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Yao M, Yang T, Li Q, Zhang X, Zheng Z, Li J, Huang J, Sun Y, Gao X, Fang C. Characteristics and clinical significance of tertiary lymphoid structures in OSCC. Oral Dis 2024. [PMID: 39049571 DOI: 10.1111/odi.15080] [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: 03/31/2024] [Revised: 06/13/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVES This study aimed to investigate the characteristics of tertiary lymphoid structures (TLSs) in oral squamous cell carcinoma (OSCC) and their association with clinical and pathological features. MATERIALS AND METHODS 12 TLS-related chemokines in TCGA database were analyzed to investigate the TLSs in OSCC. The density, maturity, and location of TLSs in a large cohort of 189 OSCC patients (114 of which had clinical and prognostic information) were assessed. And the significance between TLSs and clinicopathologic characteristics was analyzed. RESULTS Bioinformatics and analysis showed that TLSs were associated with better clinical outcomes in OSCC. Histological staining and analysis showed that the overall survival rate of the high-density group (71/112, 63.4%) was significantly higher (p < 0.0001) than that of the low-density group (41/112, 36.6%), and the high-density group had fewer lymph node metastases (50.0%/68.3%, p = 0.021). And TLSs were divided into 4 types according to the maturity and location. Different types of TLSs are associated with prognosis (OS, p < 0.0001), clinical features (T stage, p = 0.028; degree of differentiation, p = 0.043), and precancerous lesion types (OSF, p = 0.049) of OSCC patients. CONCLUSION TLSs were closely associated with better OSCC prognosis, and a more systematic classification may better guide the formulation of further treatment options.
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Affiliation(s)
- Mianfeng Yao
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Tianru Yang
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Qiulan Li
- Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Xinle Zhang
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Ziran Zheng
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Jiang Li
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Jiajun Huang
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Yuanxin Sun
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Xing Gao
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
| | - Changyun Fang
- Department of Stomatology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Center of Oral and Maxillofacial Tumor, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Institute of Oral Precancerous Lesions, Central South University, Changsha, Hunan, China
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2
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Al Hasan MM, Ghazimoghadam S, Tunlayadechanont P, Mostafiz MT, Gupta M, Roy A, Peters K, Hochhegger B, Mancuso A, Asadizanjani N, Forghani R. Automated Segmentation of Lymph Nodes on Neck CT Scans Using Deep Learning. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024:10.1007/s10278-024-01114-w. [PMID: 38937342 DOI: 10.1007/s10278-024-01114-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 06/29/2024]
Abstract
Early and accurate detection of cervical lymph nodes is essential for the optimal management and staging of patients with head and neck malignancies. Pilot studies have demonstrated the potential for radiomic and artificial intelligence (AI) approaches in increasing diagnostic accuracy for the detection and classification of lymph nodes, but implementation of many of these approaches in real-world clinical settings would necessitate an automated lymph node segmentation pipeline as a first step. In this study, we aim to develop a non-invasive deep learning (DL) algorithm for detecting and automatically segmenting cervical lymph nodes in 25,119 CT slices from 221 normal neck contrast-enhanced CT scans from patients without head and neck cancer. We focused on the most challenging task of segmentation of small lymph nodes, evaluated multiple architectures, and employed U-Net and our adapted spatial context network to detect and segment small lymph nodes measuring 5-10 mm. The developed algorithm achieved a Dice score of 0.8084, indicating its effectiveness in detecting and segmenting cervical lymph nodes despite their small size. A segmentation framework successful in this task could represent an essential initial block for future algorithms aiming to evaluate small objects such as lymph nodes in different body parts, including small lymph nodes looking normal to the naked human eye but harboring early nodal metastases.
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Affiliation(s)
- Md Mahfuz Al Hasan
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Electrical and Computer Engineering, University of Florida College of Medicine, Gainesville, FL, USA
| | - Saba Ghazimoghadam
- Augmented Intelligence and Precision Health Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Padcha Tunlayadechanont
- Augmented Intelligence and Precision Health Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Diagnostic and Therapeutic Radiology and Research, Faculty of Medicine Ramathibodi Hospital, Ratchathewi, Bangkok, Thailand
| | - Mohammed Tahsin Mostafiz
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Electrical and Computer Engineering, University of Florida College of Medicine, Gainesville, FL, USA
| | - Manas Gupta
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
| | - Antika Roy
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Electrical and Computer Engineering, University of Florida College of Medicine, Gainesville, FL, USA
| | - Keith Peters
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Bruno Hochhegger
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Anthony Mancuso
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Navid Asadizanjani
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA
- Department of Electrical and Computer Engineering, University of Florida College of Medicine, Gainesville, FL, USA
| | - Reza Forghani
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, 1600 SW Archer Road, Gainesville, FL, 32610-0374, USA.
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA.
- Division of Medical Physics, University of Florida College of Medicine, Gainesville, FL, USA.
- Department of Neurology, Division of Movement Disorders, University of Florida College of Medicine, Gainesville, FL, USA.
- Augmented Intelligence and Precision Health Laboratory, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.
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3
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Oliver J, Alapati R, Lee J, Bur A. Artificial Intelligence in Head and Neck Surgery. Otolaryngol Clin North Am 2024:S0030-6665(24)00070-7. [PMID: 38910064 DOI: 10.1016/j.otc.2024.05.001] [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] [Indexed: 06/25/2024]
Abstract
This article explores artificial intelligence's (AI's) role in otolaryngology for head and neck cancer diagnosis and management. It highlights AI's potential in pattern recognition for early cancer detection, prognostication, and treatment planning, primarily through image analysis using clinical, endoscopic, and histopathologic images. Radiomics is also discussed at length, as well as the many ways that radiologic image analysis can be utilized, including for diagnosis, lymph node metastasis prediction, and evaluation of treatment response. The study highlights AI's promise and limitations, underlining the need for clinician-data scientist collaboration to enhance head and neck cancer care.
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Affiliation(s)
- Jamie Oliver
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, 3901 Rainbow Boulevard M.S. 3010, Kansas City, KS, USA
| | - Rahul Alapati
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, 3901 Rainbow Boulevard M.S. 3010, Kansas City, KS, USA
| | - Jason Lee
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, 3901 Rainbow Boulevard M.S. 3010, Kansas City, KS, USA
| | - Andrés Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine, 3901 Rainbow Boulevard M.S. 3010, Kansas City, KS, USA.
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4
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Bourdillon AT. Computer Vision-Radiomics & Pathognomics. Otolaryngol Clin North Am 2024:S0030-6665(24)00072-0. [PMID: 38910065 DOI: 10.1016/j.otc.2024.05.003] [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: 06/25/2024]
Abstract
The role of computer vision in extracting radiographic (radiomics) and histopathologic (pathognomics) features is an extension of molecular biomarkers that have been foundational to our understanding across the spectrum of head and neck disorders. Especially within head and neck cancers, machine learning and deep learning applications have yielded advances in the characterization of tumor features, nodal features, and various outcomes. This review aims to overview the landscape of radiomic and pathognomic applications, informing future work to address gaps. Novel methodologies will be needed to potentially engineer ways of integrating multidimensional data inputs to examine disease features to guide prognosis comprehensively and ultimately clinical management.
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Affiliation(s)
- Alexandra T Bourdillon
- Department of Otolaryngology-Head & Neck Surgery, University of California-San Francisco, San Francisco, CA 94115, USA.
