUND Cervical cancer is one of the most common cancers in women with an incidence of around 6.5 % of all the cancer in women worldwide. Early detection and adequate treatment according to staging improve the patient's life expectancy. Outcome prediction models might aid treatment decisions, but a systematic review on prediction models for cervical cancer patients is not available. DESIGN We performed a systematic review for prediction models in cervical cancer following PRISMA guidelines. Key features that were used for model training and validation, the endpoints were extracted from the article and data were analyzed. Selected articles were grouped based on prediction endpoints i.e. Group1: Overall survival, Group2: progression-free survival; Group3: recurrence or distant metastasis; Group4: treatment response; Group5: toxicity or quality of life. We developed a scoring system to evaluate the manuscript. As per our criteria, studies were divided into four groups based on scores obtained in our scoring system, the Most significant study (Score > 60 %); Significant study (60 % > Score > 50 %); Moderately Significant study (50 % > Score > 40 %); least significant study (score < 40 %). A meta-analysis was performed for all the groups separately. RESULTS The first line of search selected 1358 articles and finally 39 articles were selected as eligible for inclusion in the review. As per our assessment criteria, 16, 13 and 10 studies were found to be the most significant, significant and moderately significant respectively. The intra-group pooled correlation coefficient for Group1, Group2, Group3, Group4, and Group5 were 0.76 [0.72, 0.79], 0.80 [0.73, 0.86], 0.87 [0.83, 0.90], 0.85 [0.77, 0.90], 0.88 [0.85, 0.90] respectively. All the models were found to be good (prediction accuracy [c-index/AUC/R2] >0.7) in endpoint prediction. CONCLUSIONS Prediction models of cervical cancer toxicity, local or distant recurrence and survival prediction show promising results with reasonable prediction accuracy [c-index/AUC/R2 > 0.7]. These models should also be validated on external data and evaluated in prospective clinical studies.
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Affiliation(s)
- Ashish Kumar Jha
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India.
| | - Sneha Mithun
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Umeshkumar B Sherkhane
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands; Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Vinay Jaiswar
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Biche Osong
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Nilendu Purandare
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sadhana Kannan
- Homi Bhabha National Institute, Mumbai, Maharashtra, India; Advance Centre for Treatment, Research, Education in Cancer, Mumbai, Maharashtra, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India; Advance Centre for Treatment, Research, Education in Cancer, Mumbai, Maharashtra, India
| | - Ben Vanneste
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Venkatesh Rangarajan
- Department of Nuclear Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India; Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Andre Dekker
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Leonard Wee
- Department of Radiation Oncology (Maastro), GROW School for Oncology, Maastricht University Medical Centre+, Maastricht, the Netherlands
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Huang Q, Deng B, Wang Y, Shen Y, Hu X, Feng C, Li Z. Reduced field-of-view DWI‑derived clinical-radiomics model for the prediction of stage in cervical cancer. Insights Imaging 2023; 14:18. [PMID: 36701003 PMCID: PMC9880109 DOI: 10.1186/s13244-022-01346-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/08/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Pretreatment prediction of stage in patients with cervical cancer (CC) is vital for tailoring treatment strategy. This study aimed to explore the feasibility of a model combining reduced field-of-view (rFOV) diffusion-weighted imaging (DWI)-derived radiomics with clinical features in staging CC. METHODS Patients with pathologically proven CC were enrolled in this retrospective study. The rFOV DWI with b values of 0 and 800 s/mm2 was acquired and the clinical characteristics of each patient were collected. Radiomics features were extracted from the apparent diffusion coefficient maps and key features were selected subsequently. A clinical-radiomics model combining radiomics with clinical features was constructed. The receiver operating characteristic curve was introduced to evaluate the predictive efficacy of the model, followed by comparisons with the MR-based subjective stage assessment (radiological model). RESULTS Ninety-four patients were analyzed and divided into training (n = 61) and testing (n = 33) cohorts. In the training cohort, the area under the curve (AUC) of clinical-radiomics model (AUC = 0.877) for staging CC was similar to that of radiomics model (AUC = 0.867), but significantly higher than that of clinical model (AUC = 0.673). In the testing cohort, the clinical-radiomics model yielded the highest predictive performance (AUC = 0.887) of staging CC, even without a statistically significant difference when compared with the clinical model (AUC = 0.793), radiomics model (AUC = 0.846), or radiological model (AUC = 0.823). CONCLUSIONS The rFOV DWI-derived clinical-radiomics model has the potential for staging CC, thereby facilitating clinical decision-making.
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Affiliation(s)
- Qiuhan Huang
- grid.412793.a0000 0004 1799 5032Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Baodi Deng
- grid.412793.a0000 0004 1799 5032Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Yanchun Wang
- grid.412793.a0000 0004 1799 5032Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Yaqi Shen
- grid.412793.a0000 0004 1799 5032Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Xuemei Hu
- grid.412793.a0000 0004 1799 5032Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Cui Feng
- grid.412793.a0000 0004 1799 5032Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
| | - Zhen Li
- grid.412793.a0000 0004 1799 5032Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan, 430030 China
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Radiomics Signature Using Manual Versus Automated Segmentation for Lymph Node Staging of Bladder Cancer. Eur Urol Focus 2023; 9:145-153. [PMID: 36115774 DOI: 10.1016/j.euf.2022.08.015] [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: 06/08/2022] [Revised: 07/26/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Bladder cancer (BC) treatment algorithms depend on accurate tumor staging. To date, computed tomography (CT) is recommended for assessment of lymph node (LN) metastatic spread in muscle-invasive and high-risk BC. However, the diagnostic efficacy of radiologist-evaluated CT imaging studies is limited. OBJECTIVE To evaluate the performance of quantitative radiomics signatures for detection of LN metastases in BC. DESIGN, SETTING, AND PARTICIPANTS Of 1354 patients with BC who underwent radical cystectomy (RC) with lymphadenectomy who were screened, 391 with pathological nodal staging (pN0: n = 297; pN+: n = 94) were included and randomized into training (n = 274) and test (n = 117) cohorts. Pelvic LNs were segmented manually and automatically. A total of 1004 radiomics features were extracted from each LN and a machine learning model was trained to assess pN status using histopathology labels as the ground truth. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Radiologist assessment was compared to radiomics-based analysis using manual and automated LN segmentations for detection of LN metastases in BC. Statistical analysis was performed using the receiver operating characteristics curve method and evaluated in terms of sensitivity, specificity, and area under the curve (AUC). RESULTS AND LIMITATIONS In total, 1845 LNs were manually segmented. Automated segmentation correctly located 361/557 LNs in the test cohort. Manual and automatic masks achieved an AUC of 0.80 (95% confidence interval [CI] 0.69-0.91; p = 0.64) and 0.70 (95% CI: 0.58-0.82; p = 0.17), respectively, in the test cohort compared to radiologist assessment, with an AUC of 0.78 (95% CI 0.67-0.89). A combined model of a manually segmented radiomics signature and radiologist assessment reached an AUC of 0.81 (95% CI 0.71-0.92; p = 0.63). CONCLUSIONS A radiomics signature allowed discrimination of nodal status with high diagnostic accuracy. The model based on manual LN segmentation outperformed the fully automated approach. PATIENT SUMMARY For patients with bladder cancer, evaluation of computed tomography (CT) scans before surgery using a computer-based method for image analysis, called radiomics, may help in standardizing and improving the accuracy of assessment of lymph nodes. This could be a valuable tool for optimizing treatment options.
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Li Y, Gao X, Tang X, Lin S, Pang H. Research on automatic classification technology of kidney tumor and normal kidney tissue based on computed tomography radiomics. Front Oncol 2023; 13:1013085. [PMID: 36910615 PMCID: PMC9998940 DOI: 10.3389/fonc.2023.1013085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Purpose By using a radiomics-based approach, multiple radiomics features can be extracted from regions of interest in computed tomography (CT) images, which may be applied to automatically classify kidney tumors and normal kidney tissues. The study proposes a method based on CT radiomics and aims to use extracted radiomics features to automatically classify of kidney tumors and normal kidney tissues and to establish an automatic classification model. Methods CT data were retrieved from the 2019 Kidney and Kidney Tumor Segmentation Challenge (KiTS19) in The Cancer Imaging Archive (TCIA) open access database. Arterial phase-enhanced CT images from 210 cases were used to establish an automatic classification model. These CT images of patients were randomly divided into training (168 cases) and test (42 cases) sets. Furthermore, the radiomics features of gross tumor volume (GTV) and normal kidney tissues in the training set were extracted and screened, and a binary logistic regression model was established. For the test set, the radiomic features and cutoff value of P were consistent with the training set. Results Three radiomics features were selected to establish the binary logistic regression model. The accuracy (ACC), sensitivity (SENS), specificity (SPEC), area under the curve (AUC), and Youden index of the training and test sets based on the CT radiomics classification model were all higher than 0.85. Conclusion The automatic classification model of kidney tumors and normal kidney tissues based on CT radiomics exhibited good classification ability. Kidney tumors could be distinguished from normal kidney tissues. This study may complement automated tumor delineation techniques and warrants further research.
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Affiliation(s)
- Yunfei Li
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xinrui Gao
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xuemei Tang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Sheng Lin
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Haowen Pang
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Qian W, Li Z, Chen W, Yin H, Zhang J, Xu J, Hu C. RESOLVE-DWI-based deep learning nomogram for prediction of normal-sized lymph node metastasis in cervical cancer: a preliminary study. BMC Med Imaging 2022; 22:221. [PMID: 36528577 PMCID: PMC9759891 DOI: 10.1186/s12880-022-00948-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND It is difficult to predict normal-sized lymph node metastasis (LNM) in cervical cancer clinically. We aimed to investigate the feasibility of using deep learning (DL) nomogram based on readout segmentation of long variable echo-trains diffusion weighted imaging (RESOLVE-DWI) and related patient information to preoperatively predict normal-sized LNM in patients with cervical cancer. METHODS A dataset of MR images [RESOLVE-DWI and apparent diffusion coefficient (ADC)] and patient information (age, tumor size, International Federation of Gynecology and Obstetrics stage, ADC value and squamous cell carcinoma antigen level) of 169 patients with cervical cancer between November 2013 and January 2022 were retrospectively collected. The LNM status was determined by final histopathology. The collected studies were randomly divided into a development cohort (n = 126) and a test cohort (n = 43). A single-channel convolutional neural network (CNN) and a multi-channel CNN based on ResNeSt architectures were proposed for predicting normal-sized LNM from single or multi modalities of MR images, respectively. A DL nomogram was constructed by incorporating the clinical information and the multi-channel CNN. These models' performance was analyzed by the receiver operating characteristic analysis in the test cohort. RESULTS Compared to the single-channel CNN model using RESOLVE-DWI and ADC respectively, the multi-channel CNN model that integrating both two MR modalities showed improved performance in development cohort [AUC 0.848; 95% confidence interval (CI) 0.774-0.906] and test cohort (AUC 0.767; 95% CI 0.613-0.882). The DL nomogram showed the best performance in development cohort (AUC 0.890; 95% CI 0.821-0.938) and test cohort (AUC 0.844; 95% CI 0.701-0.936). CONCLUSION The DL nomogram incorporating RESOLVE-DWI and clinical information has the potential to preoperatively predict normal-sized LNM of cervical cancer.
