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Lu J, Ji X, Liu X, Jiang Y, Li G, Fang P, Li W, Zuo A, Guo Z, Yang S, Ji Y, Lu D. Machine learning-based radiomics strategy for prediction of acquired EGFR T790M mutation following treatment with EGFR-TKI in NSCLC. Sci Rep 2024; 14:446. [PMID: 38172228 PMCID: PMC10764785 DOI: 10.1038/s41598-023-50984-7] [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: 10/15/2023] [Accepted: 12/28/2023] [Indexed: 01/05/2024] Open
Abstract
The epidermal growth factor receptor (EGFR) Thr790 Met (T790M) mutation is responsible for approximately half of the acquired resistance to EGFR-tyrosine kinase inhibitor (TKI) in non-small-cell lung cancer (NSCLC) patients. Identifying patients at diagnosis who are likely to develop this mutation after first- or second-generation EGFR-TKI treatment is crucial for better treatment outcomes. This study aims to develop and validate a radiomics-based machine learning (ML) approach to predict the T790M mutation in NSCLC patients at diagnosis. We collected retrospective data from 210 positive EGFR mutation NSCLC patients, extracting 1316 radiomics features from CT images. Using the LASSO algorithm, we selected 10 radiomics features and 2 clinical features most relevant to the mutations. We built models with 7 ML approaches and assessed their performance through the receiver operating characteristic (ROC) curve. The radiomics model and combined model, which integrated radiomics features and relevant clinical factors, achieved an area under the curve (AUC) of 0.80 (95% confidence interval [CI] 0.79-0.81) and 0.86 (0.87-0.88), respectively, in predicting the T790M mutation. Our study presents a convenient and noninvasive radiomics-based ML model for predicting this mutation at the time of diagnosis, aiding in targeted treatment planning for NSCLC patients with EGFR mutations.
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Affiliation(s)
- Jiameng Lu
- Department of Respiratory, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong Institute of Anesthesia and Respiratory Critical Medicine, 16766 Jingshilu, Lixia, Jinan, 250014, Shandong, People's Republic of China
- School of Microelectronics, Shandong University, Jinan, 250100, Shandong, People's Republic of China
| | - Xiaoqing Ji
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, Shandong, People's Republic of China
| | - Xinyi Liu
- Graduate School of Shandong First Medical University, Jinan, 250000, Shandong, People's Republic of China
| | - Yunxiu Jiang
- Graduate School of Shandong First Medical University, Jinan, 250000, Shandong, People's Republic of China
| | - Gang Li
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Abdominal Medicine Imaging, Shandong Lung Cancer Institute, Shandong Institute of Neuroimmunology, Jinan, 250000, Shandong, China
| | - Ping Fang
- Department of Blood Transfusion, The First Affiliated Hospital of Shandong First Medical University and Shandong Province Qianfoshan Hospital, Jinan, 250014, Shandong, China
| | - Wei Li
- Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Abdominal Medicine Imaging, Shandong Lung Cancer Institute, Shandong Institute of Neuroimmunology, Jinan, 250000, Shandong, China
| | - Anli Zuo
- Graduate School of Shandong First Medical University, Jinan, 250000, Shandong, People's Republic of China
| | - Zihan Guo
- Graduate School of Shandong First Medical University, Jinan, 250000, Shandong, People's Republic of China
| | - Shuran Yang
- Graduate School of Shandong First Medical University, Jinan, 250000, Shandong, People's Republic of China
| | - Yanbo Ji
- Department of Nursing, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, 250014, Shandong, People's Republic of China
| | - Degan Lu
- Department of Respiratory, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Respiratory Diseases, Shandong Institute of Anesthesia and Respiratory Critical Medicine, 16766 Jingshilu, Lixia, Jinan, 250014, Shandong, People's Republic of China.
