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La Greca Saint-Esteven A, Bogowicz M, Konukoglu E, Riesterer O, Balermpas P, Guckenberger M, Tanadini-Lang S, van Timmeren JE. A 2.5D convolutional neural network for HPV prediction in advanced oropharyngeal cancer. Comput Biol Med 2022; 142:105215. [PMID: 34999414 DOI: 10.1016/j.compbiomed.2022.105215] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infection with human papilloma virus (HPV) is one of the most relevant prognostic factors in advanced oropharyngeal cancer (OPC) treatment. In this study we aimed to assess the diagnostic accuracy of a deep learning-based method for HPV status prediction in computed tomography (CT) images of advanced OPC. METHOD An internal dataset and three public collections were employed (internal: n = 151, HNC1: n = 451; HNC2: n = 80; HNC3: n = 110). Internal and HNC1 datasets were used for training, whereas HNC2 and HNC3 collections were used as external test cohorts. All CT scans were resampled to a 2 mm3 resolution and a sub-volume of 72x72x72 pixels was cropped on each scan, centered around the tumor. Then, a 2.5D input of size 72x72x3 pixels was assembled by selecting the 2D slice containing the largest tumor area along the axial, sagittal and coronal planes, respectively. The convolutional neural network employed consisted of the first 5 modules of the Xception model and a small classification network. Ten-fold cross-validation was applied to evaluate training performance. At test time, soft majority voting was used to predict HPV status. RESULTS A final training mean [range] area under the curve (AUC) of 0.84 [0.76-0.89], accuracy of 0.76 [0.64-0.83] and F1-score of 0.74 [0.62-0.83] were achieved. AUC/accuracy/F1-score values of 0.83/0.75/0.69 and 0.88/0.79/0.68 were achieved on the HNC2 and HNC3 test sets, respectively. CONCLUSION Deep learning was successfully applied and validated in two external cohorts to predict HPV status in CT images of advanced OPC, proving its potential as a support tool in cancer precision medicine.
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Affiliation(s)
- Agustina La Greca Saint-Esteven
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Computer Vision Laboratory, ETH Zurich, Zurich, Switzerland.
| | - Marta Bogowicz
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | | | - Oliver Riesterer
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Center for Radiation Oncology KSA-KSB, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Stephanie Tanadini-Lang
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Janita E van Timmeren
- Department of Radiation Oncology, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
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Fernandes VT, De Santis RJ, Enepekides DJ, Higgins KM. Surgeon-performed ultrasound guided fine-needle aspirate biopsy with report of learning curve; a consecutive case-series study. J Otolaryngol Head Neck Surg 2015; 44:42. [PMID: 26510834 PMCID: PMC4625451 DOI: 10.1186/s40463-015-0099-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
Background Fine-needle aspiration biopsy has become the standard of care for the evaluation of thyroid nodules. More recently, the use of ultrasound guided fine-needle aspiration biopsy (UG-FNAB) has improved adequacy of sampling. Now there has been improved access to UG-FNAB as ultrasound technology has become more accessible. Here we review the adequacy rate and learning curve of a single surgeon starting at the adoption of UG-FNAB into surgical practice. Methods UG-FNABs performed at Sunnybrook Health Sciences Centre from 2010 to 2015 were reviewed retrospectively. Nodule characteristics were recorded along with cytopathology and final pathology reports. Chi-square analysis, followed by the reporting of odds ratios with confidence intervals, were used to assess the statistical significance and frequencies, respectively, of nodule characteristics amongst both diagnostic and non-diagnostic samples. A multiple regression analysis was conducted to determine if any nodule characteristic were predictive of adequacy of UG-FNABs. The learning curve was assessed by calculating the eventual adequacy rates across each year, and its statistical significance was measured using Fischer’s Exact Test. Results In total 423 biopsies were reviewed in 289 patients. The average nodule size was 23.05 mm. When examining if each patient eventually received a diagnostic UG-FNAB, regardless of the number attempts, adequacy was seen to increase from 70.8 % in 2010 to, 81.0 % in 2011, 90.3 % in 2012, 85.7 % in 2013, 89.7 % in 2014, and 94.3 % in 2015 (Fischer’s Exact Test, p = 0.049). Cystic (χ2 = 19.70, p <0.001) nodules were found to yield higher rates of non-diagnostic samples, and their absence are predictive of obtaining an adequate biopsy as seen in a multiple regression analysis (p < 0.001) Adequacy of repeat biopsies following an initial non-diagnostic sample was 75.0 %. Conclusions Surgeons are capable of performing UG-FNAB with a learning curve noted to achieve standard adequacy rates. Cystic nodules are shown to yield more non-diagnostic samples in the surgeon’s office.
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Affiliation(s)
- Vinay T Fernandes
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Canada.
| | - Robert J De Santis
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada.
| | - Danny J Enepekides
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada
| | - Kevin M Higgins
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Suite M1 102, Toronto, ON, M4N 3 M5, Canada.