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Affiliation(s)
- Weiliang Qian
- grid.429222.d0000 0004 1798 0228Department of Radiology, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, 215006 Jiangsu People’s Republic of China ,grid.89957.3a0000 0000 9255 8984Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, No.26 Daoqian Street, Suzhou, 215002 Jiangsu People’s Republic of China
| | - Zhisen Li
- grid.89957.3a0000 0000 9255 8984Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, No.26 Daoqian Street, Suzhou, 215002 Jiangsu People’s Republic of China
| | - Weidao Chen
- grid.507939.1Beijing Infervision Technology Co., Ltd, No.60 Dongsihuan Middle Road, Chaoyang District, Beijing, 100020 People’s Republic of China
| | - Hongkun Yin
- grid.507939.1Beijing Infervision Technology Co., Ltd, No.60 Dongsihuan Middle Road, Chaoyang District, Beijing, 100020 People’s Republic of China
| | - Jibin Zhang
- grid.89957.3a0000 0000 9255 8984Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, No.26 Daoqian Street, Suzhou, 215002 Jiangsu People’s Republic of China
| | - Jianming Xu
- grid.89957.3a0000 0000 9255 8984Department of Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, No.26 Daoqian Street, Suzhou, 215002 Jiangsu People’s Republic of China
| | - Chunhong Hu
- grid.429222.d0000 0004 1798 0228Department of Radiology, The First Affiliated Hospital of Soochow University, No.188 Shizi Street, Suzhou, 215006 Jiangsu People’s Republic of China
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Liu X, Tian J, Wu J, Zhang Y, Wang X, Zhang X, Wang X. Utility of diffusion weighted imaging-based radiomics nomogram to predict pelvic lymph nodes metastasis in prostate cancer. BMC Med Imaging 2022; 22:190. [DOI: 10.1186/s12880-022-00905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background
Preoperative pelvic lymph node metastasis (PLNM) prediction can help clinicians determine whether to perform pelvic lymph node dissection (PLND). The purpose of this research is to explore the feasibility of diffusion-weighted imaging (DWI)-based radiomics for preoperative PLNM prediction in PCa patients at the nodal level.
Methods
The preoperative MR images of 1116 pathologically confirmed lymph nodes (LNs) from 84 PCa patients were enrolled. The subjects were divided into a primary cohort (67 patients with 192 positive and 716 negative LNs) and a held-out cohort (17 patients with 43 positive and 165 negative LNs) at a 4:1 ratio. Two preoperative pelvic lymph node metastasis (PLNM) prediction models were constructed based on automatic LN segmentation with quantitative radiological LN features alone (Model 1) and combining radiological and radiomics features (Model 2) via multiple logistic regression. The visual assessments of junior (Model 3) and senior (Model 4) radiologists were compared.
Results
No significant difference was found between the area under the curve (AUCs) of Models 1 and 2 (0.89 vs. 0.90; P = 0.573) in the held-out cohort. Model 2 showed the highest AUC (0.83, 95% CI 0.76, 0.89) for PLNM prediction in the LN subgroup with a short diameter ≤ 10 mm compared with Model 1 (0.78, 95% CI 0.70, 0.84), Model 3 (0.66, 95% CI 0.52, 0.77), and Model 4 (0.74, 95% CI 0.66, 0.88). The nomograms of Models 1 and 2 yielded C-index values of 0.804 and 0.910, respectively, in the held-out cohort. The C-index of the nomogram analysis (0.91) and decision curve analysis (DCA) curves confirmed the clinical usefulness and benefit of Model 2.
Conclusions
A DWI-based radiomics nomogram incorporating the LN radiomics signature with quantitative radiological features is promising for PLNM prediction in PCa patients, particularly for normal-sized LNM.
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Xiao ML, Wei Y, Zhang J, Jian JM, Song Y, Lin ZJ, Qian L, Zhang GF, Qiang JW. MRI Texture Analysis for Preoperative Prediction of Lymph Node Metastasis in Patients with Nonsquamous Cell Cervical Carcinoma. Acad Radiol 2022; 29:1661-1671. [PMID: 35151550 DOI: 10.1016/j.acra.2022.01.005] [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: 11/16/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES To preoperatively predict lymph node metastasis (LNM) in patients with cervical nonsquamous cell carcinoma (non-SCC) based on magnetic resonance imaging (MRI) texture analysis. MATERIALS AND METHODS This retrospective study included 104 consecutive patients (mean age of 47.2 ± 11.3 years) with stage IB-IIA cervical non-SCC. According to the ratio of 7:3, 72, and 32 patients were randomly divided into the training and testing cohorts. A total of 272 original features were extracted. In the process of feature selection, features with intraclass correlation coefficients (ICCs) less than 0.8 were eliminated. The Pearson correlation coefficient (PCC) and analysis of variance (ANOVA) were applied to reduce redundancy, overfitting, and selection biases. Further, a support vector machine (SVM) with linear kernel function was applied to select the optimal feature set with a high discrimination power. RESULTS The T2WI + DWI-based, T2WI + DWI + CE-T1WI-based and T2WI + DWI + LNS-MRI (LN status on MRI)-based SVM models yielded an AUC and accuracy of 0.78 and 0.79; 0.79 and 0.69; 0.79 and 0.81 for predicting LNM in the training cohort, and 0.82 and 0.78; 0.82 and 0.69; 0.79 and 0.72 in the testing cohort. The T2WI + DWI-based, T2WI + DWI + CE-T1WI-based and T2WI + DWI + LNS-MRI-based SVM models performed better than morphologic criteria of LNS-MRI and yield similar discrimination abilities in predicting LNM in the training and testing cohorts (all p-value > 0.05). In addition, the T2WI + DWI-based and T2WI + DWI + LNS-MRI-based SVM models showed robust performance in the AC and ASC subgroups (all p-value > 0.05). CONCLUSION The T2WI + DWI-based, T2WI + DWI + CE-T1WI-based and T2WI+DWI+LNS-MRI-based SVM models showed similar good discrimination ability and performed better than the morphologic criteria of LNS-MRI in predicting LNM in patients with cervical non-SCC. The inclusion of the CE-T1WI sequence and morphologic criteria of LNS-MRI did not significantly improve the performance of the T2WI + DWI-based model. The T2WI + DWI-based and T2WI + DWI + LNS-MRI-based SVM models showed robust performance in the subgroup analysis.
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Affiliation(s)
- Mei Ling Xiao
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China; Departments of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Yan Wei
- Department of Automation, Zhejiang University of Technology, Hangzhou, China
| | - Jing Zhang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, China
| | - Jun Ming Jian
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Yang Song
- MR Scientific Marketing, Siemens Healthineers, Shanghai, China
| | - Zi Jing Lin
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China
| | - Lan Qian
- Departments of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Guo Fu Zhang
- Departments of Radiology, Obstetrics & Gynecology Hospital, Fudan University, Shanghai, China
| | - Jin Wei Qiang
- Department of Radiology, Jinshan Hospital, Fudan University, Shanghai, China.
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Ciulla S, Celli V, Aiello AA, Gigli S, Ninkova R, Miceli V, Ercolani G, Dolciami M, Ricci P, Palaia I, Catalano C, Manganaro L. Post treatment imaging in patients with local advanced cervical carcinoma. Front Oncol 2022; 12:1003930. [PMID: 36465360 PMCID: PMC9710522 DOI: 10.3389/fonc.2022.1003930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/26/2022] [Indexed: 10/29/2023] Open
Abstract
Cervical cancer (CC) is the fourth leading cause of death in women worldwide and despite the introduction of screening programs about 30% of patients presents advanced disease at diagnosis and 30-50% of them relapse in the first 5-years after treatment. According to FIGO staging system 2018, stage IB3-IVA are classified as locally advanced cervical cancer (LACC); its correct therapeutic choice remains still controversial and includes neoadjuvant chemo-radiotherapy, external beam radiotherapy, brachytherapy, hysterectomy or a combination of these modalities. In this review we focus on the most appropriated therapeutic options for LACC and imaging protocols used for its correct follow-up. We explore the imaging findings after radiotherapy and surgery and discuss the role of imaging in evaluating the response rate to treatment, selecting patients for salvage surgery and evaluating recurrence of disease. We also introduce and evaluate the advances of the emerging imaging techniques mainly represented by spectroscopy, PET-MRI, and radiomics which have improved diagnostic accuracy and are approaching to future direction.
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Affiliation(s)
- S Ciulla
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Celli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - A A Aiello
- Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - S Gigli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - R Ninkova
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - V Miceli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - G Ercolani
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - M Dolciami
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - P Ricci
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - I Palaia
- Department of Maternal and Child Health and Urological Sciences, Sapienza, University of Rome, Rome, Italy
| | - C Catalano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
| | - L Manganaro
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, Italy
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22
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Xia X, Li D, Du W, Wang Y, Nie S, Tan Q, Gou Q. Radiomics Based on Nomogram Predict Pelvic Lymphnode Metastasis in Early-Stage Cervical Cancer. Diagnostics (Basel) 2022; 12:diagnostics12102446. [PMID: 36292135 PMCID: PMC9600299 DOI: 10.3390/diagnostics12102446] [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: 09/01/2022] [Revised: 09/23/2022] [Accepted: 10/06/2022] [Indexed: 12/09/2022] Open
Abstract
The accurate prediction of the status of PLNM preoperatively plays a key role in treatment strategy decisions in early-stage cervical cancer. The aim of this study was to develop and validate a radiomics-based nomogram for the preoperative prediction of pelvic lymph node metastatic status in early-stage cervical cancer. One hundred fifty patients were enrolled in this study. Radiomics features were extracted from T2-weighted MRI imaging (T2WI). Based on the selected features, a support vector machine (SVM) algorithm was used to build the radiomics signature. The radiomics-based nomogram was developed incorporating radiomics signature and clinical risk factors. In the training cohort (AUC = 0.925, accuracy = 81.6%, sensitivity = 70.3%, and specificity = 92.0%) and the testing cohort (AUC = 0.839, accuracy = 74.2%, sensitivity = 65.7%, and specificity = 82.8%), clinical models that combine stromal invasion depth, FIGO stage, and MTD perform poorly. The combined model had the highest AUC in the training cohort (AUC = 0.988, accuracy = 95.9%, sensitivity = 92.0%, and specificity = 100.0%) and the testing cohort (AUC = 0.922, accuracy = 87.1%, sensitivity = 85.7%, and specificity = 88.6%) when compared to the radiomics and clinical models. The study may provide valuable guidance for clinical physicians regarding the treatment strategies for early-stage cervical cancer patients.