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Tang X, Li Y, Shen LT, Yan WF, Qian WL, Yang ZG. CT Radiomics Predict EGFR-T790M Resistance Mutation in Advanced Non-Small Cell Lung Cancer Patients After Progression on First-line EGFR-TKI. Acad Radiol 2023; 30:2574-2587. [PMID: 36941156 DOI: 10.1016/j.acra.2023.01.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 03/23/2023]
Abstract
RATIONALE AND OBJECTIVES We aim to explore the value of chest CT radiomics in predicting the epidermal growth factor receptor (EGFR)-T790M resistance mutation of advanced non-small cell lung cancer (NSCLC) patients after the failure of first-line EGFR-tyrosine kinase inhibitor (EGFR-TKI). MATERIALS AND METHODS A total of 211 and 135 advanced NSCLC patients with tumor tissue-based (Cohort-1) or circulating tumor DNA (ctDNA)-based (Cohort-2) EGFR-T790M testing were included, respectively. Cohort-1 was used for modeling and Cohort-2 was for models' validation. Radiomic features were extracted from tumor lesions on chest nonenhanced CT (NECT) and/or contrast-enhanced CT (CECT). We used eight feature selectors and eight classifier algorithms to establish radiomic models. Models were evaluated by area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). RESULTS CT morphological manifestations of peripheral location and pleural indentation sign were associated with EGFR-T790M. For NECT, CECT, and NECT+CECT radiomic features, the feature selector and classifier algorithms of LASSO and Stepwise logistic regression, Boruta and SVM, and LASSO and SVM were chosen to develop the optimal model, respectively (AUC: 0.844, 0.811, and 0.897). All models performed well in calibration curves and DCA. Independent validation of models in Cohort-2 revealed that both NECT and CECT models individually had limited power for predicting EGFR-T790M mutation detected by ctDNA (AUC: 0.649, 0.675), while the NECT+CECT radiomic model had a satisfactory AUC (0.760). CONCLUSION This study proved the feasibility of using CT radiomic features to predict the EGFR-T790M resistance mutation, which could be helpful in guiding personalized therapeutic strategies.
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Affiliation(s)
- Xin Tang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li-Ting Shen
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wen-Lei Qian
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Xie Z, Zhang H. Analysis of the Diagnosis Model of Peripheral Non-Small-Cell Lung Cancer under Computed Tomography Images. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:3107965. [PMID: 35222880 PMCID: PMC8881128 DOI: 10.1155/2022/3107965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/23/2021] [Accepted: 08/11/2021] [Indexed: 11/17/2022]
Abstract
This study aimed to explore the effect of deep learning models on lung CT image lung parenchymal segmentation (LPS) and the application value of CT image texture features in the diagnosis of peripheral non-small-cell lung cancer (NSCLC). Data of peripheral lung cancer (PLC) patients was collected retrospectively and was divided into peripheral SCLC group and peripheral NSCLC group according to the pathological examination results, ResNet50 model and feature pyramid network (FPN) algorithm were undertaken to improve the Mask-RCNN model, and after the MaZda software extracted the texture features of the CT images of PLC patients, the Fisher coefficient was used to reduce the dimensionality, and the texture features of the CT images were analyzed and compared. The results showed that the average Dice coefficients of the 2D CH algorithm, Faster-RCNN, Mask-RCNN, and the algorithm proposed in the validation set were 0.882, 0.953, 0.961, and 0.986, respectively. The accuracy rates were 88.3%, 93.5%, 94.4%, and 97.2%. The average segmentation speeds in lung CT images were 0.289 s/sheet, 0.115 s/sheet, 0.108 s/sheet, and 0.089 s/sheet. The improved deep learning model showed higher accuracy, better robustness, and faster speed than other algorithms in the LPS of CT images. In summary, deep learning can achieve the LPS of CT images and show excellent segmentation efficiency. The texture parameters of GLCM in CT images have excellent differential diagnosis performance for NSCLC and SCLC and potential clinical application value.