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Fernandes VT, Magarey MJR, Kamdar DP, Freeman JL. Surgeon performed ultrasound-guided fine-needle aspirates of the thyroid: 1067 biopsies and learning curve in a teaching center. Head Neck 2015; 38 Suppl 1:E1281-4. [PMID: 26316053 DOI: 10.1002/hed.24212] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 06/12/2015] [Accepted: 07/11/2015] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Surgeon performed ultrasound-guided fine-needle aspirates (UG-FNAs) reduce delay in diagnosis and allow for surgeon surveillance. We present the first report on a learning curve and impact of head and neck surgical trainees on adequacy rates. METHODS Thyroid UG-FNA biopsies from 2009 to 2013 were reviewed retrospectively. Specimen adequacy, cytologic diagnosis, and surgical pathology were used to calculate adequacy and accuracy. RESULTS One thousand sixty-seven biopsies were examined in 723 individuals. The adequacy rate from adoption into practice improved from 71% to 78% to 85% over 300 cases. When UG-FNA was subsequently taught to trainees, adequacy rates varied among trainees (p < .037), and there were higher nondiagnostic rates earlier in training (p = .04). Adequacy was not related to size or palpability, but cystic lesions yielded more inadequate specimens (p < .001). CONCLUSION Surgeon performed UG-FNA biopsy can be performed adequately in an outpatient setting. Adequacy rates reach acceptable levels after 300 cases, whereas trainee involvement impacts adequacy rates. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1281-E1284, 2016.
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Affiliation(s)
- Vinay T Fernandes
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | - Dev P Kamdar
- Hofstra North Shore - LIJ School of Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Jeremy L Freeman
- Department of Otolaryngology - Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Mount Sinai Hospital, Toronto, Canada
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Routine non-thyroid head and neck cytology in a large UK centre: clinical utility and pitfalls. The Journal of Laryngology & Otology 2015; 129:682-7. [DOI: 10.1017/s0022215115000092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:This study aimed to examine the performance of head and neck cytology at Nottingham University Hospitals between 2009 and 2010.Methods:Cases were extracted from the Winpath pathology reporting system and correlations were investigated between results and the histological and clinical outcomes. Specimen adequacy and the sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the cytology tests were calculated.Results:In all, 19.7 per cent of aspirates were judged to be inadequate. The absolute and relative sensitivities of head and neck cytology were 87.0 per cent and 89.0 per cent, respectively, and the absolute and relative specificities were 99.0 per cent and 97.0 per cent, respectively. The positive predictive values were 99.0 per cent and 96.0 per cent and the negative predictive values were 92.0 per cent and 92.0 per cent for a diagnostic accuracy of 94.5 per cent and 93.0 per cent. The performance was consistent with previous reports and superior to that of a recent UK series. The high rate of inadequate samples is, however, a concern.Conclusion:Head and neck cytology is a robust technique at our institution, although there are certain problem areas. There is room for improvement in the technical quality of fine needle aspiration.
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Sharma SD, Kumar G, Horsburgh A, Huq M, Alkilani R, Chawda S, Kaddour H. Do Immediate Cytology and Specialist Radiologists Improve the Adequacy of Ultrasound-Guided Fine-Needle Aspiration Cytology? Otolaryngol Head Neck Surg 2014; 152:292-6. [DOI: 10.1177/0194599814561204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To assess whether a dedicated “1-stop” neck lump clinic has improved the percentage of adequate fine-needle aspiration cytology (FNAC) samples and reduced the need for repeat FNAC. Study Design Retrospective review. Setting District General Hospital in the United Kingdom. Subjects and Methods Patients attending for ultrasound-guided FNAC over a 6-month period from August 2012 to February 2013. Patients were placed in 4 groups: group 1, FNAC performed by any of the subspecialist radiologists with cytology support (n = 100); group 2, FNAC performed by general radiologists without cytology support (n = 112); group 3, FNAC performed by a particular subspecialist radiologist with cytology support (n = 61); and group 4, FNAC performed by the same subspecialist radiologist without cytology support (n = 125). Results There was a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist with immediate cytology (group 1) versus a general radiologist without cytology support (group 2; 87/100 vs 63/112, P = .0001), a significantly higher rate of adequacy of FNAC in the presence of cytology support with the same radiologist (group 3 vs group 4, 55/61 vs 97/125, P = .04), and a significantly higher rate of adequacy of FNAC in the presence of a subspecialist radiologist versus a general radiologist without cytology support (group 4 vs group 2, 97/125 vs 63/112, P = .0005). Conclusion Immediate cytology and the presence of a subspecialist radiologist increase the adequacy of FNAC. The adequacy rate of non–cytology-supported FNAC or nonsubspecialist FNAC is below the adequate rate expected from the literature or as recommended in national guidelines.