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5
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Li S, Wei X, Wang L, Zhang G, Jiang L, Zhou X, Huang Q. Dual-source dual-energy CT and deep learning for equivocal lymph nodes on CT images for thyroid cancer. Eur Radiol 2024:10.1007/s00330-024-10854-w. [PMID: 38904758 DOI: 10.1007/s00330-024-10854-w] [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: 06/21/2023] [Revised: 04/08/2024] [Accepted: 04/23/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES This study investigated the diagnostic performance of dual-energy computed tomography (CT) and deep learning for the preoperative classification of equivocal lymph nodes (LNs) on CT images in thyroid cancer patients. METHODS In this prospective study, from October 2020 to March 2021, 375 patients with thyroid disease underwent thin-section dual-energy thyroid CT at a small field of view (FOV) and thyroid surgery. The data of 183 patients with 281 LNs were analyzed. The targeted LNs were negative or equivocal on small FOV CT images. Six deep-learning models were used to classify the LNs on conventional CT images. The performance of all models was compared with pathology reports. RESULTS Of the 281 LNs, 65.5% had a short diameter of less than 4 mm. Multiple quantitative dual-energy CT parameters significantly differed between benign and malignant LNs. Multivariable logistic regression analyses showed that the best combination of parameters had an area under the curve (AUC) of 0.857, with excellent consistency and discrimination, and its diagnostic accuracy and sensitivity were 74.4% and 84.2%, respectively (p < 0.001). The visual geometry group 16 (VGG16) based model achieved the best accuracy (86%) and sensitivity (88%) in differentiating between benign and malignant LNs, with an AUC of 0.89. CONCLUSIONS The VGG16 model based on small FOV CT images showed better diagnostic accuracy and sensitivity than the spectral parameter model. Our study presents a noninvasive and convenient imaging biomarker to predict malignant LNs without suspicious CT features in thyroid cancer patients. CLINICAL RELEVANCE STATEMENT Our study presents a deep-learning-based model to predict malignant lymph nodes in thyroid cancer without suspicious features on conventional CT images, which shows better diagnostic accuracy and sensitivity than the regression model based on spectral parameters. KEY POINTS Many cervical lymph nodes (LNs) do not express suspicious features on conventional computed tomography (CT). Dual-energy CT parameters can distinguish between benign and malignant LNs. Visual geometry group 16 model shows superior diagnostic accuracy and sensitivity for malignant LNs.
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Affiliation(s)
- Sheng Li
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
- Guangdong Esophageal Cancer Institute, Guangzhou, 510060, China
| | - Xiaoting Wei
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China
| | - Li Wang
- School of Artificial Intelligence, Optics and Electronics (iOPEN), Northwestern Polytechnical University, Xi'an, 710072, China
| | - Guizhi Zhang
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China
| | - Linling Jiang
- Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, 510060, China
| | - Xuhui Zhou
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518036, China.
| | - Qinghua Huang
- School of Artificial Intelligence, Optics and Electronics (iOPEN), Northwestern Polytechnical University, Xi'an, 710072, China.
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6
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Sahin O, Kamel S, Wahid KA, Dede C, Taku N, He R, Naser MA, Sharafi S, Mäkitie A, Kann BH, Kaski K, Sahlsten J, Jaskari J, Amit M, Chronowski GM, Diaz EM, Garden AS, Goepfert RP, Guenette JP, Gunn GB, Hirvonen J, Hoebers F, Hutcheson KA, Guha-Thakurta N, Johnson J, Kaya D, Khanpara SD, Nyman K, Lai SY, Lango M, Learned KO, Lee A, Lewis CM, Maniakas A, Moreno AC, Myers JN, Phan J, Pytynia KB, Rosenthal DI, Sandulache VC, Schellingerhout D, Shah SJ, Sikora AG, Mohamed ASR, Chen MM, Fuller CD. International Multi-Specialty Expert Physician Preoperative Identification of Extranodal Extension n Oropharyngeal Cancer Patients using Computed Tomography: Prospective Blinded Human Inter-Observer Performance Evaluation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.02.25.23286432. [PMID: 36865096 PMCID: PMC9980252 DOI: 10.1101/2023.02.25.23286432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Importance Extranodal extension (pENE) is a critical prognostic factor in oropharyngeal cancer (OPC) that drives therapeutic disposition. Determination of pENE from radiological imaging has been associated with high inter-observer variability. However, the impact of clinician specialty on human observer performance of imaging-detected extranodal extension (iENE) remains poorly understood. Objective To characterize the impact of clinician specialty on the accuracy of pre-operative iENE in human papillomavirus-positive (HPV+) OPC using computed tomography (CT) images. Design Setting and Participants This prospective observational human performance study analyzed pre-therapy CT images from 24 HPV+ OPC patients, with duplication of 6 scans (n=30) of which 21 were pathologically confirmed pENE. Thirty-four expert observers, including 11 radiologists, 12 surgeons, and 11 radiation oncologists, independently assessed these scans for iENE and reported human-detected radiologic criteria and observer confidence. Main Outcomes and Measures The primary outcomes included accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and Brier score for each physician, compared to ground-truth pENE. The significance of radiographic signs for prediction of pENE were determined through logistic regression analysis. Fleiss' kappa measured interobserver agreement, and Hanley-MacNeil AUC discrimination testing. Results Median accuracy across all specialties was 0.57 (95%CI 0.39 to 0.73), with no specialty showing discriminate performance greater than random estimation (median AUC 0.64, 95%CI 0.44 to 0.83). Significant differences between radiologists and surgeons in Brier scores (0.33 vs. 0.26, p < 0.01), radiation oncologists and surgeons in sensitivity (0.48 vs. 0.69, p > 0.1), and radiation oncologists and radiologists/surgeons in specificity (0.89 vs. 0.56, p > 0.1). Indistinct capsular contour and nodal necrosis were significant predictors of correct pENE status among all specialties. Interobserver agreement was weak for all the radiographic criteria, regardless of specialty (κ<0.6). Conclusions and Relevance Multiobserver testing shows physician discrimination of HPV+OPC pENE on pre-operative CT remains non-different than blind guessing, with high interrater variability and low diagnostic accuracy, regardless of clinician specialty. While minor differences in diagnostic performance among specialties are noted, they do not significantly affect the overall poor agreement and discrimination rates observed. The findings underscore the need for further research into automated detection systems or enhanced imaging techniques to improve the accuracy and reliability of iENE assessments in clinical practice.