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Affiliation(s)
- Zhonghai Xie
- Huzhou Central Hospital, Huzhou 313000, Zhejiang, China
| | - Huaizhong Zhang
- Lishui City People's Hospital, Lishui 323000, Zhejiang, China
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Wang Y, Ma LY, Yin XP, Gao BL. Radiomics and Radiogenomics in Evaluation of Colorectal Cancer Liver Metastasis. Front Oncol 2022; 11:689509. [PMID: 35070948 PMCID: PMC8776634 DOI: 10.3389/fonc.2021.689509] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/03/2021] [Indexed: 12/12/2022] Open
Abstract
Colorectal cancer is one common digestive malignancy, and the most common approach of blood metastasis of colorectal cancer is through the portal vein system to the liver. Early detection and treatment of liver metastasis is the key to improving the prognosis of the patients. Radiomics and radiogenomics use non-invasive methods to evaluate the biological properties of tumors by deeply mining the texture features of images and quantifying the heterogeneity of metastatic tumors. Radiomics and radiogenomics have been applied widely in the detection, treatment, and prognostic evaluation of colorectal cancer liver metastases. Based on the imaging features of the liver, this paper reviews the current application of radiomics and radiogenomics in the diagnosis, treatment, monitor of disease progression, and prognosis of patients with colorectal cancer liver metastases.
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Affiliation(s)
| | | | - Xiao-Ping Yin
- CT-MRI Room, Affiliated Hospital of Hebei University, Baoding, China
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Xie X, Li X, Tang W, Xie P, Tan X. Primary tumor location in lung cancer: the evaluation and administration. Chin Med J (Engl) 2021; 135:127-136. [PMID: 34784305 PMCID: PMC8769119 DOI: 10.1097/cm9.0000000000001802] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Lung cancer continues to be the leading cause of cancer-related death in the world, which is classically subgrouped into two major histological types: Non-small cell lung cancer (NSCLC) (85% of patients) and small-cell lung cancer (SCLC) (15%). Tumor location has been reported to be associated with the prognosis of various solid tumors. Several types of cancer often occur in a specific region and are more prone to spread to predilection locations, including colorectal cancer, prostate cancer, gastric cancer, ovarian cancer, cervical cancer, bladder cancer, lung tumor, and so on. Besides, tumor location is also considered as a risk factor for lung neoplasm with chronic obstructive pulmonary disease/emphysema. Additionally, the primary lung cancer location is associated with specific lymph node metastasis. And the recent analysis has shown that the primary location may affect metastasis pattern in metastatic NSCLC based on a large population. Numerous studies have enrolled the "location" factor in the risk model. Anatomy location and lobe-specific location are both important in prognosis. Therefore, it is important for us to clarify the characteristics about tumor location according to various definitions. However, the inconsistent definitions about tumor location among different articles are controversial. It is also a significant guidance in multimode therapy in the present time. In this review, we mainly aim to provide a new insight about tumor location, including anatomy, clinicopathology, and prognosis in patients with lung neoplasm.
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Affiliation(s)
- Xueqi Xie
- School of Medicine and Life Sciences, Shandong First Medical University, Jinan, Shandong 250117, China Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong 250117, China
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Kano H, Kubo T, Ninomiya K, Ichihara E, Ohashi K, Rai K, Hotta K, Tabata M, Hiraki T, Kanazawa S, Maeda Y, Kiura K. Comparison of bronchoscopy and computed tomography-guided needle biopsy for re-biopsy in non-small cell lung cancer patients. Respir Investig 2021; 59:240-246. [PMID: 33436353 DOI: 10.1016/j.resinv.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 12/09/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND New therapeutic drugs have been developed for non-small cell lung cancer (NSCLC), and the prognosis of advanced NSCLC patients has improved. However, resistance to these drugs is a concern, and re-biopsy is necessary to determine the mechanism of drug resistance. There are many reports about the protocols for re-biopsy, including techniques such as bronchoscopy and computed tomography-guided needle biopsy (CTNB); however, there is no consensus on which method is optimal. Therefore, we retrospectively reviewed the bronchoscopy and CTNB re-biopsies conducted at our hospital. METHODS We retrospectively analyzed 79 cases of re-biopsies with bronchoscopy or CTNB in patients with NSCLC from January 2014 to December 2016 at our institute. RESULTS Forty-nine cases of bronchoscopy and 30 cases of CTNB were taken for re-biopsy. The diagnostic rates of bronchoscopy and CTNB were 83.7% and 100%, respectively (p = 0.023). The complication rates of bronchoscopy and CTNB were 18.4% and 36.7%, respectively (p = 0.11), with a statistically significant difference in the incidence of pneumothorax (0% vs. 23.3%, respectively; p < 0.01). Pneumothorax required drainage in 6.7% of all CTNB cases. There were no fatalities in either group. CONCLUSIONS CTNB showed a higher diagnostic rate; however, it was associated with a higher rate of complications such as pneumothorax. Hence, the optimal modality must be determined individually for each patient.