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Affiliation(s)
- Xueming Xia
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Radiotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Dongdong Li
- Department of Network Engineering, School of Computer Science and Engineering, South China University of Technology, Guangzhou 510641, China
| | - Wei Du
- Department of Radiotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yu Wang
- Department of Radiology, The Affiliated Hospital of Southwest Medical University, Luzhou 402103, China
| | - Shihong Nie
- Department of Radiotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiaoyue Tan
- Department of Radiotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiheng Gou
- Department of Head and Neck Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Department of Radiotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, China
- Correspondence:
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23
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Ren K, Shen L, Qiu J, Sun K, Chen T, Xuan L, Yang M, She HY, Shen L, Zhu H, Deng L, Jing D, Shi L. Treatment planning computed tomography radiomics for predicting treatment outcomes and haematological toxicities in locally advanced cervical cancer treated with radiotherapy: A retrospective cohort study. BJOG 2022; 130:222-230. [PMID: 36056595 DOI: 10.1111/1471-0528.17285] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/08/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We evaluated whether radiomic features extracted from planning computed tomography (CT) scans predict clinical end points in patients with locally advanced cervical cancer (LACC) undergoing intensity-modulated radiation therapy and brachytherapy. DESIGN A retrospective cohort study. SETTING Xiangya Hospital of Central South University, Changsha, Hunan, China. POPULATION Two hundred and fifty-seven LACC patients who were treated with intensity-modulated radiotherapy from 2014 to 2017. METHODS Patients were allocated into the training/validation sets (3:1 ratio) using proportional random sampling, resulting in the same proportion of groups in the two sets. We extracted 254 radiomic features from each of the gross target volume, pelvis and sacral vertebrae. The sequentially backward elimination support vector machine algorithm was used for feature selection and end point prediction. MAIN OUTCOMES AND MEASURES Clinical end points include tumour complete response (CR), 5-year overall survival (OS), anaemia, and leucopenia. RESULTS A combination of ten clinicopathological parameters and 34 radiomic features performed best for predicting CR (validation balanced accuracy: 80.8%). The validation balanced accuracy of 54 radiomic features was 85.8% for OS, and their scores can stratify patients into the low-risk and high-risk groups (5-year OS: 95.5% versus 36.4%, p < 0.001). The clinical and radiomic models were also predictive of anaemia and leucopenia (validation balanced accuracies: 71.0% and 69.9%). CONCLUSION This study demonstrated that combining clinicopathological parameters with CT-based radiomics may have value for predicting clinical end points in LACC. If validated, this model may guide therapeutic strategy to optimise the effectiveness and minimise toxicity or treatment for LACC.
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Affiliation(s)
- Kang Ren
- Department of Oncology, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.,Department of Radiation Oncology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Lin Shen
- Department of Oncology, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jianfeng Qiu
- Medical Science and Technology Innovation Centre, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Kui Sun
- Medical Science and Technology Innovation Centre, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, China
| | - Tingyin Chen
- Department of Network and Information Centre, Xiangya Hospital, Central South University, Changsha, China
| | - Long Xuan
- XiangYa School of Life Medicine, Central South University, Changsha, China
| | - Minwu Yang
- Xiangya School of Stomatology, Central South University, Changsha, China
| | - Hao-Yuan She
- School of Life Science, Central South University, Changsha, China
| | - Liangfang Shen
- Department of Oncology, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Hong Zhu
- Department of Oncology, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lan Deng
- Hunan Polytechnic of Environment and Biology, Hengyang, China
| | - Di Jing
- Department of Oncology, National Clinical Research Centre for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Liting Shi
- Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China
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Zhang Y, Zhang KY, Jia HD, Fang X, Lin TT, Wei C, Qian LT, Dong JN. Feasibility of Predicting Pelvic Lymph Node Metastasis Based on IVIM-DWI and Texture Parameters of the Primary Lesion and Lymph Nodes in Patients with Cervical Cancer. Acad Radiol 2022; 29:1048-1057. [PMID: 34654623 DOI: 10.1016/j.acra.2021.08.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/22/2021] [Accepted: 08/27/2021] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate the feasibility and value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and texture parameters of primary lesions and lymph nodes for predicting pelvic lymph node metastasis in patients with cervical cancer. MATERIALS AND METHODS A total of 143 patients with cervical cancer confirmed by surgical pathology were analyzed retrospectively and 125 patients were enrolled in primary lesions study, 83 patients and 134 lymph nodes were enrolled in lymph nodes study. Patients and lymph nodes were randomly divided into training group and test group at a ratio of 2: 1. The IVIM-DWI parameters and 3D texture features of primary lesions and lymph nodes of all patients were measured. The least absolute shrinkage and selection operator algorithm, spearman's correlation analysis, independent two-sample t-test and Mann-Whitney U-test were used to select texture parameters. Multivariate Logistic regression analysis and receiver operating characteristic curves were used to model and evaluate diagnostic performances. RESULTS In primary lesions study, model 1 was constructed by combining f value, original_shape_Sphericity and original_firstorder_Mean of primary lesions. In lymph nodes study, model 2 was constructed by combining short diameter, circular enhancement and rough margin of lymph nodes. Model 3 was constructed by combining ADC, f value and original_glszm_Small Area Emphasis of lymph nodes. The areas under curve of model 1, 2 and 3 in training group and test group were 0.882, 0.798, 0.907 and 0.862, 0.771, 0.937 respectively. CONCLUSION Models based on IVIM-DWI and texture parameters of primary lesions and lymph nodes both performed well in diagnosing pelvic lymph node metastasis of cervical cancer and were superior to morphological features of lymph nodes. Especially, parameters of lymph nodes showed higher diagnostic efficiency and clinical significance.
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Yang S, Liu C, Li C, Hua K. Nomogram Predicting Lymph Node Metastasis in the Early-Stage Cervical Cancer. Front Med (Lausanne) 2022; 9:866283. [PMID: 35847788 PMCID: PMC9280490 DOI: 10.3389/fmed.2022.866283] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background Accurately predicting the risk level of lymph node metastasis is essential for the treatment of patients with early cervical cancer. The purpose of this study is to construct a new nomogram based on 2-deoxy-2-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and clinical characteristics to assess early-stage cervical cancer patients’ risk of lymph node metastasis. Materials and Methods From January 2019 to November 2020, the records of 234 patients with stage IA-IIA [International Federation of Gynecology and Obstetrics (FIGO) 2018] cervical cancer who had undergone PET/CT examination within 30 days before surgery were retrospectively reviewed. A nomogram to predict the risk of lymph node metastasis was constructed based on it. The nomogram was developed and validated by internal and external validation. The validation cohorts included 191 cervical cancer patients from December 2020 to October 2021. Results Four factors [squamous cell carcinoma associated antigen (SCCA), maximum standardized uptake value of lymph node (nSUVmax), uterine corpus invasion in PET/CT and tumor size in PET/CT] were finally determined as the predictors of the nomogram. At the area under the receiver operating characteristic curve cohort was 0.926 in the primary and was 0.897 in the validation cohort. The calibration curve shows good agreement between the predicted probability and the actual probability. The decision curve analysis showed the clinical utility of the nomogram. Conclusion We had established and verified a simple and effective nomogram, which can be used to predict the lymph node metastasis of cervical cancer patients before surgery.
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Affiliation(s)
- Shimin Yang
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Chunli Liu
- Shanghai Universal Medical Imaging Diagnostic Center, Shanghai, China
| | - Chunbo Li
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- *Correspondence: Chunbo Li,
| | - Keqin Hua
- Department of Obstetrics and Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
- Keqin Hua,
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26
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Wang W, Jiao Y, Zhang L, Fu C, Zhu X, Wang Q, Gu Y. Multiparametric MRI-based radiomics analysis: differentiation of subtypes of cervical cancer in the early stage. Acta Radiol 2022; 63:847-856. [PMID: 33975448 DOI: 10.1177/02841851211014188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are significant differences in outcomes for different histological subtypes of cervical cancer (CC). Yet, it is difficult to distinguish CC subtypes using non-invasive methods. PURPOSE To investigate whether multiparametric magnetic resonance imaging (MRI)-based radiomics analysis can differentiate CC subtypes and explore tumor heterogeneity. MATERIAL AND METHODS This study retrospectively analyzed 96 patients with CC (squamous cell carcinoma [SCC] = 50, adenocarcinoma [AC] = 46) who underwent pelvic MRI before surgery. Radiomics features were extracted from the tumor volumes on five sequences (sagittal T2-weighted imaging [T2SAG], transverse T2-weighted imaging [T2TRA], sagittal contrast-enhanced T1-weighted imaging [CESAG], transverse contrast-enhanced T1-weighted imaging [CETRA], and apparent diffusion coefficient [ADC]). Clustering and logistic regression were used to examine the distinguishing capabilities of radiomics features extracted from five different MR sequences. RESULTS Among the 105 extracted radiomics features, there were 51, 38, 37, and 2 features that showed intergroup differences for T2SAG, T2TRA, ADC, and CESAG, respectively (all P < 0.05). AC had greater textural heterogeneity than SCC (P < 0.05). Upon unsupervised clustering of significantly different features, T2SAG achieved the highest accuracy (0.844; sensitivity = 0.920; specificity = 0.761). The largest area under the curve (AUC) for classification ability was 0.86 for T2SAG. Hence, the radiomics model from five combined MR sequences (AUC = 0.89; accuracy = 0.81; sensitivity = 0.67; specificity = 0.94) exhibited better differentiation ability than any MR sequence alone. CONCLUSION Multiparametric MRI-based radiomics models may be a promising method to differentiate AC and SCC. AC showed more heterogeneous features than SCC.
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Affiliation(s)
- Wei Wang
- Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
| | - YiNing Jiao
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, PR China
| | - LiChi Zhang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, PR China
| | - Caixia Fu
- MR Applications Development, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, PR China
| | - XiaoLi Zhu
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
- Department of Pathology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, PR China
| | - Qian Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, PR China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, PR China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, PR China
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27
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Hou X, Shen G, Zhou L, Li Y, Wang T, Ma X. Artificial Intelligence in Cervical Cancer Screening and Diagnosis. Front Oncol 2022; 12:851367. [PMID: 35359358 PMCID: PMC8963491 DOI: 10.3389/fonc.2022.851367] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 02/10/2022] [Indexed: 12/11/2022] Open
Abstract
Cervical cancer remains a leading cause of cancer death in women, seriously threatening their physical and mental health. It is an easily preventable cancer with early screening and diagnosis. Although technical advancements have significantly improved the early diagnosis of cervical cancer, accurate diagnosis remains difficult owing to various factors. In recent years, artificial intelligence (AI)-based medical diagnostic applications have been on the rise and have excellent applicability in the screening and diagnosis of cervical cancer. Their benefits include reduced time consumption, reduced need for professional and technical personnel, and no bias owing to subjective factors. We, thus, aimed to discuss how AI can be used in cervical cancer screening and diagnosis, particularly to improve the accuracy of early diagnosis. The application and challenges of using AI in the diagnosis and treatment of cervical cancer are also discussed.