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Affiliation(s)
| | - Onur Sahin
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Kareem A. Wahid
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Cem Dede
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Nicolette Taku
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Renjie He
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Setareh Sharafi
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Antti Mäkitie
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Benjamin H. Kann
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | | | | | | | - Moran Amit
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Eduardo M. Diaz
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Adam S. Garden
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Jeffrey P. Guenette
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - G. Brandon Gunn
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Jussi Hirvonen
- Tampere University, Faculty of Medicine and Health Technology and Tampere University Hospital, Tampere, Finland
| | - Frank Hoebers
- Brigham and Women’s Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | | | | | - Jason Johnson
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Diana Kaya
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Kristofer Nyman
- University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Stephen Y. Lai
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Miriam Lango
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Kim O. Learned
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Anna Lee
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Carol M. Lewis
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Amy C. Moreno
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Jack Phan
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | | | - Vlad C. Sandulache
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | | | - Shalin J. Shah
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | | | - Abdallah S. R. Mohamed
- The University of Texas MD Anderson Cancer Center, Houston, USA
- Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | - Melissa M. Chen
- The University of Texas MD Anderson Cancer Center, Houston, USA
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7
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Bryant AK, Zamora‐Resendiz R, Dai X, Morrow D, Lin Y, Jungles KM, Rae JM, Tate A, Pearson AN, Jiang R, Fritsche L, Lawrence TS, Zou W, Schipper M, Ramnath N, Yoo S, Crivelli S, Green MD. Artificial intelligence to unlock real-world evidence in clinical oncology: A primer on recent advances. Cancer Med 2024; 13:e7253. [PMID: 38899720 PMCID: PMC11187737 DOI: 10.1002/cam4.7253] [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: 08/17/2023] [Revised: 02/05/2024] [Accepted: 04/28/2024] [Indexed: 06/21/2024] Open
Abstract
PURPOSE Real world evidence is crucial to understanding the diffusion of new oncologic therapies, monitoring cancer outcomes, and detecting unexpected toxicities. In practice, real world evidence is challenging to collect rapidly and comprehensively, often requiring expensive and time-consuming manual case-finding and annotation of clinical text. In this Review, we summarise recent developments in the use of artificial intelligence to collect and analyze real world evidence in oncology. METHODS We performed a narrative review of the major current trends and recent literature in artificial intelligence applications in oncology. RESULTS Artificial intelligence (AI) approaches are increasingly used to efficiently phenotype patients and tumors at large scale. These tools also may provide novel biological insights and improve risk prediction through multimodal integration of radiographic, pathological, and genomic datasets. Custom language processing pipelines and large language models hold great promise for clinical prediction and phenotyping. CONCLUSIONS Despite rapid advances, continued progress in computation, generalizability, interpretability, and reliability as well as prospective validation are needed to integrate AI approaches into routine clinical care and real-time monitoring of novel therapies.
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Affiliation(s)
- Alex K. Bryant
- Department of Radiation OncologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Rafael Zamora‐Resendiz
- Applied Mathematics and Computational Research Division, Lawrence Berkeley National LaboratoryBerkeleyCaliforniaUSA
| | - Xin Dai
- Computational Science Initiative, Brookhaven National LaboratoryUptonNew YorkUSA
| | - Destinee Morrow
- Applied Mathematics and Computational Research Division, Lawrence Berkeley National LaboratoryBerkeleyCaliforniaUSA
| | - Yuewei Lin
- Computational Science Initiative, Brookhaven National LaboratoryUptonNew YorkUSA
| | - Kassidy M. Jungles
- Department of PharmacologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | - James M. Rae
- Department of PharmacologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
- Department of Internal MedicineUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | - Akshay Tate
- Department of Radiation OncologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | - Ashley N. Pearson
- Department of Radiation OncologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | - Ralph Jiang
- Department of Radiation OncologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
- Department of StatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Lars Fritsche
- Department of StatisticsUniversity of MichiganAnn ArborMichiganUSA
| | - Theodore S. Lawrence
- Department of Radiation OncologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | - Weiping Zou
- Department of StatisticsUniversity of MichiganAnn ArborMichiganUSA
- Center of Excellence for Cancer Immunology and ImmunotherapyUniversity of Michigan Rogel Cancer CenterAnn ArborMichiganUSA
- Department of PathologyUniversity of MichiganAnn ArborMichiganUSA
- Graduate Program in ImmunologyUniversity of MichiganAnn ArborMichiganUSA
| | - Matthew Schipper
- Department of Radiation OncologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
- Department of PharmacologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
| | - Nithya Ramnath
- Division of Hematology Oncology, Department of MedicineUniversity of Michigan School of MedicineAnn ArborMichiganUSA
- Division of Hematology Oncology, Department of MedicineVeterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
| | - Shinjae Yoo
- Computational Science Initiative, Brookhaven National LaboratoryUptonNew YorkUSA
| | - Silvia Crivelli
- Applied Mathematics and Computational Research Division, Lawrence Berkeley National LaboratoryBerkeleyCaliforniaUSA
| | - Michael D. Green
- Department of Radiation OncologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
- Department of Radiation Oncology, Veterans Affairs Ann Arbor Healthcare SystemAnn ArborMichiganUSA
- Graduate Program in ImmunologyUniversity of MichiganAnn ArborMichiganUSA
- Graduate Program in Cancer BiologyUniversity of MichiganAnn ArborMichiganUSA
- Department of Microbiology and ImmunologyUniversity of Michigan School of MedicineAnn ArborMichiganUSA
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8
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Nakagawa J, Fujima N, Hirata K, Harada T, Wakabayashi N, Takano Y, Homma A, Kano S, Minowa K, Kudo K. Diagnosis of skull-base invasion by nasopharyngeal tumors on CT with a deep-learning approach. Jpn J Radiol 2024; 42:450-459. [PMID: 38280100 PMCID: PMC11056334 DOI: 10.1007/s11604-023-01527-7] [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: 11/10/2023] [Accepted: 12/24/2023] [Indexed: 01/29/2024]
Abstract
PURPOSE To develop a convolutional neural network (CNN) model to diagnose skull-base invasion by nasopharyngeal malignancies in CT images and evaluate the model's diagnostic performance. MATERIALS AND METHODS We divided 100 malignant nasopharyngeal tumor lesions into a training (n = 70) and a test (n = 30) dataset. Two head/neck radiologists reviewed CT and MRI images and determined the positive/negative skull-base invasion status of each case (training dataset: 29 invasion-positive and 41 invasion-negative; test dataset: 13 invasion-positive and 17 invasion-negative). Preprocessing involved extracting continuous slices of the nasopharynx and clivus. The preprocessed training dataset was used for transfer learning with Residual Neural Networks 50 to create a diagnostic CNN model, which was then tested on the preprocessed test dataset to determine the invasion status and model performance. Original CT images from the test dataset were reviewed by a radiologist with extensive head/neck imaging experience (senior reader: SR) and another less-experienced radiologist (junior reader: JR). Gradient-weighted class activation maps (Grad-CAMs) were created to visualize the explainability of the invasion status classification. RESULTS The CNN model's diagnostic accuracy was 0.973, significantly higher than those of the two radiologists (SR: 0.838; JR: 0.595). Receiver operating characteristic curve analysis gave an area under the curve of 0.953 for the CNN model (versus 0.832 and 0.617 for SR and JR; both p < 0.05). The Grad-CAMs suggested that the invasion-negative cases were present predominantly in bone marrow, while the invasion-positive cases exhibited osteosclerosis and nasopharyngeal masses. CONCLUSIONS This CNN technique would be useful for CT-based diagnosis of skull-base invasion by nasopharyngeal malignancies.