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Affiliation(s)
- Hirohisa Kano
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Toshio Kubo
- Center for Clinical Oncology, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Kiichiro Ninomiya
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Eiki Ichihara
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Kadoaki Ohashi
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Kammei Rai
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan; Hospital-based Cancer Registry Division, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Katsuyuki Hotta
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan; Center for Innovative Clinical Medicine, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Masahiro Tabata
- Center for Clinical Oncology, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Takao Hiraki
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Susumu Kanazawa
- Department of Radiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Yoshinobu Maeda
- Department of Hematology, Oncology and Respiratory Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
| | - Katsuyuki Kiura
- Allergy and Respiratory Medicine, Okayama University Hospital, 2-5-1, Kita-ku, Shikata-cho, Okayama City, Okayama, Japan.
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Abstract
PURPOSE OF REVIEW Radiogenomics is a growing field that has garnered immense interest over the past decade, owing to its numerous applications in the field of oncology and its potential value in improving patient outcomes. Current applications have only begun to delve into the potential of radiogenomics, and particularly in interventional oncology, there is room for development and increased value of these applications. RECENT FINDINGS The field of interventional oncology (IO) has seen valuable radiogenomic applications, from prediction of response to locoregional therapies in hepatocellular carcinoma to identification of genetic mutations in non-small cell lung cancer. Future directions that can increase the value of radiogenomics include applications that address tumor heterogeneity, predict immune responsiveness of tumors, and differentiate between oligoprogression and early widespread progression, among others. Radiogenomics, whether in terms of methodologies or applications, is still in the early stages of development and far from maturation. Future applications, particularly in the field of interventional oncology, will allow realization of its full potential.
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Lee SH, Kim EY, Kim A, Chang YS. Clinical implication and usefulness of de novo EGFR T790M mutation in lung adenocarcinoma with EGFR-tyrosine kinase inhibitor sensitizing mutation. Cancer Biol Ther 2020; 21:741-748. [PMID: 32543264 DOI: 10.1080/15384047.2020.1776579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In total, 102 cases diagnosed as lung adenocarcinoma with EGFR-tyrosine kinase inhibitor (TKI) sensitizing mutations (mEGFR) and had been treated with 1st ~ 2nd generation EGFR-TKI alone were enrolled for this study. De novo T790 M status was tested using the tissues at the initial diagnosis and positivity was defined as the ratio of T790 M/wild-type copies over 0.00294 by ddPCR. Seventy patients (68.6%) harbored the de novo T790 M. De novo T790 M was more frequently detected in cases with EGFR L858 R mutation than those with EGFR exon 19 deletion (E19d) mutations (P = 0.024). Forty-three patients underwent rebiopsy due to disease progression. The cases who experienced progression due to acquired T790 M were more likely to have E19d at initial diagnosis and the presence of de novo T790 M and the ratio of T790 M/wild-type copies did not relate to the emergence of acquired T790 M. On the other hand, the cases with a longer duration of disease-control by EGFR-TKI had higher change to get acquired T790 M mutation (P-value = 0.040). The presence of de novo T790 M has limitation in predicting disease progression by acquired T790 M, suggesting that identifying de novo T790 M through the ultrasensitive methods may not be necessary identifying patients who would be beneficial by 3rd-generation EGFR-TKI as the 1st line treatment.