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Affiliation(s)
- Xin Hou
- Department of Obstetrics and Gynecology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Guangyang Shen
- Department of Obstetrics and Gynecology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liqiang Zhou
- Cancer Centre and Center of Reproduction, Development and Aging, Faculty of Health Sciences, University of Macau, Macau, Macau SAR, China
| | - Yinuo Li
- Department of Obstetrics and Gynecology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Tian Wang
- Department of Obstetrics and Gynecology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Xiangyi Ma
- Department of Obstetrics and Gynecology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Xiangyi Ma,
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Ikushima H, Haga A, Ando K, Kato S, Kaneyasu Y, Uno T, Okonogi N, Yoshida K, Ariga T, Isohashi F, Harima Y, Kanemoto A, Ii N, Wakatsuki M, Ohno T. Prediction of out-of-field recurrence after chemoradiotherapy for cervical cancer using a combination model of clinical parameters and magnetic resonance imaging radiomics: a multi-institutional study of the Japanese Radiation Oncology Study Group. JOURNAL OF RADIATION RESEARCH 2022; 63:98-106. [PMID: 34865079 PMCID: PMC8776693 DOI: 10.1093/jrr/rrab104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/13/2021] [Indexed: 06/13/2023]
Abstract
We retrospectively assessed whether magnetic resonance imaging (MRI) radiomics combined with clinical parameters can improve the predictability of out-of-field recurrence (OFR) of cervical cancer after chemoradiotherapy. The data set was collected from 204 patients with stage IIB (FIGO: International Federation of Gynecology and Obstetrics 2008) cervical cancer who underwent chemoradiotherapy at 14 Japanese institutes. Of these, 180 patients were finally included for analysis. OFR-free survival was calculated using the Kaplan-Meier method, and the statistical significance of clinicopathological parameters for the OFR-free survival was evaluated using the log-rank test and Cox proportional-hazards model. Prediction of OFR from the analysis of diffusion-weighted images (DWI) and T2-weighted images of pretreatment MRI was done using the least absolute shrinkage and selection operator (LASSO) model for engineering image feature extraction. The accuracy of prediction was evaluated by 5-fold cross-validation of the receiver operating characteristic (ROC) analysis. Para-aortic lymph node metastasis (p = 0.003) was a significant prognostic factor in univariate and multivariate analyses. ROC analysis showed an area under the curve (AUC) of 0.709 in predicting OFR using the pretreatment status of para-aortic lymph node metastasis, 0.667 using the LASSO model for DWIs and 0.602 using T2 weighted images. The AUC improved to 0.734 upon combining the pretreatment status of para-aortic lymph node metastasis with that from the LASSO model for DWIs. Combining MRI radiomics with clinical parameters improved the accuracy of predicting OFR after chemoradiotherapy for locally advanced cervical cancer.
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Affiliation(s)
- Hitoshi Ikushima
- Corresponding author. Department of Therapeutic Radiology, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima 7708503, Japan, Telephone: +81 88 633 9051; Fax: +81 88 633 9051, E-mail address:
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Combining Intravoxel Incoherent Motion Diffusion Weighted Imaging and Texture Analysis for a Nomogram to Predict Early Treatment Response to Concurrent Chemoradiotherapy in Cervical Cancer Patients. JOURNAL OF ONCOLOGY 2022; 2021:9345353. [PMID: 34976060 PMCID: PMC8720018 DOI: 10.1155/2021/9345353] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/10/2021] [Indexed: 12/30/2022]
Abstract
This study aimed to predict early treatment response to concurrent chemoradiotherapy (CCRT) by combining intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) with texture analysis (TA) for cervical cancer patients and to develop a nomogram for estimating the risk of residual tumor. Ninty-three cervical cancer patients underwent conventional MRI and IVIM-DWI before CCRT. We conducted TA using T2WI. The patients were allocated to partial response (PR) and complete response (CR) groups on the basis of posttreatment MRI. Multivariate logistic regression analysis on IVIM-DWI parameters and texture features was employed to filter the independent predictors and construct the predictive nomogram. Its discrimination and calibration performances were estimated. Multivariate analysis on the IVIM-DWI parameters showed that D and f were independent predictors (OR = 4.029 and 0.889, resp.; p < 0.05). However, the multivariate analysis on the texture features indicated that GLCM-correlation, GLRLM-LRE, and GLSZM-ZE were independent predictors (OR = 43.789, 9.774, and 23.738, resp.;p < 0.05). The combination of IVIM-DWI parameters and texture features exhibited the highest predictive performance (AUC = 0.975). The nomogram to identify the patients with high-risk residual tumors exhibited an acceptable predictive performance and stability with a C-index of 0.953. Decision curve analysis demonstrated the clinical use of the nomogram. The results demonstrate that D, f, GLCM-correlation, GLRLM-LRE, and GLSZM-ZE were independent predictors for cervical cancer. The nomogram combining IVIM-DWI parameters and texture features makes it possible to identify cervical cancer patients at a high risk of residual tumor after CCRT.
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Cai M, Yao F, Ding J, Zheng R, Huang X, Yang Y, Lin F, Hu Z. MRI Radiomic Features: A Potential Biomarker for Progression-Free Survival Prediction of Patients With Locally Advanced Cervical Cancer Undergoing Surgery. Front Oncol 2022; 11:749114. [PMID: 34970482 PMCID: PMC8712932 DOI: 10.3389/fonc.2021.749114] [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: 07/29/2021] [Accepted: 11/19/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate the prognostic role of radiomic features based on pretreatment MRI in predicting progression-free survival (PFS) of locally advanced cervical cancer (LACC). Methods All 181 women with histologically confirmed LACC were randomly divided into the training cohort (n = 126) and the validation cohort (n = 55). For each patient, we extracted radiomic features from whole tumors on sagittal T2WI and axial DWI. The least absolute shrinkage and selection operator (LASSO) algorithm combined with the Cox survival analysis was applied to select features and construct a radiomic score (Rad-score) model. The cutoff value of the Rad-score was used to divide the patients into high- and low-risk groups by the X-tile. Kaplan–Meier analysis and log-rank test were used to assess the prognostic value of the Rad-score. In addition, we totally developed three models, the clinical model, the Rad-score, and the combined nomogram. Results The Rad-score demonstrated good performance in stratifying patients into high- and low-risk groups of progression in the training (HR = 3.279, 95% CI: 2.865–3.693, p < 0.0001) and validation cohorts (HR = 2.247, 95% CI: 1.735–2.759, p < 0.0001). Otherwise, the combined nomogram, integrating the Rad-score and patient’s age, hemoglobin, white blood cell, and lymph vascular space invasion, demonstrated prominent discrimination, yielding an AUC of 0.879 (95% CI, 0.811–0.947) in the training cohort and 0.820 (95% CI, 0.668–0.971) in the validation cohort. The Delong test verified that the combined nomogram showed better performance in estimating PFS than the clinical model and Rad-score in the training cohort (p = 0.038, p = 0.043). Conclusion The radiomics nomogram performed well in individualized PFS estimation for the patients with LACC, which might guide individual treatment decisions.
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Affiliation(s)
- Mengting Cai
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Fei Yao
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jie Ding
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Ruru Zheng
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaowan Huang
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunjun Yang
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Feng Lin
- Department of Gynecology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhangyong Hu
- Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Shi J, Dong Y, Jiang W, Qin F, Wang X, Cui L, Liu Y, Jin Y, Luo Y, Jiang X. MRI-based peritumoral radiomics analysis for preoperative prediction of lymph node metastasis in early-stage cervical cancer: A multi-center study. Magn Reson Imaging 2021; 88:1-8. [PMID: 34968703 DOI: 10.1016/j.mri.2021.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/29/2021] [Accepted: 12/22/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE To evaluate intra- and preitumoral radiomics on the contrast-enhanced T1-weighted (CE-T1) and T2-weighted (T2W) MRI for predicting the LNM, and develop a nomogram for potential clinical uses. METHODS We enrolled 169 cervical cancer cases who underwent CE-T1 and T2W MR scans from two hospitals between Dec. 2015 and Sep. 2021. Intra- and peritumoral features were extracted separately and selected by the least absolute shrinkage and selection operator (LASSO) regression. Radiomics signatures were built using the selected features from different regions. Clinical parameters were evaluated by statistical analysis. The nomogram was developed combining the multi-regional radiomics signature and the most predictive clinical parameters. RESULTS Five radiomics features were finally selected from the peritumoral regions with 1 and 3 mm distances in the CE-T1 and T2W MRI, respectively. The nomogram incorporating multi-regional combined radiomics signature, MR-reported LN status and tumor diameter achieved the highest AUCs in the training (nomogram vs. combined radiomics signature vs. clinical model, 0.891 vs. 0.830 vs. 0.812), internal validation (nomogram vs. combined radiomics signature vs. clinical model, 0.863 vs. 0.853 vs. 0.816) and external validation (nomogram vs. combined radiomics signature vs. clinical model, 0.804 vs. 0.701 vs. 0.787) cohort. DCA suggested good clinical usefulness of our developed models. CONCLUSION The current work suggested clinical potential for intra- and peritumoral radiomics with multi-modal MRI for preoperative predicting LNM.
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Affiliation(s)
- Jiaxin Shi
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Shenyang 110122, PR China
| | - Yue Dong
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, PR China
| | - Wenyan Jiang
- Scientific Research and Academic Department, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, PR China
| | - Fengying Qin
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, PR China
| | - Xiaoyu Wang
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, PR China
| | - Linpeng Cui
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Shenyang 110122, PR China
| | - Yan Liu
- The Affiliated Reproductive Hospital of China Medical University, Liaoning Research Institute of Family Planning, Shenyang 110031, PR China
| | - Ying Jin
- The Affiliated Reproductive Hospital of China Medical University, Liaoning Research Institute of Family Planning, Shenyang 110031, PR China
| | - Yahong Luo
- Department of Radiology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang 110042, PR China
| | - Xiran Jiang
- Department of Biomedical Engineering, School of Intelligent Medicine, China Medical University, Shenyang 110122, PR China.
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Liu Y, Song T, Dong TF, Zhang W, Wen G. MRI-based radiomics analysis to evaluate the clinicopathological characteristics of cervical carcinoma: a multicenter study. Acta Radiol 2021; 64:395-403. [PMID: 34918963 DOI: 10.1177/02841851211065142] [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: 12/09/2022]
Abstract
BACKGROUND Preoperative prediction of clinical pathological indicators of cervical cancer (CC) is of great significance to the formulation of personalized treatment plans for CC. PURPOSE To investigate magnetic resonance imaging (MRI) radiomics analysis for the evaluation of pathological types, tumor grade, FIGO stage, and lymph node metastasis (LNM) of CC. MATERIAL AND METHODS A total of 235 patients with CC from three institutes were enrolled in the study. All patients underwent T2/SPAIR and contrast-enhanced T1-weighted (CE-T1WI) imaging scans before radical hysterectomy by pelvic lymph node dissection surgery. Radiomics features extracted from T2/SPAIR and CE-T1WI imaging were selected by the least absolute shrinkage and selection operator (LASSO) methods for further radiomics signature calculation. These radiomic features were used to construct regression and decision tree models to evaluate the performance of radiomic features in distinguishing clinicopathological indicators. RESULTS The area under the curve (AUC) of T2/SPAIR and CE-T1WI imaging were 0.777 and 0.750, respectively, for differentiating between adenocarcinoma and squamous cell carcinoma. From the two sequences, the AUC of the verification group that distinguished low FIGO stage from high FIGO stage was 0.716 and 0.676, respectively. The AUC for moderately well and poorly differentiated tumors were 0.729 on T2/SPAIR and 0.749 on CE-T1WI imaging. The AUC of the verification groups for LNM was 0.730 and 0.618 on T2/SPAIR and CE-T1WI imaging, respectively. CONCLUSION MRI radiomics features can be used as a non-invasive method to evaluate the clinicopathological indexes of CC and provide an important auxiliary examination method for patients to determine individualized treatment plans before operation.