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Affiliation(s)
- Sunil Dutt Sharma
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Gaurav Kumar
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Avril Horsburgh
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Mahmuda Huq
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Raed Alkilani
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Sanjiv Chawda
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
| | - Hesham Kaddour
- Department of Otorhinolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex, United Kingdom
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Schmidt RL, Jedrzkiewicz JD, Allred RJ, Matsuoka S, Witt BL. Verification bias in diagnostic accuracy studies for fine- and core needle biopsy of salivary gland lesions in otolaryngology journals: a systematic review and analysis. Head Neck 2014; 36:1654-61. [PMID: 24114985 DOI: 10.1002/hed.23495] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 07/08/2013] [Accepted: 09/09/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Diagnostic test accuracy (DTA) studies for needle biopsy are frequently published in otolaryngology journals, but this body of literature has not been assessed for verification bias. METHODS We conducted a systematic review of DTA studies on needle biopsy of salivary gland lesions appearing in otolaryngology journals. Studies were assessed by 2 reviewers for verification bias. RESULTS We identified 95 DTA studies for needle biopsy of salivary gland lesions. Eighty-one studies (84%) had verification bias. Five of the biased studies provided sufficient data to estimate the extent of bias. Verification bias was associated with an overestimate of sensitivity and an underestimate of specificity. Studies on core needle biopsy (CNB) had a lower rate of verification bias than fine-needle aspiration (FNA) studies. CONCLUSION Verification bias is common in DTA studies of needle biopsy for salivary gland lesions published in ear, nose, and throat (ENT) journals. Such studies overestimated sensitivity and underestimated specificity.
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Affiliation(s)
- Robert L Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah School of Medicine, Salt Lake City, Utah
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Neck lump clinics: is on-site assessment of fine needle aspirate diagnostic adequacy cost-effective? The Journal of Laryngology & Otology 2013; 127:1122-6. [PMID: 24131944 DOI: 10.1017/s0022215113002272] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To establish the diagnostic adequacy of ultrasound-guided fine needle aspiration cytology samples at the East Berkshire neck lump clinic, and to perform a cost-benefit analysis related to the hypothetical addition of an on-site cytology technician (required to review fine needle aspiration specimen adequacy). METHOD The adequacy of all ultrasound-guided fine needle aspiration procedures was reviewed from 1 January to 30 June 2011. These results were used in the cost-benefit analysis related to on-site cytology assessment. RESULTS Of the 307 ultrasound-guided fine needle aspiration cytology procedures performed over 6 months, 67 (22 per cent) were reported to be non-diagnostic. Operator experience was found to correlate significantly with diagnostic adequacy (p < 0.001). Only 5 per cent of all fine needle aspirations were initially non-diagnostic but diagnostic on repeat sampling. This suggests that the financial and time costs of on-site fine needle aspirate adequacy assessment would outweigh any benefit. CONCLUSION In this series, the experience of individuals performing fine needle aspirations was the most important factor related to adequacy.
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Akhavan-Moghadam J, Afaaghi M, Maleki AR, Saburi A. Fine needle aspiration: an atraumatic method to diagnose head and neck masses. Trauma Mon 2013; 18:117-21. [PMID: 24350168 PMCID: PMC3864395 DOI: 10.5812/traumamon.10541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 02/18/2013] [Accepted: 09/23/2013] [Indexed: 11/24/2022] Open
Abstract
Background Patients presenting with a mass require tissue biopsy for histological diagnosis and treatment. Fine needle aspiration (FNA) is offered as an atraumatic, well tolerated, and inexpensive method for obtaining a biopsy from these lesions. Objectives In this study we evaluated the accuracy of FNA as an atraumatic method among patients with nonthyroidal masses for diagnosis of neoplastic masses compared to open surgery. Patients and Methods In a cross-sectional study, 65 patients with a head and neck masses (nonthyroidal) referred to us from 2004 to 2009. Those who had both FNA and open biopsy (the gold standard) were assessed for specificity, sensitivity, positive and negative predictive values of FNA in diagnoses. Results Sixty-five cases with both definite diagnoses of open biopsy and FNA were assessed. The mean (± standard deviation) age of patients was 39.96 ± 19.69 years (range 10 to 82 years). Twenty-five (40.8%) subjects were categorized as malignant neoplasms, 16 (19.4%) as benign neoplasms, and 24 (39.8%) as non-neoplastic lesions. The sensitivity, specificity, positive and also negative predictive values of FNA in the diagnosis of neoplastic masses were 95%, 85%, 92.68%, and 91.66% respectively, and the diagnostic accuracy was 92.3%. Conclusions It seems that FNA is a useful atraumatic diagnostic technique with a high diagnostic accuracy which can provide a highly sensitive diagnosis with low false positive diagnoses in patients with nonthyroidal masses.
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Affiliation(s)
- Jamal Akhavan-Moghadam
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Department of Surgery, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Mahdi Afaaghi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Department of Surgery, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Ali Reza Maleki
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Department of Surgery, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Amin Saburi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IR Iran
- Corresponding author: Amin Saburi, Health Research Center, Baqiyatallah University of Medical Sciences, Mollasadra Av., Vanak Sq., Tehran, IR Iran. Tel./Fax: +98-2188600067, E-mail:
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Al Hamarneh O, Liew L, Shortridge RJ. Diagnostic yield of a one-stop neck lump clinic. Eur Arch Otorhinolaryngol 2012; 270:1711-4. [DOI: 10.1007/s00405-012-2197-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 09/19/2012] [Indexed: 11/28/2022]
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