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Affiliation(s)
- Sang Hoon Lee
- Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea
| | - Eun Young Kim
- Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea
| | - Arum Kim
- Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea
| | - Yoon Soo Chang
- Department of Internal Medicine, Yonsei University College of Medicine , Seoul, Republic of Korea
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Zhu Y, Liu YL, Feng Y, Yang XY, Zhang J, Chang DD, Wu X, Tian X, Tang KJ, Xie CM, Guo YB, Feng ST, Ke ZF. A CT-derived deep neural network predicts for programmed death ligand-1 expression status in advanced lung adenocarcinomas. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:930. [PMID: 32953730 PMCID: PMC7475404 DOI: 10.21037/atm-19-4690] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Programmed death ligand-1 (PD-L1) expression remains a crucial predictor in selecting patients for immunotherapy. The current study aimed to non-invasively predict PD-L1 expression based on chest computed tomography (CT) images in advanced lung adenocarcinomas (LUAD), thus help select optimal patients who can potentially benefit from immunotherapy. Methods A total of 127 patients with stage III and IV LUAD were enrolled into this study. Pretreatment enhanced thin-section CT images were available for all patients and were analyzed in terms of both morphologic characteristics by radiologists and deep learning (DL), so to further determine the association between CT features and PD-L1 expression status. Univariate analysis and multivariate logical regression analysis were applied to evaluate significant variables. For DL, the 3D DenseNet model was built and validated. The study cohort were grouped by PD-L1 Tumor Proportion Scores (TPS) cutoff value of 1% (positive/negative expression) and 50% respectively. Results Among 127 LUAD patients, 46 (36.2%) patients were PD-L1-positive and 38 (29.9%) patients expressed PD-L1-TPS ≥50%. For morphologic characteristics, univariate and multivariate analysis revealed that only lung metastasis was significantly associated with PD-L1 expression status despite of different PD-L1 TPS cutoff values, and its Area under the receiver operating characteristic curve (AUC) for predicting PD-L1 expression were less than 0.700. On the other hand, the predictive value of DL-3D DenseNet model was higher than that of the morphologic characteristics, with AUC more than 0.750. Conclusions The traditional morphologic CT characteristics analyzed by radiologists show limited prediction efficacy for PD-L1 expression. By contrast, CT-derived deep neural network improves the prediction efficacy, it may serve as an important alternative marker for clinical PD-L1 detection.
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Affiliation(s)
- Ying Zhu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Institution of Precision Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yang-Li Liu
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu Feng
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Yu Yang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jing Zhang
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dan-Dan Chang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Wu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Tian
- Advanced Institute, Infervision, Beijing, China
| | - Ke-Jing Tang
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Can-Mao Xie
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu-Biao Guo
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zun-Fu Ke
- Institution of Precision Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Digumarthy SR, Mendoza DP, Padole A, Chen T, Peterson PG, Piotrowska Z, Sequist LV. Diffuse Lung Metastases in EGFR-Mutant Non-Small Cell Lung Cancer. Cancers (Basel) 2019; 11:cancers11091360. [PMID: 31540242 PMCID: PMC6769768 DOI: 10.3390/cancers11091360] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/06/2019] [Accepted: 09/10/2019] [Indexed: 12/29/2022] Open
Abstract
Diffuse lung metastases have been reported in non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor (EGFR) mutations. The purpose of our study was to compare the incidence of diffuse lung metastases in EGFR-mutant NSCLC and EGFR-wild type NSCLC and to assess other imaging features that may be associated with diffuse lung metastases in EGFR-mutant NSCLC. Two radiologists retrospectively reviewed pre-treatment imaging of metastatic NSCLC cases with known EGFR mutation status. We assessed the imaging features of the primary tumor and patterns of metastases. The cohort consisted of 217 patients (117 EGFR-mutant, 100 EGFR wild-type). Diffuse lung metastasis was significantly more common in EGFR-mutant NSCLC compared with wild-type (18% vs. 3%, p < 0.01). Among the EGFR-mutant group, diffuse lung metastases were inversely correlated with the presence of a nodule greater than 6 mm other than the primary lung lesion (OR: 0.13, 95% CI: 0.04–0.41, p < 0.01). EGFR mutations in NSCLC are associated with increased frequency of diffuse lung metastases. The presence of diffuse lung metastases in EGFR-mutant NSCLC is also associated with a decreased presence of other larger discrete lung metastases. EGFR mutations in NSCLC should be suspected in the setting of a dominant primary lung mass associated with diffuse lung metastases.