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Affiliation(s)
- Yi Liu
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Ting Song
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, PR China
| | - Tian-Fa Dong
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, PR China
| | - Wei Zhang
- Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, PR China
| | - Ge Wen
- Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
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Li P, Feng B, Liu Y, Chen Y, Zhou H, Chen Y, Li W, Long W. Deep learning nomogram for predicting lymph node metastasis using computed tomography image in cervical cancer. Acta Radiol 2021; 64:360-369. [PMID: 34874188 DOI: 10.1177/02841851211058934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Deep learning (DL) has been used on medical images to grade, differentiate, and predict prognosis in many tumors. PURPOSE To explore the effect of computed tomography (CT)-based deep learning nomogram (DLN) for predicting cervical cancer lymph node metastasis (LNM) before surgery. MATERIAL AND METHODS In total, 418 patients with stage IB-IIB cervical cancer were retrospectively enrolled for model exploration (n = 296) and internal validation (n = 122); 62 patients from another independent institution were enrolled for external validation. A convolutional neural network (CNN) was used for DL features extracting from all lesions. The least absolute shrinkage and selection operator (Lasso) logistic regression was used to develop a deep learning signature (DLS). A DLN incorporating the DLS and clinical risk factors was proposed to predict LNM individually. The performance of the DLN was evaluated on internal and external validation cohorts. RESULTS Stage, CT-reported pelvic lymph node status, and DLS were found to be independent predictors and could be used to construct the DLN. The combination showed a better performance than the clinical model and DLS. The proposed DLN had an area under the curve (AUC) of 0.925 in the training cohort, 0.771 in the internal validation cohort, and 0.790 in the external validation cohort. Decision curve analysis and stratification analysis suggested that the DLN has potential ability to generate a personalized probability of LNM in cervical cancer. CONCLUSION The proposed CT-based DLN could be used as a personalized non-invasive tool for preoperative prediction of LNM in cervical cancer, which could facilitate the choice of clinical treatment methods.
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Affiliation(s)
- Peijun Li
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong Province, PR China
| | - Bao Feng
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, Guangxi Province, PR China
| | - Yu Liu
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, Guangxi Province, PR China
| | - Yehang Chen
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, Guangxi Province, PR China
| | - Haoyang Zhou
- School of Electronic Information and Automation, Guilin University of Aerospace Technology, Guilin, Guangxi Province, PR China
| | - Yuan Chen
- Department of Gynecology, Jiangmen Central Hospital, Jiangmen, Guangdong Province, PR China
| | - Wenming Li
- Department of Nutrition, Jiangmen Central Hospital, Jiangmen, Guangdong Province, PR China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Jiangmen, Guangdong Province, PR China
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Yan J, He Y, Wang M, Wu Y. Prognostic Nomogram for Overall Survival of Patients Aged 50 Years or Older with Cervical Cancer. Int J Gen Med 2021; 14:7741-7754. [PMID: 34785932 PMCID: PMC8579836 DOI: 10.2147/ijgm.s335409] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 10/07/2021] [Indexed: 11/23/2022] Open
Abstract
Objective The prognostic factors of cervical cancer in elderly patients have not been researched systematically. We aimed to investigate the clinicopathological characteristics of patients with cervical cancer aged ≥50 years and establish a nomogram for evaluating their prognoses for overall survival. Methods From the Surveillance, Epidemiology, and End Results database, we obtained data of 8538 patients with pathology-confirmed cervical cancer between 2004 and 2015. Patients were divided into training (n = 5941) and validation (n = 2597) cohorts. A nomogram was constructed to evaluate the prognostic prediction value for disease progression. The concordance index, receiver operating characteristic curve, and calibration chart were used to evaluate the model's prediction accuracy and discriminative ability. Survival condition was analyzed using the Kaplan-Meier method. Results In the training cohort, age at diagnosis, race, histology, grade, stage, tumor size, number of examined lymph nodes, and treatment significantly correlated with outcome and were used to develop the nomogram. The calibration curve for survival probability showed an excellent agreement between the nomogram-predicted and actual survival in the training cohort. Conclusion Our nomogram has less bias and gives better accuracy than the International Federation of Gynecology and Obstetrics staging system and can help set up a more individualized feasible follow-up plan.
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Affiliation(s)
- Jing Yan
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University; Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China.,Department of Gynecology, Fuxing Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yue He
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University; Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Ming Wang
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University; Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
| | - Yumei Wu
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University; Beijing Maternal and Child Health Care Hospital, Beijing, People's Republic of China
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Zhang J, Wang Y, Cao D, Shen K. MRI-based three-dimensional reconstruction for staging cervical cancer and predicting high-risk patients. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1398. [PMID: 34733950 PMCID: PMC8506782 DOI: 10.21037/atm-21-2246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/16/2021] [Indexed: 11/06/2022]
Abstract
Background Cervical tumors usually have an irregular morphology. It is often difficult to estimate tumor size or volume based on a diameter measurement from a two-dimensional magnetic resonance imaging slice. This study aimed to explore the use of magnetic resonance imaging-based three-dimensional reconstruction in cervical cancer. Methods We retrospectively created a three-dimensional reconstruction based on the pre-treatment magnetic resonance imaging data of 54 cervical cancer patients at a single center to evaluate tumor size and extent of invasion, as well as to review cervical cancer staging and treatment. The tissues and organs were automatically outlined by the three-dimensional application, based on the signal intensity difference of magnetic resonance imaging data. Results The maximum tumor diameters calculated using the magnetic resonance imaging-based three-dimensional reconstruction were larger than those calculated from the direct magnetic resonance imaging findings or gynecological examinations. Initial underestimation of the maximum tumor diameter led to under-staging in up to 29.6% of patients. The magnetic resonance imaging-based three-dimensional reconstruction revealed that upstaging was warranted based on lymph node metastasis (3.7% of patients) and invasion of the vaginal fornix (1.9% of patients). Lymph node metastasis was associated with a significantly larger tumor volume (P<0.05). A volume cut-off value ≥18.6 mL provided 60% sensitivity, 96.7% specificity, 75% positive predictive value and 93.5% negative predictive value for predicting high-risk patients (P<0.05). Conclusions Magnetic resonance imaging-based three-dimensional reconstruction is a new approach that could potentially measure cervical cancer more accurately.
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Affiliation(s)
- Jingjing Zhang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Yingteng Wang
- Department of Radiology, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, National Clinical Research Center for Obstetric & Gynecologic Diseases, Beijing, China
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Can Conization Specimens Predict Sentinel Lymph Node Status in Early-Stage Cervical Cancer? A SENTICOL Group Study. Cancers (Basel) 2021; 13:cancers13215423. [PMID: 34771586 PMCID: PMC8582355 DOI: 10.3390/cancers13215423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
Simple Summary Lymph node involvement is one of the major prognosis factors for early-stage cervical cancer. Improvement in preoperative identification of node-positive patients may lead to a more accurate triage to primary chemoradiation for these patients instead of radical surgery followed by adjuvant radiotherapy, given the increased morbidity of combined treatment. Several studies have well established risk factors for node involvement, but they are based on final pathologic examination of radical hysterectomy specimens and are usually extrapolated for preoperative risk assessment. Among these risk factors, tumor size, lymphovascular space invasion (LVSI) and depth of stromal invasion might be assessed in conization specimens. Our findings suggest that patients with depth of stromal invasion lower than 10 mm and no LVSI in conization specimens had lower risk of micro- and macrometastatic SLN. In this subpopulation, full node dissection may be questionable in case of SLN unilateral detection. Abstract Background: The prognosis of patients with cervical cancer is significantly worsened in case of lymph node involvement. The goal of this study was to determine whether pathologic features in conization specimens can predict the sentinel lymph node (SLN) status in early-stage cervical cancer. Methods: An ancillary analysis of two prospective multicentric database on SLN biopsy for cervical cancer (SENTICOL I and II) was carried out. Patients with IA to IB2 2018 FIGO stage, who underwent preoperative conization before SLN biopsy were included. Results: Between January 2005 and July 2012, 161 patients from 25 French centers fulfilled the inclusion criteria. Macrometastases, micrometastases and Isolated tumor cells (ITCs) were found in 4 (2.5%), 6 (3.7%) and 5 (3.1%) patients respectively. Compared to negative SLN patients, patients with micrometastatic and macrometastatic SLN were more likely to have lymphovascular space invasion (LVSI) (60% vs. 29.5%, p = 0.04) and deep stromal invasion (DSI) ≥ 10 mm (50% vs. 17.8%, p = 0.04). Among the 93 patients with DSI < 10 mm and absence of LVSI on conization specimens, three patients (3.2%) had ITCs and only one (1.1%) had micrometastases. Conclusions: Patients with DSI < 10 mm and no LVSI in conization specimens had lower risk of micro- and macrometastatic SLN. In this subpopulation, full node dissection may be questionable in case of SLN unilateral detection.
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Akazawa M, Hashimoto K. Artificial intelligence in gynecologic cancers: Current status and future challenges - A systematic review. Artif Intell Med 2021; 120:102164. [PMID: 34629152 DOI: 10.1016/j.artmed.2021.102164] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/28/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Over the past years, the application of artificial intelligence (AI) in medicine has increased rapidly, especially in diagnostics, and in the near future, the role of AI in medicine will become progressively more important. In this study, we elucidated the state of AI research on gynecologic cancers. METHODS A search was conducted in three databases-PubMed, Web of Science, and Scopus-for research papers dated between January 2010 and December 2020. As keywords, we used "artificial intelligence," "deep learning," "machine learning," and "neural network," combined with "cervical cancer," "endometrial cancer," "uterine cancer," and "ovarian cancer." We excluded genomic and molecular research, as well as automated pap-smear diagnoses and digital colposcopy. RESULTS Of 1632 articles, 71 were eligible, including 34 on cervical cancer, 13 on endometrial cancer, three on uterine sarcoma, and 21 on ovarian cancer. A total of 35 studies (49%) used imaging data and 36 studies (51%) used value-based data as the input data. Magnetic resonance imaging (MRI), computed tomography (CT), ultrasound, cytology, and hysteroscopy data were used as imaging data, and the patients' backgrounds, blood examinations, tumor markers, and indices in pathological examination were used as value-based data. The targets of prediction were definitive diagnosis and prognostic outcome, including overall survival and lymph node metastasis. The size of the dataset was relatively small because 64 studies (90%) included less than 1000 cases, and the median size was 214 cases. The models were evaluated by accuracy scores, area under the receiver operating curve (AUC), and sensitivity/specificity. Owing to the heterogeneity, a quantitative synthesis was not appropriate in this review. CONCLUSIONS In gynecologic oncology, more studies have been conducted on cervical cancer than on ovarian and endometrial cancers. Prognoses were mainly used in the study of cervical cancer, whereas diagnoses were primarily used for studying ovarian cancer. The proficiency of the study design for endometrial cancer and uterine sarcoma was unclear because of the small number of studies conducted. The small size of the dataset and the lack of a dataset for external validation were indicated as the challenges of the studies.