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Affiliation(s)
- Junichi Nakagawa
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.
| | - Kenji Hirata
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
- Medical AI Research and Development Center, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Taisuke Harada
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Naoto Wakabayashi
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Yuki Takano
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita Ku, Sapporo, 060-8638, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita Ku, Sapporo, 060-8638, Japan
| | - Kazuyuki Minowa
- Faculty of Dental Medicine Department of Radiology, Hokkaido University, N13 W7, Kita-Ku, Sapporo, Hokkaido, 060-8586, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
- Department of Nuclear Medicine, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
- Medical AI Research and Development Center, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
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Wang Y, Rahman A, Duggar WN, Thomas TV, Roberts PR, Vijayakumar S, Jiao Z, Bian L, Wang H. A gradient mapping guided explainable deep neural network for extracapsular extension identification in 3D head and neck cancer computed tomography images. Med Phys 2024; 51:2007-2019. [PMID: 37643447 DOI: 10.1002/mp.16680] [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: 11/09/2022] [Revised: 07/13/2023] [Accepted: 08/03/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Diagnosis and treatment management for head and neck squamous cell carcinoma (HNSCC) is guided by routine diagnostic head and neck computed tomography (CT) scans to identify tumor and lymph node features. The extracapsular extension (ECE) is a strong predictor of patients' survival outcomes with HNSCC. It is essential to detect the occurrence of ECE as it changes staging and treatment planning for patients. Current clinical ECE detection relies on visual identification and pathologic confirmation conducted by clinicians. However, manual annotation of the lymph node region is a required data preprocessing step in most of the current machine learning-based ECE diagnosis studies. PURPOSE In this paper, we propose a Gradient Mapping Guided Explainable Network (GMGENet) framework to perform ECE identification automatically without requiring annotated lymph node region information. METHODS The gradient-weighted class activation mapping (Grad-CAM) technique is applied to guide the deep learning algorithm to focus on the regions that are highly related to ECE. The proposed framework includes an extractor and a classifier. In a joint training process, informative volumes of interest (VOIs) are extracted by the extractor without labeled lymph node region information, and the classifier learns the pattern to classify the extracted VOIs into ECE positive and negative. RESULTS In evaluation, the proposed methods are well-trained and tested using cross-validation. GMGENet achieved test accuracy and area under the curve (AUC) of 92.2% and 89.3%, respectively. GMGENetV2 achieved 90.3% accuracy and 91.7% AUC in the test. The results were compared with different existing models and further confirmed and explained by generating ECE probability heatmaps via a Grad-CAM technique. The presence or absence of ECE has been analyzed and correlated with ground truth histopathological findings. CONCLUSIONS The proposed deep network can learn meaningful patterns to identify ECE without providing lymph node contours. The introduced ECE heatmaps will contribute to the clinical implementations of the proposed model and reveal unknown features to radiologists. The outcome of this study is expected to promote the implementation of explainable artificial intelligence-assiste ECE detection.
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Affiliation(s)
- Yibin Wang
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, Mississippi, USA
| | - Abdur Rahman
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, Mississippi, USA
| | - William Neil Duggar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Toms V Thomas
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Paul Russell Roberts
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Srinivasan Vijayakumar
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Zhicheng Jiao
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Linkan Bian
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, Mississippi, USA
| | - Haifeng Wang
- Department of Industrial and Systems Engineering, Mississippi State University, Mississippi State, Mississippi, USA
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi, USA
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10
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Whitley CA, Ellis BG, Triantafyllou A, Gunning PJ, Gardner P, Barrett SD, Shaw RJ, Smith CI, Weightman P, Risk JM. Prediction of prognosis in oral squamous cell carcinoma using infrared microspectroscopy. Cancer Med 2024; 13:e7094. [PMID: 38468595 DOI: 10.1002/cam4.7094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/14/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Estimation of prognosis of oral squamous cell carcinoma (OSCC) is inaccurate prior to surgery, only being effected following subsequent pathological analysis of the primary tumour and excised lymph nodes. Consequently, a proportion of patients are overtreated, with an increase in morbidity, or undertreated, with inadequate margins and risk of recurrence. We hypothesise that it is possible to accurately characterise clinical outcomes from infrared spectra arising from diagnostic biopsies. In this first step, we correlate survival with IR spectra derived from the primary tumour. METHODS Infrared spectra were collected from tumour tissue from 29 patients with OSCC and subject to classification modelling. RESULTS The model had a median AUROC of 0.89 with regard to prognosis, a median specificity of 0.83, and a hazard ratio of 6.29 in univariate Cox proportional hazard modelling. CONCLUSION The data suggest that FTIR spectra may be a useful early biomarker of prognosis in OSCC.
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Affiliation(s)
- Conor A Whitley
- Department of Physics, University of Liverpool, Liverpool, UK
| | - Barnaby G Ellis
- Department of Physics, University of Liverpool, Liverpool, UK
| | - Asterios Triantafyllou
- Department of Pathology, Liverpool Clinical Laboratories, University of Liverpool, Liverpool, UK
| | - Philip J Gunning
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Peter Gardner
- Department of Chemical Engineering, The University of Manchester, Manchester, UK
| | - Steve D Barrett
- Department of Physics, University of Liverpool, Liverpool, UK
| | - Richard J Shaw
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
- Regional Maxillofacial Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Peter Weightman
- Department of Physics, University of Liverpool, Liverpool, UK
| | - Janet M Risk
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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11
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Hancioglu T, Pekcevik Y, Akdogan AI, Kucuk U, Ekmekci S, Arslan IB, Cukurova I. Imaging Characteristics Predictive of Cervical Extranodal Tumor Extension in Patients With Head and Neck Squamous Cell Carcinoma. J Comput Assist Tomogr 2024; 48:129-136. [PMID: 37478483 DOI: 10.1097/rct.0000000000001512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
OBJECTIVES The aims of the study were to determine the predictive imaging findings of extranodal extension (ENE) in metastatic cervical lymph nodes of head and neck squamous cell carcinoma and to investigate the interobserver agreement among radiologists with different experience levels. MATERIALS AND METHODS Patients with cervical lymph node dissection and who had metastatic lymph nodes and preoperative imaging were included. Three radiologists evaluated nodal necrosis, irregular contour, gross invasion, and perinodal fat stranding. They also noted their overall impression regarding the presence of the ENE. Sensitivity, specificity, odds ratios based on logistic regression, and interobserver agreement of ENE status were calculated. RESULTS Of 106 lymph nodes (that met inclusion criteria), 31 had radiologically determined ENE. On pathologic examination, 22 of 31 nodes were positive for ENE. The increasing number of metastatic lymph nodes was associated with the presence of the ENE ( P = 0.010). Irregular contour had the highest sensitivity (78.6%) and gross invasion had the highest specificity (96%) for the determination of the ENE. The radiologists' impression regarding the presence of the pathlogical ENE had 39.3% sensitivity and 82% specificity. Metastatic lymph nodes with a perinodal fat stranding and with the longest diameter of greater than 2 cm were found to be strong predictors of the ENE. The gross invasion demonstrated the highest κ value (0.731) among the evaluated imaging criteria. CONCLUSIONS In the assessment of ENE, the gross invasion had the highest specificity among imaging features and showed the highest interobserver agreement. Perinodal fat stranding and the longest diameter of greater than 2 cm in a metastatic lymph node were the best predictors of the ENE.