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Affiliation(s)
- Subba R Digumarthy
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Dexter P Mendoza
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Atul Padole
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Tianqi Chen
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA 02215, USA.
| | - P Gabriel Peterson
- Department of Radiology, Walter Reed National Military Medical Center and Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
| | - Zofia Piotrowska
- Massachusetts General Hospital Cancer Center and Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
| | - Lecia V Sequist
- Massachusetts General Hospital Cancer Center and Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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11
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Dal Maso A, Lorenzi M, Roca E, Pilotto S, Macerelli M, Polo V, Cecere FL, Del Conte A, Nardo G, Buoro V, Scattolin D, Monteverdi S, Urso L, Zulato E, Frega S, Bonanno L, Indraccolo S, Calabrese F, Conte P, Pasello G. Clinical Features and Progression Pattern of Acquired T790M-positive Compared With T790M-negative EGFR Mutant Non-small-cell Lung Cancer: Catching Tumor and Clinical Heterogeneity Over Time Through Liquid Biopsy. Clin Lung Cancer 2019; 21:1-14.e3. [PMID: 31601525 DOI: 10.1016/j.cllc.2019.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 06/18/2019] [Accepted: 07/26/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Clinical-pathologic predictors of acquired T790M epidermal growth factor receptor (EGFR) mutation in Caucasian patients with non-small-cell lung cancer (NSCLC) progressing after first-/second-generation tyrosine kinase inhibitors (TKIs) is an open field for research. Similarly, the best time point for T790M detection by liquid or tissue biopsy after disease progression is currently matter of debate. PATIENTS AND METHODS This is an observational study at 7 Italian centers enrolling patients with EGFR-mutant NSCLC progressing after first-/second-generation EGFR TKIs, between 2014 and 2018, aiming at comparing baseline clinical-pathologic features and progression patterns in acquired T790M-positive compared with T790M-negative cases. RESULTS A total of 235 patients received first-line treatment with gefitinib (N = 126; 53%), erlotinib (N = 51; 22%), or afatinib (N = 58; 25%). In 120 (51%) cases, T790M was detected in liquid biopsy, tissue biopsy, or both. Age younger than 65 years (P = .037), the presence of common mutations (P = .004), and better response to first-line TKI (P = .023) were correlated with T790M positivity. T790M detection was associated with higher number of new progressing sites (P = .04), liver progression (P = .002), and a lower frequency of lung metastases (P = .027). When serial liquid biopsies were performed (N = 15), an oligoprogressive disease was correlated with a negative test outcome, whereas systemic progression was observed at the time of T790M positivity. CONCLUSION This study on a Caucasian population showed that age, type of EGFR mutation at diagnosis, response to first-line treatment, and peculiar progression pattern are associated with T790M status. Serial liquid biopsy might be useful for treatment selection, especially when tissue rebiopsy is not feasible.