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Affiliation(s)
- Munetoshi Akazawa
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan.
| | - Kazunori Hashimoto
- Department of Obstetrics and Gynecology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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Histogram analysis of diffusion-weighted imaging and dynamic contrast-enhanced MRI for predicting occult lymph node metastasis in early-stage oral tongue squamous cell carcinoma. Eur Radiol 2021; 32:2739-2747. [PMID: 34642806 DOI: 10.1007/s00330-021-08310-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 08/24/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate the feasibility of whole-tumor histogram analysis of diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) MRI for predicting occult lymph node metastasis (LNM) in early-stage oral tongue squamous cell cancer (OTSCC). MATERIALS AND METHODS This retrospective study included 55 early-stage OTSCC (cT1-2N0M0) patients; 34 with pathological LNM and 21 without. Eight whole-tumor histogram features were extracted from quantitative apparent diffusion coefficient (ADC) maps and two semi-quantitative DCE parametric maps (wash-in and wash-out). The clinicopathological factors and histogram features were compared between the two groups. Stepwise logistic regression was used to identify independent predictors. Receiver operating characteristic curves were generated to assess the performances of significant variables and a combined model for predicting occult LNM. RESULTS MRI-determined depth of invasion and ADCentropy was significantly higher in the LNM group, with respective areas under the curve (AUCs) of 0.67 and 0.69, and accuracies of 0.73 and 0.73. ADC10th. ADCuniformity and wash-inskewness were significantly lower in the LNM group, with respective AUCs of 0.68, 0.71, and 0.69, and accuracies of 0.65, 0.71, and 0.64. Histogram features from wash-out maps were not significantly associated with cervical node status. In the logistic regression analysis, ADC10th, ADCuniformity, and wash-inskewness were independent predictors. The combined model yielded the best predictive performance, with an AUC of 0.87 and an accuracy of 0.82. CONCLUSIONS Whole-tumor histogram analysis of ADC and wash-in maps is a feasible tool for preoperative evaluation of cervical node status in early-stage OTSCC. KEY POINTS • Histogram analysis of parametric maps from DWI and DCE-MRI may assist the prediction of occult LNM in early-stage OTSCC. • ADC10th, ADCuniformity, and wash-inskewness were independent predictors. • The combined model exhibited good predictive performance, with an accuracy of 0.82.
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Li H, Zhu M, Jian L, Bi F, Zhang X, Fang C, Wang Y, Wang J, Wu N, Yu X. Radiomic Score as a Potential Imaging Biomarker for Predicting Survival in Patients With Cervical Cancer. Front Oncol 2021; 11:706043. [PMID: 34485139 PMCID: PMC8415417 DOI: 10.3389/fonc.2021.706043] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Accurate prediction of prognosis will help adjust or optimize the treatment of cervical cancer and benefit the patients. We aimed to investigate the incremental value of radiomics when added to the FIGO stage in predicting overall survival (OS) in patients with cervical cancer. METHODS This retrospective study included 106 patients with cervical cancer (FIGO stage IB1-IVa) between October 2017 and May 2019. Patients were randomly divided into a training cohort (n = 74) and validation cohort (n = 32). All patients underwent contrast-enhanced computed tomography (CT) prior to treatment. The ITK-SNAP software was used to delineate the region of interest on pre-treatment standard-of-care CT scans. We extracted 792 two-dimensional radiomic features by the Analysis Kit (AK) software. Pearson correlation coefficient analysis and Relief were used to detect the most discriminatory features. The radiomic signature (i.e., Radscore) was constructed via Adaboost with Leave-one-out cross-validation. Prognostic models were built by Cox regression model using Akaike information criterion (AIC) as the stopping rule. A nomogram was established to individually predict the OS of patients. Patients were then stratified into high- and low-risk groups according to the Youden index. Kaplan-Meier curves were used to compare the survival difference between the high- and low-risk groups. RESULTS Six textural features were identified, including one gray-level co-occurrence matrix feature and five gray-level run-length matrix features. Only the FIGO stage and Radscore were independent risk factors associated with OS (p < 0.05). The C-index of the FIGO stage in the training and validation cohorts was 0.703 (95% CI: 0.572-0.834) and 0.700 (95% CI: 0.526-0.874), respectively. Correspondingly, the C-index of Radscore was 0.794 (95% CI: 0.707-0.880) and 0.754 (95% CI: 0.623-0.885). The incorporation of the FIGO stage and Radscore achieved better performance, with a C-index of 0.830 (95% CI: 0.738-0.922) and 0.772 (95% CI: 0.615-0.929), respectively. The nomogram based on the FIGO stage and Radscore could individually predict the OS probability with good discrimination and calibration. The high-risk patients had shorter OS compared with the low-risk patients (p < 0.05). CONCLUSION Radiomics has the potential for noninvasive risk stratification and may improve the prediction of OS in patients with cervical cancer when added to the FIGO stage.
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Affiliation(s)
- Handong Li
- Department of Radiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Miaochen Zhu
- Central Laboratory, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Lian Jian
- Department of Radiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Feng Bi
- Department of Radiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaoye Zhang
- Central Laboratory, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Chao Fang
- Department of Clinical Pharmaceutical Research Institution, Hunan Cancer Hospital, Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
| | - Ying Wang
- Central Laboratory, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Jing Wang
- Gynecological Oncology Clinical Research Center, Hunan Cancer Hospital, Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, China
| | - Nayiyuan Wu
- Central Laboratory, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Xiaoping Yu
- Department of Radiology, Hunan Cancer Hospital, The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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Combination of Radiomics and Machine Learning with Diffusion-Weighted MR Imaging for Clinical Outcome Prognostication in Cervical Cancer. ACTA ACUST UNITED AC 2021; 7:344-357. [PMID: 34449713 PMCID: PMC8396356 DOI: 10.3390/tomography7030031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/02/2021] [Indexed: 12/13/2022]
Abstract
Objectives: To explore the potential of Radiomics alone and in combination with a diffusion-weighted derived quantitative parameter, namely the apparent diffusion co-efficient (ADC), using supervised classification algorithms in the prediction of outcomes and prognosis. Materials and Methods: Retrospective evaluation of the imaging was conducted for a study cohort of uterine cervical cancer, candidates for radical treatment with chemo radiation. ADC values were calculated from the darkest part of the tumor, both before (labeled preADC) and post treatment (labeled postADC) with chemo radiation. Post extraction of 851 Radiomics features and feature selection analysis—by taking the union of the features that had Pearson correlation >0.35 for recurrence, >0.49 for lymph node and >0.40 for metastasis—was performed to predict clinical outcomes. Results: The study enrolled 52 patients who presented with variable FIGO stages in the age range of 28–79 (Median = 53 years) with a median follow-up of 26.5 months (range: 7–76 months). Disease recurrence occurred in 12 patients (23%). Metastasis occurred in 15 patients (28%). A model generated with 24 radiomics features and preADC using a monotone multi-layer perceptron neural network to predict the recurrence yields an AUC of 0.80 and a Kappa value of 0.55 and shows that the addition of radiomics features to ADC values improves the statistical metrics by approximately 40% for AUC and approximately 223% for Kappa. Similarly, the neural network model for prediction of metastasis returns an AUC value of 0.84 and a Kappa value of 0.65, thus exceeding performance expectations by approximately 25% for AUC and approximately 140% for Kappa. There was a significant input of GLSZM features (SALGLE and LGLZE) and GLDM features (SDLGLE and DE) in correlation with clinical outcomes of recurrence and metastasis. Conclusions: The study is an effort to bridge the unmet need of translational predictive biomarkers in the stratification of uterine cervical cancer patients based on prognosis.
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Zhong YW, Jiang Y, Dong S, Wu WJ, Wang LX, Zhang J, Huang MW. Tumor radiomics signature for artificial neural network-assisted detection of neck metastasis in patient with tongue cancer. J Neuroradiol 2021; 49:213-218. [PMID: 34358534 DOI: 10.1016/j.neurad.2021.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 07/23/2021] [Accepted: 07/23/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE To determine the neck management of tongue cancer, this study attempted to construct an artificial neural network (ANN)-assisted model based on computed tomography (CT) radiomics of primary tumors to predict neck lymph node (LN) status in patients with tongue squamous cell carcinoma (SCC). MATERIALS AND METHODS Three hundred thirteen patients with tongue SCC were retrospectively included and randomly divided into training (60%), validation (20%) and internally independent test (20%) sets. In total, 1673 feature values were extracted after the semiautomatic segmentation of primary tumors and set as input layers of a classical 3-layer ANN incorporated with or without clinical LN (cN) status after dimension reduction. The receiver operating characteristic (ROC) curve, accuracy (ACC), sensitivity (SEN), specificity (SPE), area under curve (AUC) and Net Reclassification Index (NRI), were used to evaluate and compare the models. RESULTS Four models with different settings were constructed. The ACC, SEN, SPE and AUC reached 84.1%, 93.1%, 76.5% and 0.943 (95% confidence interval: 0.891-0.996, p<.001), respectively, in the test set. The NRI of models compared with radiologists reached 40% (p<.001). The occult nodal metastasis rate was reduced from 30.9% to a minimum of 12.7% in the T1-2 group. CONCLUSION ANN-based models that incorporated CT radiomics of primary tumors with traditional LN evaluation were constructed and validated to more precisely predict neck LN metastasis in patients with tongue SCC than with naked eyes, especially in early-stage cancer.
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Affiliation(s)
- Yi-Wei Zhong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Yin Jiang
- Department of Physics, Beihang University, Beijing, PR China; Beijing Advanced Innovation Center for Big Data-based Precision Medicine, Beihang University, Beijing, PR China
| | - Shuang Dong
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Wen-Jie Wu
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China.
| | - Ling-Xiao Wang
- Department of Physics, Tsinghua University, Beijing, PR China; Frankfurt Institute for Advanced Studies, Frankfurt am Main, Germany
| | - Jie Zhang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
| | - Ming-Wei Huang
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, PR China
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Fournier L, Costaridou L, Bidaut L, Michoux N, Lecouvet FE, de Geus-Oei LF, Boellaard R, Oprea-Lager DE, Obuchowski NA, Caroli A, Kunz WG, Oei EH, O'Connor JPB, Mayerhoefer ME, Franca M, Alberich-Bayarri A, Deroose CM, Loewe C, Manniesing R, Caramella C, Lopci E, Lassau N, Persson A, Achten R, Rosendahl K, Clement O, Kotter E, Golay X, Smits M, Dewey M, Sullivan DC, van der Lugt A, deSouza NM, European Society Of Radiology. Incorporating radiomics into clinical trials: expert consensus endorsed by the European Society of Radiology on considerations for data-driven compared to biologically driven quantitative biomarkers. Eur Radiol 2021; 31:6001-6012. [PMID: 33492473 PMCID: PMC8270834 DOI: 10.1007/s00330-020-07598-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
Existing quantitative imaging biomarkers (QIBs) are associated with known biological tissue characteristics and follow a well-understood path of technical, biological and clinical validation before incorporation into clinical trials. In radiomics, novel data-driven processes extract numerous visually imperceptible statistical features from the imaging data with no a priori assumptions on their correlation with biological processes. The selection of relevant features (radiomic signature) and incorporation into clinical trials therefore requires additional considerations to ensure meaningful imaging endpoints. Also, the number of radiomic features tested means that power calculations would result in sample sizes impossible to achieve within clinical trials. This article examines how the process of standardising and validating data-driven imaging biomarkers differs from those based on biological associations. Radiomic signatures are best developed initially on datasets that represent diversity of acquisition protocols as well as diversity of disease and of normal findings, rather than within clinical trials with standardised and optimised protocols as this would risk the selection of radiomic features being linked to the imaging process rather than the pathology. Normalisation through discretisation and feature harmonisation are essential pre-processing steps. Biological correlation may be performed after the technical and clinical validity of a radiomic signature is established, but is not mandatory. Feature selection may be part of discovery within a radiomics-specific trial or represent exploratory endpoints within an established trial; a previously validated radiomic signature may even be used as a primary/secondary endpoint, particularly if associations are demonstrated with specific biological processes and pathways being targeted within clinical trials. KEY POINTS: • Data-driven processes like radiomics risk false discoveries due to high-dimensionality of the dataset compared to sample size, making adequate diversity of the data, cross-validation and external validation essential to mitigate the risks of spurious associations and overfitting. • Use of radiomic signatures within clinical trials requires multistep standardisation of image acquisition, image analysis and data mining processes. • Biological correlation may be established after clinical validation but is not mandatory.