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Affiliation(s)
- Tugce Hancioglu
- From the Department of Radiology, Turgutlu State Hospital, Manisa
| | - Yeliz Pekcevik
- Department of Radiology, Izmir Health Sciences University, Tepecik Training and Research Hospital
| | - Aslı Irmak Akdogan
- Department of Radiology, Ataturk Training and Research Hospital, Katip Celebi University
| | | | | | - Ilker Burak Arslan
- Otolaryngology-Head and Neck, Izmir Health Sciences University, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ibrahim Cukurova
- Otolaryngology-Head and Neck, Izmir Health Sciences University, Tepecik Training and Research Hospital, Izmir, Turkey
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12
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Rokhshad R, Salehi SN, Yavari A, Shobeiri P, Esmaeili M, Manila N, Motamedian SR, Mohammad-Rahimi H. Deep learning for diagnosis of head and neck cancers through radiographic data: a systematic review and meta-analysis. Oral Radiol 2024; 40:1-20. [PMID: 37855976 DOI: 10.1007/s11282-023-00715-5] [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: 05/09/2023] [Accepted: 09/23/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE This study aims to review deep learning applications for detecting head and neck cancer (HNC) using magnetic resonance imaging (MRI) and radiographic data. METHODS Through January 2023, a PubMed, Scopus, Embase, Google Scholar, IEEE, and arXiv search were carried out. The inclusion criteria were implementing head and neck medical images (computed tomography (CT), positron emission tomography (PET), MRI, Planar scans, and panoramic X-ray) of human subjects with segmentation, object detection, and classification deep learning models for head and neck cancers. The risk of bias was rated with the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. For the meta-analysis diagnostic odds ratio (DOR) was calculated. Deeks' funnel plot was used to assess publication bias. MIDAS and Metandi packages were used to analyze diagnostic test accuracy in STATA. RESULTS From 1967 studies, 32 were found eligible after the search and screening procedures. According to the QUADAS-2 tool, 7 included studies had a low risk of bias for all domains. According to the results of all included studies, the accuracy varied from 82.6 to 100%. Additionally, specificity ranged from 66.6 to 90.1%, sensitivity from 74 to 99.68%. Fourteen studies that provided sufficient data were included for meta-analysis. The pooled sensitivity was 90% (95% CI 0.820.94), and the pooled specificity was 92% (CI 95% 0.87-0.96). The DORs were 103 (27-251). Publication bias was not detected based on the p-value of 0.75 in the meta-analysis. CONCLUSION With a head and neck screening deep learning model, detectable screening processes can be enhanced with high specificity and sensitivity.
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Affiliation(s)
- Rata Rokhshad
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group, AI On Health, Berlin, Germany
| | - Seyyede Niloufar Salehi
- Executive Secretary of Research Committee, Board Director of Scientific Society, Dental Faculty, Azad University, Tehran, Iran
| | - Amirmohammad Yavari
- Student Research Committee, School of Dentistry, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mahdieh Esmaeili
- Faculty of Dentistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Nisha Manila
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group, AI On Health, Berlin, Germany
- Department of Diagnostic Sciences, Louisiana State University Health Science Center School of Dentistry, Louisiana, USA
| | - Saeed Reza Motamedian
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group, AI On Health, Berlin, Germany.
- Dentofacial Deformities Research Center, Research Institute of Dental, Sciences & Department of Orthodontics, School of Dentistry, Shahid Beheshti University of Medical Sciences, Daneshjou Blvd, Tehran, Iran.
| | - Hossein Mohammad-Rahimi
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group, AI On Health, Berlin, Germany
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13
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Michelutti L, Tel A, Zeppieri M, Ius T, Sembronio S, Robiony M. The Use of Artificial Intelligence Algorithms in the Prognosis and Detection of Lymph Node Involvement in Head and Neck Cancer and Possible Impact in the Development of Personalized Therapeutic Strategy: A Systematic Review. J Pers Med 2023; 13:1626. [PMID: 38138853 PMCID: PMC10745006 DOI: 10.3390/jpm13121626] [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: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/18/2023] [Indexed: 12/24/2023] Open
Abstract
Given the increasingly important role that the use of artificial intelligence algorithms is taking on in the medical field today (especially in oncology), the purpose of this systematic review is to analyze the main reports on such algorithms applied for the prognostic evaluation of patients with head and neck malignancies. The objective of this paper is to examine the currently available literature in the field of artificial intelligence applied to head and neck oncology, particularly in the prognostic evaluation of the patient with this kind of tumor, by means of a systematic review. The paper exposes an overview of the applications of artificial intelligence in deriving prognostic information related to the prediction of survival and recurrence and how these data may have a potential impact on the choice of therapeutic strategy, making it increasingly personalized. This systematic review was written following the PRISMA 2020 guidelines.
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Affiliation(s)
- Luca Michelutti
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy (A.T.)
| | - Alessandro Tel
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy (A.T.)
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Piazzale S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Tamara Ius
- Neurosurgery Unit, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Salvatore Sembronio
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy (A.T.)
| | - Massimo Robiony
- Clinic of Maxillofacial Surgery, Head-Neck and NeuroScience Department, University Hospital of Udine, p.le S. Maria della Misericordia 15, 33100 Udine, Italy (A.T.)
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14
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Netzer N, Eith C, Bethge O, Hielscher T, Schwab C, Stenzinger A, Gnirs R, Schlemmer HP, Maier-Hein KH, Schimmöller L, Bonekamp D. Application of a validated prostate MRI deep learning system to independent same-vendor multi-institutional data: demonstration of transferability. Eur Radiol 2023; 33:7463-7476. [PMID: 37507610 PMCID: PMC10598076 DOI: 10.1007/s00330-023-09882-9] [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: 03/24/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 07/30/2023]
Abstract
OBJECTIVES To evaluate a fully automatic deep learning system to detect and segment clinically significant prostate cancer (csPCa) on same-vendor prostate MRI from two different institutions not contributing to training of the system. MATERIALS AND METHODS In this retrospective study, a previously bi-institutionally validated deep learning system (UNETM) was applied to bi-parametric prostate MRI data from one external institution (A), a PI-RADS distribution-matched internal cohort (B), and a csPCa stratified subset of single-institution external public challenge data (C). csPCa was defined as ISUP Grade Group ≥ 2 determined from combined targeted and extended systematic MRI/transrectal US-fusion biopsy. Performance of UNETM was evaluated by comparing ROC AUC and specificity at typical PI-RADS sensitivity levels. Lesion-level analysis between UNETM segmentations and radiologist-delineated segmentations was performed using Dice coefficient, free-response operating characteristic (FROC), and weighted alternative (waFROC). The influence of using different diffusion sequences was analyzed in cohort A. RESULTS In 250/250/140 exams in cohorts A/B/C, differences in ROC AUC were insignificant with 0.80 (95% CI: 0.74-0.85)/0.87 (95% CI: 0.83-0.92)/0.82 (95% CI: 0.75-0.89). At sensitivities of 95% and 90%, UNETM achieved specificity of 30%/50% in A, 44%/71% in B, and 43%/49% in C, respectively. Dice coefficient of UNETM and radiologist-delineated lesions was 0.36 in A and 0.49 in B. The waFROC AUC was 0.67 (95% CI: 0.60-0.83) in A and 0.7 (95% CI: 0.64-0.78) in B. UNETM performed marginally better on readout-segmented than on single-shot echo-planar-imaging. CONCLUSION For same-vendor examinations, deep learning provided comparable discrimination of csPCa and non-csPCa lesions and examinations between local and two independent external data sets, demonstrating the applicability of the system to institutions not participating in model training. CLINICAL RELEVANCE STATEMENT A previously bi-institutionally validated fully automatic deep learning system maintained acceptable exam-level diagnostic performance in two independent external data sets, indicating the potential of deploying AI models without retraining or fine-tuning, and corroborating evidence that AI models extract a substantial amount of transferable domain knowledge about MRI-based prostate cancer assessment. KEY POINTS • A previously bi-institutionally validated fully automatic deep learning system maintained acceptable exam-level diagnostic performance in two independent external data sets. • Lesion detection performance and segmentation congruence was similar on the institutional and an external data set, as measured by the weighted alternative FROC AUC and Dice coefficient. • Although the system generalized to two external institutions without re-training, achieving expected sensitivity and specificity levels using the deep learning system requires probability thresholds to be adjusted, underlining the importance of institution-specific calibration and quality control.