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Affiliation(s)
- Alessandro Dal Maso
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Martina Lorenzi
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisa Roca
- Department of Medical Oncology, ASST - Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Sara Pilotto
- Department of Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Marianna Macerelli
- Department of Medical Oncology - ASUIUD Santa Maria della Misericordia, Udine, Italy
| | - Valentina Polo
- Oncology Unit, AULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | - Fabiana Letizia Cecere
- Department of Oncology 1, Regina Elena National Cancer Institute IRCCS Rome, Rome, Italy
| | - Alessandro Del Conte
- Department of Medical Oncology and Immunorelated Tumors, Centro di Riferimento Oncologico (CRO) - IRCCS, Aviano (PN), Italy
| | - Giorgia Nardo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Vanessa Buoro
- Department of Medical Oncology - ASUIUD Santa Maria della Misericordia, Udine, Italy
| | - Daniela Scattolin
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Sara Monteverdi
- Department of Medical Oncology, University of Verona, AOUI Verona, Verona, Italy
| | - Loredana Urso
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Elisabetta Zulato
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Stefano Frega
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Laura Bonanno
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Stefano Indraccolo
- Immunology and Molecular Oncology Unit, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Fiorella Calabrese
- Pathology Unit, Department of Cardio-Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - PierFranco Conte
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Giulia Pasello
- Department of Oncology 2, Istituto Oncologico Veneto - IRCCS, Padova, Italy.
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12
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A Radiologist's Guide to the Changing Treatment Paradigm of Advanced Non-Small Cell Lung Cancer: The ASCO 2018 Molecular Testing Guidelines and Targeted Therapies. AJR Am J Roentgenol 2019; 213:1047-1058. [PMID: 31361530 DOI: 10.2214/ajr.19.21135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to provide an imaging-based guide of the modern genomic classifications and targeted therapies for advanced non-small cell lung cancer (NSCLC) with an emphasis on the relevance of the 2018 American Society of Clinical Oncology molecular testing guidelines for radiologists. CONCLUSION. Knowledge of the radiologic relevance of lung cancer driver mutations and modern targeted agents is essential for imaging interpretation of advanced NSCLC in the modern age of precision medicine.
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13
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Kim HC, Kang YR, Ji W, Kim YJ, Yoon S, Lee JC, Choi CM. Frequency and clinical features of BRAF mutations among patients with stage III/IV lung adenocarcinoma without EGFR/ALK aberrations. Onco Targets Ther 2019; 12:6045-6052. [PMID: 31440061 PMCID: PMC6666367 DOI: 10.2147/ott.s213928] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/03/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose BRAF mutations are found in 1-5% of non-small cell lung cancers, particularly adenocarcinomas. However, information regarding this mutation is limited in patients without EGFR/ALK aberrations, who have limited treatment options. Patients and methods The medical records of 224 stage III/IV adenocarcinoma patients without EGFR/ALK aberrations and with available pathologic tissue, were retrospectively reviewed. BRAF mutations were evaluated using a PNAClampTM BRAF mutation detection kit (Panagene, Daejeon, Korea). The outcomes in the study population were compared with stage III/IV adenocarcinoma patients harboring an EGFR mutation. A case report of targeted therapy against BRAF mutations was also presented. Results A cohort of 222 adenocarcinoma patients with adequate pathologic tissue samples was analyzed. The median patient age was 63 years, 68.8% of the patients were male and 68.7% were ever-smokers. The V600E BRAF mutation was detected in 4 patients (1.8%). The 222 study patients had a poorer survival outcome compared to stage III/IV adenocarcinoma patients with an EGFR mutation (median, 12 vs 67 months, P<0.001) from a recent previous study. Moreover, a 47-year-old female with a recurrent adenocarcinoma and a BRAF V600E mutation exhibited tumor regression after a fourth line therapy with dabrafenib and trametinib, targeting agents against BRAF mutations. Conclusion Although BRAF mutations are found in 1.8% of advanced adenocarcinoma patients without EGFR/ALK aberration, they may be able to serve as a treatment target in those patients.