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Affiliation(s)
- Laure Fournier
- PARCC, INSERM, Radiology Department, AP-HP, Hopital europeen Georges Pompidou, Université de Paris, F-75015, Paris, France
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
| | - Lena Costaridou
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- School of Medicine, University of Patras, University Campus, Rio, 26 500, Patras, Greece
| | - Luc Bidaut
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- College of Science, University of Lincoln, Lincoln, LN6 7TS, UK
| | - Nicolas Michoux
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), B-1200, Brussels, Belgium
| | - Frederic E Lecouvet
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), B-1200, Brussels, Belgium
| | - Lioe-Fee de Geus-Oei
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
- Biomedical Photonic Imaging Group, University of Twente, Enschede, The Netherlands
| | - Ronald Boellaard
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology & Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centers (VU University), Amsterdam, The Netherlands
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA
| | - Daniela E Oprea-Lager
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology & Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centers (VU University), Amsterdam, The Netherlands
| | - Nancy A Obuchowski
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Anna Caroli
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Biomedical Engineering, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Wolfgang G Kunz
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Edwin H Oei
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - James P B O'Connor
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Marius E Mayerhoefer
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Manuela Franca
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology, Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas de Abel Salazar, University of Porto, Porto, Portugal
| | - Angel Alberich-Bayarri
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Quantitative Imaging Biomarkers in Medicine (QUIBIM), Valencia, Spain
| | - Christophe M Deroose
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Christian Loewe
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Division of Cardiovascular and Interventional Radiology, Dept. for Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Rashindra Manniesing
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Caroline Caramella
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Radiology Department, Hôpital Marie Lannelongue, Institut d'Oncologie Thoracique, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Egesta Lopci
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Nuclear Medicine, Humanitas Clinical and Research Hospital - IRCCS, Rozzano, MI, Italy
| | - Nathalie Lassau
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA
- Imaging Department, Gustave Roussy Cancer Campus Grand, Paris, UMR 1281, INSERM, CNRS, CEA, Universite Paris-Saclay, Saint-Aubin, France
| | - Anders Persson
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology, and Department of Health, Medicine and Caring Sciences, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Rik Achten
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology and Medical Imaging, Ghent University Hospital, Gent, Belgium
| | - Karen Rosendahl
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Olivier Clement
- PARCC, INSERM, Radiology Department, AP-HP, Hopital europeen Georges Pompidou, Université de Paris, F-75015, Paris, France
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
| | - Elmar Kotter
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
| | - Xavier Golay
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA
- Queen Square Institute of Neurology, University College London, London, UK
| | - Marion Smits
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marc Dewey
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel C Sullivan
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA
- Dept. of Radiology, Duke University, 311 Research Dr, Durham, NC, 27710, USA
| | - Aad van der Lugt
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Nandita M deSouza
- European Imaging Biomarkers Alliance (EIBALL), European Society of Radiology, Vienna, Austria.
- Imaging Group, European Organisation of Research and Treatment in Cancer (EORTC), Brussels, Belgium.
- Quantitative Imaging Biomarkers Alliance, Radiological Society of North America, Oak Brook, IL, USA.
- Division of Radiotherapy and Imaging, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK.
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Bizzarri N, Boldrini L, Ferrandina G, Fanfani F, Pedone Anchora L, Scambia G, Gueli Alletti S. Radiomic models for lymph node metastasis prediction in cervical cancer: can we think beyond sentinel lymph node? Transl Oncol 2021; 14:101185. [PMID: 34329940 PMCID: PMC8335647 DOI: 10.1016/j.tranon.2021.101185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023] Open
Abstract
Liu and colleagues performed a retrospective study to validate a computed tomography (CT) scan-based radiomic model to detect lymph node metastasis in cervical cancer. The proposed model incorporating the arterial and venous phase CT-scan features represented a non-invasive method exhibiting high sensitivity in the prediction of lymph node metastasis. It is well established that lymph node metastasis is one of the most significant prognostic factors in cervical cancer. For this reason, management of cervical cancer is strictly related to lymph node status, with international guidelines recommending definitive chemo-radiation in case of metastatic lymph node. More and more evidence supports the use of sentinel lymph node in early-stage cervical cancer but its frozen section analysis may result in false negative results; in locally-advanced stages staging para-aortic lymphadenectomy is proposed by many Authors to tailor chemoradiotherapy treatment, with potential intra-and post-operative related complications. The use of a validated radiomic model able to predict lymph node metastases in radiologically normal lymph nodes may represent an essential tool to possibly spare lympadenectomy related morbidity.
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Affiliation(s)
- Nicolò Bizzarri
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Luca Boldrini
- Fondazione Policlinico Universitario A. Gemelli, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Rome, Italy
| | - Gabriella Ferrandina
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Fanfani
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Pedone Anchora
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Salvatore Gueli Alletti
- Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
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Olthof EP, van der Aa MA, Adam JA, Stalpers LJA, Wenzel HHB, van der Velden J, Mom CH. The role of lymph nodes in cervical cancer: incidence and identification of lymph node metastases-a literature review. Int J Clin Oncol 2021; 26:1600-1610. [PMID: 34241726 DOI: 10.1007/s10147-021-01980-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/24/2021] [Indexed: 01/15/2023]
Abstract
Correct identification of patients with lymph node metastasis from cervical cancer prior to treatment is of great importance, because it allows more tailored therapy. Patients may be spared unnecessary surgery or extended field radiotherapy if the nodal status can be predicted correctly. This review captures the existing knowledge on the identification of lymph node metastases in cervical cancer. The risk of nodal metastases increases per 2009 FIGO stage, with incidences in the pelvic region ranging from 2% (stage IA2) to 14-36% (IB), 38-51% (IIA) and 47% (IIB); and in the para-aortic region ranging from 2 to 5% (stage IB), 10-20% (IIA), 9% (IIB), 13-30% (III) and 50% (IV). In addition, age, tumor size, lymph vascular space invasion, parametrial invasion, depth of stromal invasion, histological type, and histological grade are reported to be independent prognostic factors for the risk of nodal metastases. Furthermore, biomarkers can contribute to predict a patient's nodal status, of which the squamous cell carcinoma antigen (SCC-Ag) is currently the most widely used in squamous cell cervical cancer. Still, pre-treatment lymph node assessment is primarily performed by imaging, of which diffusion-weighted magnetic resonance imaging has the highest sensitivity and 2-deoxy-2-[18F]fluoro-D-glucose positron emission computed tomography the highest specificity. Imaging results can be combined with clinical parameters in nomograms to increase the accuracy of predicting positives nodes. Despite all the progress regarding pre-treatment prediction of lymph node metastases in cervical cancer in recent years, prediction rates are not robust enough to safely abandon surgical staging of the pelvic or para-aortic region yet.
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Affiliation(s)
- Ester P Olthof
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Postbus 19079, 3501 DB, Utrecht, The Netherlands.
| | - Maaike A van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Lukas J A Stalpers
- Department of Radiation Oncology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Hans H B Wenzel
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT, Utrecht, The Netherlands
| | - Jacobus van der Velden
- Department of Gynaecological Oncology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Constantijne H Mom
- Department of Gynaecological Oncology, Amsterdam University Medical Centre, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Qin H, Que Q, Lin P, Li X, Wang XR, He Y, Chen JQ, Yang H. Magnetic resonance imaging (MRI) radiomics of papillary thyroid cancer (PTC): a comparison of predictive performance of multiple classifiers modeling to identify cervical lymph node metastases before surgery. Radiol Med 2021; 126:1312-1327. [PMID: 34236572 DOI: 10.1007/s11547-021-01393-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/25/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE To compare predictive efficiency of multiple classifiers modeling and establish a combined magnetic resonance imaging (MRI) radiomics model for identifying lymph node (LN) metastases of papillary thyroid cancer (PTC) preoperatively. MATERIALS AND METHODS A retrospective analysis based on the preoperative MRI scans of 109 PTC patients including 77 patients with LN metastases and 32 patients without metastases was conducted, and we divided enroll cases into trained group and validation group. Radiomics signatures were selected from fat-suppressed T2-weighted MRI images, and the optimal characteristics were confirmed by spearman correlation test, hypothesis testing and random forest methods, and then, eight predictive models were constructed by eight classifiers. The receiver operating characteristic (ROC) curves analysis were performed to demonstrate the effectiveness of the models. RESULTS The area under the curve (AUC) of ROC based on MRI texture diagnosed LN status by naked eye was 0.739 (sensitivity = 0.571, specificity = 0.906). Based on the 5 optimal signatures, the best AUC of MRI radiomics model by logistics regression classifier had a considerable prediction performance with AUCs 0.805 in trained group and 0.760 in validation group, respectively, and a combination of best radiomics model with visual diagnosis of MRI texture had a high AUC as 0.969 (sensitivity = 0.938, specificity = 1.000), suggesting combined model had a preferable diagnostic efficiency in evaluating LN metastases of PTC. CONCLUSION Our combined radiomics model with visual diagnosis could be a potentially effective strategy to preoperatively predict LN metastases in PTC patients before clinical intervention.
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Affiliation(s)
- Hui Qin
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Qiao Que
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Peng Lin
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Xin Li
- Department of GE Healthcare Global Research, GE Healthcare, Shanghai, 201203, People's Republic of China
| | - Xin-Rong Wang
- Department of GE Healthcare Global Research, GE Healthcare, Shanghai, 201203, People's Republic of China
| | - Yun He
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China
| | - Jun-Qiang Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China.
| | - Hong Yang
- Department of Medical Ultrasonics, The First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Guangxi Zhuang Autonomous Region, Nanning, People's Republic of China.
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Manganaro L, Nicolino GM, Dolciami M, Martorana F, Stathis A, Colombo I, Rizzo S. Radiomics in cervical and endometrial cancer. Br J Radiol 2021; 94:20201314. [PMID: 34233456 PMCID: PMC9327743 DOI: 10.1259/bjr.20201314] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Radiomics is an emerging field of research that aims to find associations between quantitative information extracted from imaging examinations and clinical data to support the best clinical decision. In the last few years, some papers have been evaluating the role of radiomics in gynecological malignancies, mainly focusing on ovarian cancer. Nonetheless, cervical cancer is the most frequent gynecological malignancy in developing countries and endometrial cancer is the most common in western countries. The purpose of this narrative review is to give an overview of the latest published papers evaluating the role of radiomics in cervical and endometrial cancer, mostly evaluating association with tumor prognostic factors, with response to therapy and with prediction of recurrence and distant metastasis.