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Affiliation(s)
- Nils Netzer
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Heidelberg University Medical School, Heidelberg, Germany
| | - Carolin Eith
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- Heidelberg University Medical School, Heidelberg, Germany
| | - Oliver Bethge
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Thomas Hielscher
- Division of Biostatistics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Constantin Schwab
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Albrecht Stenzinger
- Institute of Pathology, University of Heidelberg Medical Center, Heidelberg, Germany
| | - Regula Gnirs
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Heinz-Peter Schlemmer
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
- National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
| | - Klaus H Maier-Hein
- National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany
- Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | - Lars Schimmöller
- Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - David Bonekamp
- Division of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
- Heidelberg University Medical School, Heidelberg, Germany.
- German Cancer Consortium (DKTK), Heidelberg, Germany.
- National Center for Tumor Diseases (NCT) Heidelberg, Heidelberg, Germany.
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Kang J, Chowdhry AK, Pugh SL, Park JH. Integrating Artificial Intelligence and Machine Learning Into Cancer Clinical Trials. Semin Radiat Oncol 2023; 33:386-394. [PMID: 37684068 PMCID: PMC10880815 DOI: 10.1016/j.semradonc.2023.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
The practice of oncology requires analyzing and synthesizing abundant data. From the patient's workup to determine eligibility to the therapies received to the post-treatment surveillance, practitioners must constantly juggle, evaluate, and weigh decision-making based on their best understanding of information at hand. These complex, multifactorial decisions have a tremendous opportunity to benefit from data-driven machine learning (ML) methods to drive opportunities in artificial intelligence (AI). Within the past 5 years, we have seen AI move from simply a promising opportunity to being used in prospective trials. Here, we review recent efforts of AI in clinical trials that have moved the needle towards improved prediction of actionable outcomes, such as predicting acute care visits, short term mortality, and pathologic extranodal extension. We then pause and reflect on how these AI models ask a different question than traditional statistics models that readers may be more familiar with; how then should readers conceptualize and interpret AI models that they are not as familiar with. We end with what we believe are promising future opportunities for AI in oncology, with an eye towards allowing the data to inform us through unsupervised learning and generative models, rather than asking AI to perform specific functions.
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Affiliation(s)
- John Kang
- Department of Radiation Oncology, University of Washington, Seattle, WA..
| | - Amit K Chowdhry
- Department of Radiation Oncology, University of Rochester, Rochester, NY
| | - Stephanie L Pugh
- American College of Radiology, NRG Oncology Statistics and Data Management Center, Philadelphia PA
| | - John H Park
- Department of Radiation Oncology, Kansas City VA Medical Center, Kansas City, MO.; Department of Radiology, University of Missouri Kansas City School of Medicine, Kansas City, MO
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16
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Zhong NN, Wang HQ, Huang XY, Li ZZ, Cao LM, Huo FY, Liu B, Bu LL. Enhancing head and neck tumor management with artificial intelligence: Integration and perspectives. Semin Cancer Biol 2023; 95:52-74. [PMID: 37473825 DOI: 10.1016/j.semcancer.2023.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 07/22/2023]
Abstract
Head and neck tumors (HNTs) constitute a multifaceted ensemble of pathologies that primarily involve regions such as the oral cavity, pharynx, and nasal cavity. The intricate anatomical structure of these regions poses considerable challenges to efficacious treatment strategies. Despite the availability of myriad treatment modalities, the overall therapeutic efficacy for HNTs continues to remain subdued. In recent years, the deployment of artificial intelligence (AI) in healthcare practices has garnered noteworthy attention. AI modalities, inclusive of machine learning (ML), neural networks (NNs), and deep learning (DL), when amalgamated into the holistic management of HNTs, promise to augment the precision, safety, and efficacy of treatment regimens. The integration of AI within HNT management is intricately intertwined with domains such as medical imaging, bioinformatics, and medical robotics. This article intends to scrutinize the cutting-edge advancements and prospective applications of AI in the realm of HNTs, elucidating AI's indispensable role in prevention, diagnosis, treatment, prognostication, research, and inter-sectoral integration. The overarching objective is to stimulate scholarly discourse and invigorate insights among medical practitioners and researchers to propel further exploration, thereby facilitating superior therapeutic alternatives for patients.
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Affiliation(s)
- Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Han-Qi Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Xin-Yue Huang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Zi-Zhan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Fang-Yi Huo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China.
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China; Department of Oral & Maxillofacial - Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China.
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17
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Henson CE, Abou-Foul AK, Morton DJ, McDowell L, Baliga S, Bates J, Lee A, Bonomo P, Szturz P, Nankivell P, Huang SH, Lydiatt WM, O’Sullivan B, Mehanna H. Diagnostic challenges and prognostic implications of extranodal extension in head and neck cancer: a state of the art review and gap analysis. Front Oncol 2023; 13:1263347. [PMID: 37799466 PMCID: PMC10548228 DOI: 10.3389/fonc.2023.1263347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
Extranodal extension (ENE) is a pattern of cancer growth from within the lymph node (LN) outward into perinodal tissues, critically defined by disruption and penetration of the tumor through the entire thickness of the LN capsule. The presence of ENE is often associated with an aggressive cancer phenotype in various malignancies including head and neck squamous cell carcinoma (HNSCC). In HNSCC, ENE is associated with increased risk of distant metastasis and lower rates of locoregional control. ENE detected on histopathology (pathologic ENE; pENE) is now incorporated as a risk-stratification factor in human papillomavirus (HPV)-negative HNSCC in the eighth edition of the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) TNM classification. Although ENE was first described almost a century ago, several issues remain unresolved, including lack of consensus on definitions, terminology, and widely accepted assessment criteria and grading systems for both pENE and ENE detected on radiological imaging (imaging-detected ENE; iENE). Moreover, there is conflicting data on the prognostic significance of iENE and pENE, particularly in the context of HPV-associated HNSCC. Herein, we review the existing literature on ENE in HNSCC, highlighting areas of controversy and identifying critical gaps requiring concerted research efforts.
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Affiliation(s)
- Christina E. Henson
- Department of Radiation Oncology and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Ahmad K. Abou-Foul
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Daniel J. Morton
- Department of Pediatrics and Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lachlan McDowell
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sujith Baliga
- Department of Radiation Oncology, Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - James Bates
- Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, United States
| | - Anna Lee
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Pierluigi Bonomo
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Petr Szturz
- Department of Oncology, University of Lausanne and Lausanne University Hospital, Lausanne, Switzerland
| | - Paul Nankivell
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - William M. Lydiatt
- Department of Surgery, Creighton University, and Nebraska Methodist Health System, Omaha, NE, United States
| | - Brian O’Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Hisham Mehanna
- Institute of Head and Neck Studies and Education, School of Cancer Sciences, University of Birmingham, Birmingham, United Kingdom
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18
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Huang TT, Lin YC, Yen CH, Lan J, Yu CC, Lin WC, Chen YS, Wang CK, Huang EY, Ho SY. Prediction of extranodal extension in head and neck squamous cell carcinoma by CT images using an evolutionary learning model. Cancer Imaging 2023; 23:84. [PMID: 37700385 PMCID: PMC10496246 DOI: 10.1186/s40644-023-00601-7] [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: 05/02/2023] [Accepted: 08/08/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND Extranodal extension (ENE) in head and neck squamous cell carcinoma (HNSCC) correlates to poor prognoses and influences treatment strategies. Deep learning may yield promising performance of predicting ENE in HNSCC but lack of transparency and interpretability. This work proposes an evolutionary learning method, called EL-ENE, to establish a more interpretable ENE prediction model for aiding clinical diagnosis. METHODS There were 364 HNSCC patients who underwent neck lymph node (LN) dissection with pre-operative contrast-enhanced computerized tomography images. All the 778 LNs were divided into training and test sets with the ratio 8:2. EL-ENE uses an inheritable bi-objective combinatorial genetic algorithm for optimal feature selection and parameter setting of support vector machine. The diagnostic performances of the ENE prediction model and radiologists were compared using independent test datasets. RESULTS The EL-ENE model achieved the test accuracy of 80.00%, sensitivity of 81.13%, and specificity of 79.44% for ENE detection. The three radiologists achieved the mean diagnostic accuracy of 70.4%, sensitivity of 75.6%, and specificity of 67.9%. The features of gray-level texture and 3D morphology of LNs played essential roles in predicting ENE. CONCLUSIONS The EL-ENE method provided an accurate, comprehensible, and robust model to predict ENE in HNSCC with interpretable radiomic features for expanding clinical knowledge. The proposed transparent prediction models are more trustworthy and may increase their acceptance in daily clinical practice.