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Affiliation(s)
- Ho Cheol Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeh Rim Kang
- Medical Department, Oncology, Novartis Korea Pharmaceuticals, Seoul, South Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yeon Joo Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Shinkyo Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae Cheol Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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14
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Kim H, Lee HJ. Computed tomography characteristics of non-small cell lung cancers with EGFR T790M mutation: role of imaging in the era of precision medicine. J Thorac Dis 2019; 10:S4126-S4129. [PMID: 30631572 DOI: 10.21037/jtd.2018.10.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Hyungjin Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Ju Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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15
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Obayashi K, Shimizu K, Nakazawa S, Ohtaki Y, Kawatani N, Takashi I, Yajima T, Mogi A, Shirabe K. A leopard can't change its spots: can a T790M mutation-positive cancer change its spots after epidermal growth factor receptor-tyrosine kinase inhibitor therapy? J Thorac Dis 2019; 10:S4113-S4116. [PMID: 30631569 DOI: 10.21037/jtd.2018.10.53] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Kai Obayashi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Seshiru Nakazawa
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Yoichi Ohtaki
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Natsuko Kawatani
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Ibe Takashi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Toshiki Yajima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Akira Mogi
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
| | - Ken Shirabe
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Gunma, Japan
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16
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Lee KH, Lim KY, Suh YJ, Hur J, Han DH, Kang MJ, Choo JY, Kim C, Kim JI, Yoon SH, Lee W, Park CM. Nondiagnostic Percutaneous Transthoracic Needle Biopsy of Lung Lesions: A Multicenter Study of Malignancy Risk. Radiology 2018; 290:814-823. [PMID: 30561276 DOI: 10.1148/radiol.2018181482] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose To evaluate the malignancy risk of lung lesions that show nondiagnostic results at transthoracic needle biopsy (PTNB) of the lung and to identify any malignancy-associated risk factors in each nondiagnostic category. Materials and Methods In this retrospective study, 9384 initial PTNBs (9239 patients [mean age, 65 years; age range, 20-99 years] consisting of 5729 men [mean age, 66 years; age range, 20-99 years] and 3510 women [mean age, 63 years; age range, 20-94 years]) were performed in eight institutions between January 2010 and December 2014. PTNB results were categorized as diagnostic (malignant or specifically benign) or nondiagnostic (nonspecific benign pathologic findings, atypical cells, or insufficient specimen), and the proportion of final malignant diagnoses per nondiagnostic category was obtained. Malignancy-associated factors were determined by using multivariable analyses. Results Nondiagnostic results were present in 27.6% (2590 of 9384) of PTNBs. Proportions of final malignant diagnoses were 21.3% (339 of 1592) for nonspecific benignities, 90.1% (503 of 558) for atypical cells, and 46.6% (205 of 440) for insufficient specimens. In the nonspecific benign category, granulomatous inflammation (odds ratio [OR], 0.04; 95% confidence interval [CI]: 0.02, 0.12; P < .001), abscess (OR, 0.04; 95% CI: 0.01, 0.28; P = .001), and organizing pneumonia (OR, 0.05; 95% CI: 0.01, 0.23; P < .001) were demonstrated to be important factors negating malignancy. Atypical cells suspicious for malignancy were more associated with malignancy (OR, 6.3; 95% CI: 1.9, 21.0; P = .003) than were atypical cells of indeterminate malignancy. All 130 lesions with atypical cells suggestive of malignancy were finally malignant. Conclusion After nondiagnostic lung biopsies, lesions categorized as atypical cell lesions have a high likelihood of malignancy, with somewhat lower likelihood for lesions with insufficient specimens and nonspecific benign categories. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Elicker in this issue.
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Affiliation(s)
- Kyung Hee Lee
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Kun Young Lim
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Young Joo Suh
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Jin Hur
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Dae Hee Han
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Mi-Jin Kang
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Ji Yung Choo
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Cherry Kim
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Jung Im Kim
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Soon Ho Yoon
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Woojoo Lee
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
| | - Chang Min Park
- From the Department of Radiology, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea (K.H.L.); Department of Radiology, National Cancer Center, Gyeonggi-do, South Korea (K.Y.L.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (Y.J.S., J.H.); Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea (J.H.); Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea (D.H.H.); Department of Radiology, Inje University Sanggyepaik Hospital, Seoul, South Korea (M.J.K.); Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, South Korea (J.Y.C., C.K.); Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, South Korea (J.I.K.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (S.H.Y., C.M.P.); Department of Statistics, Inha University, Incheon, South Korea (W.L.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, 101 Daehak-ro, Jongno-gu, Seoul 03080, South Korea (C.M.P.)
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