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Affiliation(s)
- Lucia Manganaro
- Department of Radiological, Oncological and Pathological Sciences; University of Rome Sapienza (IT), Rome, Italy
| | - Gabriele Maria Nicolino
- Post-graduate School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, Milan, Italy
| | - Miriam Dolciami
- Department of Radiological, Oncological and Pathological Sciences; University of Rome Sapienza (IT), Rome, Italy
| | - Federica Martorana
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500 Bellinzona, (CH), Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500 Bellinzona, (CH), Switzerland.,Facoltà di Scienze biomediche, Università della Svizzera italiana (USI), Via Buffi 13, 6900, Lugano (CH), Switzerland
| | - Ilaria Colombo
- Oncology Institute of Southern Switzerland, San Giovanni Hospital, 6500 Bellinzona, (CH), Switzerland
| | - Stefania Rizzo
- Facoltà di Scienze biomediche, Università della Svizzera italiana (USI), Via Buffi 13, 6900, Lugano (CH), Switzerland.,Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale, Via Tesserete 46, Lugano (CH), Switzerland
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Zhou WJ, Zhang YD, Kong WT, Zhang CX, Zhang B. Preoperative prediction of axillary lymph node metastasis in patients with breast cancer based on radiomics of gray-scale ultrasonography. Gland Surg 2021; 10:1989-2001. [PMID: 34268083 DOI: 10.21037/gs-21-315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/04/2021] [Indexed: 12/23/2022]
Abstract
Background To investigate the performance of a radiomics model based on gray-scale ultrasonography (US) for the preoperative non-invasive prediction of ipsilateral axillary lymph node (ALN) metastasis in patients with breast cancer (BC). Methods A total of 192 pathologically confirmed BC patients were included in this study. The training set was comprised of 132 patients from hospital 1 and the test set was comprised of 60 patients from hospital 2. All patients underwent US before percutaneous core biopsy and the results of ALN status reported by a radiologist with 12 years of experience were recorded. Radiomic features were extracted from the gray-scale US images. Max-relevance and min-redundancy (MRMR) and least absolute shrinkage and selection operator (LASSO) were used for data dimension reduction and feature selection. A radiomics model was constructed using LASSO and was validated using the leave group out cross-validation (LGOCV) method. The performance of the model was validated with receiver operating characteristic (ROC), calibration curve, and decision curve analysis. Results A total of 860 features were extracted from the gray-scale US images of each breast lesion, and 9 radiomic features were selected for model construction. The area under the curve (AUC), sensitivity, and specificity of the model for predicting ALN metastasis were 0.85, 78.9%, and 77.3% in the training set and 0.65, 68.0%, and 79.4% in the test set, respectively. The prediction performance of the model was significantly higher than that of the radiologist (AUC: 0.85 vs. 0.59, P<0.01) in the training set and was slightly higher than that of the radiologist (AUC: 0.65 vs. 0.63, P>0.05) in the test set. Conclusions The non-invasive radiomics model has the ability to predict ALN metastasis for patients with breast cancer and may outperform US-reported ALN status performed by the radiologist.
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Affiliation(s)
- Wei-Jun Zhou
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.,Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yi-Dan Zhang
- Department of Ultrasound, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Wen-Tao Kong
- Department of Ultrasound, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
| | - Chao-Xue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Bing Zhang
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.,Institute of Brain Science, Nanjing University, Nanjing, China
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Hou Y, Bao J, Song Y, Bao ML, Jiang KW, Zhang J, Yang G, Hu CH, Shi HB, Wang XM, Zhang YD. Integration of clinicopathologic identification and deep transferrable image feature representation improves predictions of lymph node metastasis in prostate cancer. EBioMedicine 2021; 68:103395. [PMID: 34049247 PMCID: PMC8167242 DOI: 10.1016/j.ebiom.2021.103395] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/28/2021] [Accepted: 04/28/2021] [Indexed: 01/21/2023] Open
Abstract
Background Accurate identification of pelvic lymph node metastasis (PLNM) in patients with prostate cancer (PCa) is crucial for determining appropriate treatment options. Here, we built a PLNM-Risk calculator to obtain a precisely informed decision about whether to perform extended pelvic lymph node dissection (ePLND). Methods The PLNM-Risk calculator was developed in 280 patients and verified internally in 71 patients and externally in 50 patients by integrating a set of radiologists’ interpretations, clinicopathological factors and newly refined imaging indicators from MR images with radiomics machine learning and deep transfer learning algorithms. Its clinical applicability was compared with Briganti and Memorial Sloan Kettering Cancer Center (MSKCC) nomograms. Findings The PLNM-Risk achieved good diagnostic discrimination with areas under the receiver operating characteristic curve (AUCs) of 0.93 (95% CI, 0.90-0.96), 0.92 (95% CI, 0.84-0.97) and 0.76 (95% CI, 0.62-0.87) in the training/validation, internal test and external test cohorts, respectively. If the number of ePLNDs missed was controlled at < 2%, PLNM-Risk provided both a higher number of ePLNDs spared (PLNM-Risk 59.6% vs MSKCC 44.9% vs Briganti 38.9%) and a lower number of false positives (PLNM-Risk 59.3% vs MSKCC 70.1% and Briganti 72.7%). In follow-up, patients stratified by the PLNM-Risk calculator showed significantly different biochemical recurrence rates after surgery. Interpretation The PLNM-Risk calculator offers a noninvasive clinical biomarker to predict PLNM for patients with PCa. It shows improved accuracy of diagnosis support and reduced overtreatment burdens for patients with findings suggestive of PCa. Funding This work was supported by the Key Research and Development Program of Jiangsu Province (BE2017756) and the Suzhou Science and Technology Bureau-Science and Technology Demonstration Project (SS201808).
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Affiliation(s)
- Ying Hou
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University; Nanjing, Jiangsu Province, PR China.
| | - Jie Bao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, PR China.
| | - Yang Song
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, PR China.
| | - Mei-Ling Bao
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University; Nanjing, Jiangsu Province, PR China.
| | - Ke-Wen Jiang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University; Nanjing, Jiangsu Province, PR China.
| | - Jing Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University; Nanjing, Jiangsu Province, PR China.
| | - Guang Yang
- Shanghai Key Laboratory of Magnetic Resonance, East China Normal University, Shanghai, PR China.
| | - Chun-Hong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, PR China.
| | - Hai-Bin Shi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University; Nanjing, Jiangsu Province, PR China.
| | - Xi-Ming Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou 215006, PR China.
| | - Yu-Dong Zhang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University; Nanjing, Jiangsu Province, PR China.
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Liu Y, Fan H, Dong D, Liu P, He B, Meng L, Chen J, Chen C, Lang J, Tian J. Computed tomography-based radiomic model at node level for the prediction of normal-sized lymph node metastasis in cervical cancer. Transl Oncol 2021; 14:101113. [PMID: 33975178 PMCID: PMC8131712 DOI: 10.1016/j.tranon.2021.101113] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
The metastatic status of lymph nodes in cervical cancer patients can be predicted. Computed tomography-based radiomic model can identify the status of the normal-sized lymph node singly. The model may help doctors to make staging and clinical decision, and realize individualized treatment.
Purpose Radiomic models have been demonstrated to have acceptable discrimination capability for detecting lymph node metastasis (LNM). We aimed to develop a computed tomography–based radiomic model and validate its usefulness in the prediction of normal-sized LNM at node level in cervical cancer. Methods A total of 273 LNs of 219 patients from 10 centers were evaluated in this study. We randomly divided the LNs from the 2 centers with the largest number of LNs into the training and internal validation cohorts, and the rest as the external validation cohort. Radiomic features were extracted from the arterial and venous phase images. We trained an artificial neural network (ANN) to develop two single-phase models. A radiomic model reflecting the features of two-phase images was also built for directly predicting LNM in cervical cancer. Moreover, four state-of-the-art methods were used for comparison. The performance of all models was assessed using the area under the receiver operating characteristic curve (AUC). Results Among the models we built, the models combining the features of two phases surpassed the single-phase models, and the models generated by ANN had better performance than the others. We found that the radiomic model achieved the highest AUCs of 0.912 and 0.859 in the training and internal validation cohorts, respectively. In the external validation cohort, the AUC of the radiomic model was 0.800. Conclusion We constructed a radiomic model that exhibited great ability in the prediction of LNM. The application of the model could optimize clinical staging and decision-making.
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Affiliation(s)
- Yujia Liu
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China; CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China.
| | - Huijian Fan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Di Dong
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China; CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; Zhuhai Precision Medical Center, Zhuhai People's Hospital (affiliated with Jinan University), Zhuhai 519000, China.
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Bingxi He
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; School of Electronic, Electrical and Communication Engineering, University of Chinese Academy of Sciences, Beijing 100049, China.
| | - Lingwei Meng
- School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing 100049, China; CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China.
| | - Jiaming Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China; Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan Wangfujing Dongcheng District, Beijing 100730, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing 100190, China; Zhuhai Precision Medical Center, Zhuhai People's Hospital (affiliated with Jinan University), Zhuhai 519000, China; Beijing Advanced Innovation Centre for Big Data-Based Precision Medicine, School of Medicine, Beihang University, Beijing 100191, China.
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Feasibility of T 2WI-MRI-based radiomics nomogram for predicting normal-sized pelvic lymph node metastasis in cervical cancer patients. Eur Radiol 2021; 31:6938-6948. [PMID: 33585992 DOI: 10.1007/s00330-021-07735-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/22/2020] [Accepted: 02/01/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the feasibility of T2WI-based radiomics nomogram analysis to non-invasively predict normal-sized pelvic lymph node (LN) metastasis (LNM) in cervical cancer patients. METHODS Preoperative images of 219 normal-sized pathologically confirmed LNs from 132 cervical cancer patients admitted to our hospital between January 2013 and March 2020 were retrospectively reviewed. Regions of interests (ROIs) were separately delineated on whole LNs and tumors. The maximum-relevance and minimum-redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) methods were used for the construction of radiomics signature. Logistic regression modeling was employed to build models based on clinical features on LN T2WI (model 1), model 1 combined with LN radiomics features (model 2), and model 2 combined with tumor score (model 3). Diagnostic performance was assessed and compared. RESULTS Both model 2 and model 3 showed higher diagnostic accuracy (training: model 2 0.75, model 3 0.78, model 1 0.72; validation: model 2 0.77, model 3 0.69, model 1 0.66) and AUC (training: model 2 0.77, model 3 0.82, model 1 0.74; validation: model 2 0.75, model 3 0.74, model 1 0.70) than clinical model 1. Diagnostic performance of model 3 was improved compared with model 2 in primary cohort, but reduced in validation cohort. However, the differences did not show obvious statistical difference (p = 0.05 and p = 0.15). CONCLUSIONS T2WI-based radiomics nomogram incorporating the LN radiomics signature with the clinical morphological LN features is promising for predicting the normal-sized pelvic LNM in cervical cancer patients. The original tumor radiomics analysis did not significantly improve the differential diagnosis of LNM. KEY POINTS • The combination of LN radiomics signature with LN clinical morphological features on T2WI could discriminate LNM relatively well. • The tumor radiomics analysis did not significantly improve the differential diagnosis of LNM.
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