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Affiliation(s)
- Tzu-Ting Huang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 129, Dapi Road, Niaosong District, Kaohsiung, Taiwan
- Institute of Computer Science and Engineering, National Yang Ming Chiao Tung University, No. 1001 University Road, Hsinchu, Taiwan
| | - Yi-Chen Lin
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, No. 75 Po- Ai Street, Hsinchu, Taiwan
| | - Chia-Heng Yen
- Institute of Computer Science and Engineering, National Yang Ming Chiao Tung University, No. 1001 University Road, Hsinchu, Taiwan
| | - Jui Lan
- Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan
| | - Chiun-Chieh Yu
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan
| | - Wei-Che Lin
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan
| | - Yueh-Shng Chen
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan
| | - Cheng-Kang Wang
- Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Dapi Road, Niaosong District, Kaohsiung, Taiwan
| | - Eng-Yen Huang
- Department of Radiation Oncology and Proton & Radiation Therapy Center, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 129, Dapi Road, Niaosong District, Kaohsiung, Taiwan.
- School of Medicine, College of Medicine, National Sun Yat-sen University, No. 70, Lienhai Rd, 80424, Kaohsiung, Taiwan.
| | - Shinn-Ying Ho
- Institute of Bioinformatics and Systems Biology, National Yang Ming Chiao Tung University, No. 75 Po- Ai Street, Hsinchu, Taiwan.
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, No. 1001 University Road, Hsinchu, Taiwan.
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS 2 B), National Yang Ming Chiao Tung University, No. 75 Po-Ai Street, Hsinchu, Taiwan.
- College of Health Sciences, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Sanmin District, Kaohsiung, Taiwan.
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Bhattacharya K, Mahajan A, Vaish R, Rane S, Shukla S, D'Cruz AK. Imaging of Neck Nodes in Head and Neck Cancers - a Comprehensive Update. Clin Oncol (R Coll Radiol) 2023; 35:429-445. [PMID: 37061456 DOI: 10.1016/j.clon.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 02/08/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023]
Abstract
Cervical lymph node metastases from head and neck squamous cell cancers significantly reduce disease-free survival and worsen overall prognosis and, hence, deserve more aggressive management and follow-up. As per the eighth edition of the American Joint Committee on Cancer staging manual, extranodal extension, especially in human papillomavirus-negative cancers, has been incorporated in staging as it is important in deciding management and significantly impacts the outcome of head and neck squamous cell cancer. Lymph node imaging with various radiological modalities, including ultrasound, computed tomography and magnetic resonance imaging, has been widely used, not only to demonstrate nodal involvement but also for guided histopathological evaluation and therapeutic intervention. Computed tomography and magnetic resonance imaging, together with positron emission tomography, are used widely for the follow-up of treated patients. Finally, there is an emerging role for artificial intelligence in neck node imaging that has shown promising results, increasing the accuracy of detection of nodal involvement, especially normal-appearing nodes. The aim of this review is to provide a comprehensive overview of the diagnosis and management of involved neck nodes with a focus on sentinel node anatomy, pathogenesis, imaging correlates (including radiogenomics and artificial intelligence) and the role of image-guided interventions.
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Affiliation(s)
- K Bhattacharya
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - A Mahajan
- The Clatterbridge Cancer Centre, NHS Foundation Trust, Liverpool, UK.
| | - R Vaish
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Rane
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - S Shukla
- Homi Bhabha Cancer Hospital, Varanasi, Uttar Pradesh, India
| | - A K D'Cruz
- Apollo Hospitals, India; Union International Cancer Control (UICC), Geneva, Switzerland; Foundation of Head Neck Oncology, India
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20
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Song B, Yang K, Viswanathan VS, Wang X, Lee J, Stock S, Fu P, Lu C, Koyfman S, Lewis JS, Madabhushi A. CT radiomic signature predicts survival and chemotherapy benefit in stage I and II HPV-associated oropharyngeal carcinoma. NPJ Precis Oncol 2023; 7:53. [PMID: 37268691 DOI: 10.1038/s41698-023-00404-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023] Open
Abstract
Chemoradiation is a common therapeutic regimen for human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC). However, not all patients benefit from chemotherapy, especially patients with low-risk characteristics. We aim to develop and validate a prognostic and predictive radiomic image signature (pRiS) to inform survival and chemotherapy benefit using computed tomography (CT) scans from 491 stage I and II HPV-associated OPSCC, which were divided into three cohorts D1-D3. The prognostic performance of pRiS was evaluated on two test sets (D2, n = 162; D3, n = 269) using concordance index. Patients from D2 and D3 who received either radiotherapy alone or chemoradiation were used to validate pRiS as predictive of added benefit of chemotherapy. Seven features were selected to construct pRiS, which was found to be prognostic of overall survival (OS) on univariate analysis in D2 (hazard ratio [HR] = 2.14, 95% confidence interval [CI], 1.1-4.16, p = 0.02) and D3 (HR = 2.74, 95% CI, 1.34-5.62, p = 0.006). Chemotherapy was associated with improved OS for high-pRiS patients in D2 (radiation vs chemoradiation, HR = 4.47, 95% CI, 1.73-11.6, p = 0.002) and D3 (radiation vs chemoradiation, HR = 2.99, 95% CI, 1.04-8.63, p = 0.04). In contrast, chemotherapy did not improve OS for low-pRiS patients, which indicates these patients did not derive additional benefit from chemotherapy and could be considered for treatment de-escalation. The proposed radiomic signature was prognostic of patient survival and informed benefit from chemotherapy for stage I and II HPV-associated OPSCC patients.
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Affiliation(s)
- Bolin Song
- Center for Computational Imaging and Personalized Diagnostics, Emory University, Atlanta, GA, USA
| | - Kailin Yang
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - Vidya Sankar Viswanathan
- Center for Computational Imaging and Personalized Diagnostics, Emory University, Atlanta, GA, USA
| | - Xiangxue Wang
- School of Automation, Nanjing University of Information Science and Technology, Nanjing, China
| | - Jonathan Lee
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sarah Stock
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pingfu Fu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Cheng Lu
- Center for Computational Imaging and Personalized Diagnostics, Emory University, Atlanta, GA, USA
| | - Shlomo Koyfman
- Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH, USA
| | - James S Lewis
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anant Madabhushi
- Center for Computational Imaging and Personalized Diagnostics, Emory University, Atlanta, GA, USA.
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, OH, USA.
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21
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Kann BH, Likitlersuang J, Bontempi D, Ye Z, Aneja S, Bakst R, Kelly HR, Juliano AF, Payabvash S, Guenette JP, Uppaluri R, Margalit DN, Schoenfeld JD, Tishler RB, Haddad R, Aerts HJWL, Garcia JJ, Flamand Y, Subramaniam RM, Burtness BA, Ferris RL. Screening for extranodal extension in HPV-associated oropharyngeal carcinoma: evaluation of a CT-based deep learning algorithm in patient data from a multicentre, randomised de-escalation trial. Lancet Digit Health 2023; 5:e360-e369. [PMID: 37087370 PMCID: PMC10245380 DOI: 10.1016/s2589-7500(23)00046-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/18/2023] [Accepted: 02/21/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Pretreatment identification of pathological extranodal extension (ENE) would guide therapy de-escalation strategies for in human papillomavirus (HPV)-associated oropharyngeal carcinoma but is diagnostically challenging. ECOG-ACRIN Cancer Research Group E3311 was a multicentre trial wherein patients with HPV-associated oropharyngeal carcinoma were treated surgically and assigned to a pathological risk-based adjuvant strategy of observation, radiation, or concurrent chemoradiation. Despite protocol exclusion of patients with overt radiographic ENE, more than 30% had pathological ENE and required postoperative chemoradiation. We aimed to evaluate a CT-based deep learning algorithm for prediction of ENE in E3311, a diagnostically challenging cohort wherein algorithm use would be impactful in guiding decision-making. METHODS For this retrospective evaluation of deep learning algorithm performance, we obtained pretreatment CTs and corresponding surgical pathology reports from the multicentre, randomised de-escalation trial E3311. All enrolled patients on E3311 required pretreatment and diagnostic head and neck imaging; patients with radiographically overt ENE were excluded per study protocol. The lymph node with largest short-axis diameter and up to two additional nodes were segmented on each scan and annotated for ENE per pathology reports. Deep learning algorithm performance for ENE prediction was compared with four board-certified head and neck radiologists. The primary endpoint was the area under the curve (AUC) of the receiver operating characteristic. FINDINGS From 178 collected scans, 313 nodes were annotated: 71 (23%) with ENE in general, 39 (13%) with ENE larger than 1 mm ENE. The deep learning algorithm AUC for ENE classification was 0·86 (95% CI 0·82-0·90), outperforming all readers (p<0·0001 for each). Among radiologists, there was high variability in specificity (43-86%) and sensitivity (45-96%) with poor inter-reader agreement (κ 0·32). Matching the algorithm specificity to that of the reader with highest AUC (R2, false positive rate 22%) yielded improved sensitivity to 75% (+ 13%). Setting the algorithm false positive rate to 30% yielded 90% sensitivity. The algorithm showed improved performance compared with radiologists for ENE larger than 1 mm (p<0·0001) and in nodes with short-axis diameter 1 cm or larger. INTERPRETATION The deep learning algorithm outperformed experts in predicting pathological ENE on a challenging cohort of patients with HPV-associated oropharyngeal carcinoma from a randomised clinical trial. Deep learning algorithms should be evaluated prospectively as a treatment selection tool. FUNDING ECOG-ACRIN Cancer Research Group and the National Cancer Institute of the US National Institutes of Health.
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Affiliation(s)
- Benjamin H Kann
- Department of Radiation Oncology, Harvard Medical School, Boston, MA, USA; Mass General Brigham Artificial Intelligence in Medicine Program, Boston, MA, USA.
| | - Jirapat Likitlersuang
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Mass General Brigham Artificial Intelligence in Medicine Program, Boston, MA, USA
| | - Dennis Bontempi
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Mass General Brigham Artificial Intelligence in Medicine Program, Boston, MA, USA
| | - Zezhong Ye
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Mass General Brigham Artificial Intelligence in Medicine Program, Boston, MA, USA
| | - Sanjay Aneja
- Department of Therapeutic Radiology, New Haven, CT, USA
| | - Richard Bakst
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Amy F Juliano
- Mass Eye and Ear, Mass General Hospital, Boston, MA, USA
| | | | - Jeffrey P Guenette
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ravindra Uppaluri
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Danielle N Margalit
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan D Schoenfeld
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roy B Tishler
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Haddad
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Hugo J W L Aerts
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Mass General Brigham Artificial Intelligence in Medicine Program, Boston, MA, USA; Department of Radiology, Maastricht University, Maastricht, Netherlands
| | | | - Yael Flamand
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, ECOG-ACRIN Biostatistics Center, Boston, MA, USA
| | - Rathan M Subramaniam
- Department of Radiology and Nuclear Medicine, University of Notre Dame Australia, Sydney, NSW, Australia; Department of Radiology, Duke University, Durham, NC, USA
| | | | - Robert L Ferris
- Department of Otolaryngology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
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Avery EW, Joshi K, Mehra S, Mahajan A. Role of PET/CT in Oropharyngeal Cancers. Cancers (Basel) 2023; 15:2651. [PMID: 37174116 PMCID: PMC10177278 DOI: 10.3390/cancers15092651] [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: 01/24/2023] [Revised: 04/03/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
Oropharyngeal squamous cell carcinoma (OPSCC) comprises cancers of the tonsils, tongue base, soft palate, and uvula. The staging of oropharyngeal cancers varies depending upon the presence or absence of human papillomavirus (HPV)-directed pathogenesis. The incidence of HPV-associated oropharyngeal cancer (HPV + OPSCC) is expected to continue to rise over the coming decades. PET/CT is a useful modality for the diagnosis, staging, and follow up of patients with oropharyngeal cancers undergoing treatment and surveillance.
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Affiliation(s)
- Emily W. Avery
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Kavita Joshi
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Saral Mehra
- Department of Otolaryngology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520, USA
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23
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Zhang Z, Wei X. Artificial intelligence-assisted selection and efficacy prediction of antineoplastic strategies for precision cancer therapy. Semin Cancer Biol 2023; 90:57-72. [PMID: 36796530 DOI: 10.1016/j.semcancer.2023.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 02/16/2023]
Abstract
The rapid development of artificial intelligence (AI) technologies in the context of the vast amount of collectable data obtained from high-throughput sequencing has led to an unprecedented understanding of cancer and accelerated the advent of a new era of clinical oncology with a tone of precision treatment and personalized medicine. However, the gains achieved by a variety of AI models in clinical oncology practice are far from what one would expect, and in particular, there are still many uncertainties in the selection of clinical treatment options that pose significant challenges to the application of AI in clinical oncology. In this review, we summarize emerging approaches, relevant datasets and open-source software of AI and show how to integrate them to address problems from clinical oncology and cancer research. We focus on the principles and procedures for identifying different antitumor strategies with the assistance of AI, including targeted cancer therapy, conventional cancer therapy, and cancer immunotherapy. In addition, we also highlight the current challenges and directions of AI in clinical oncology translation. Overall, we hope this article will provide researchers and clinicians with a deeper understanding of the role and implications of AI in precision cancer therapy, and help AI move more quickly into accepted cancer guidelines.
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Affiliation(s)
- Zhe Zhang
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, PR China; State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, and Collaborative Innovation Center for Biotherapy, Chengdu 610041, PR China
| | - Xiawei Wei
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy and Cancer Center, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, PR China.
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24
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Gong Y, Bao L, Xu T, Yi X, Chen J, Wang S, Pan Z, Huang P, Ge M. The tumor ecosystem in head and neck squamous cell carcinoma and advances in ecotherapy. Mol Cancer 2023; 22:68. [PMID: 37024932 PMCID: PMC10077663 DOI: 10.1186/s12943-023-01769-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/27/2023] [Indexed: 04/08/2023] Open
Abstract
The development of head and neck squamous cell carcinoma (HNSCC) is a multi-step process, and its survival depends on a complex tumor ecosystem, which not only promotes tumor growth but also helps to protect tumor cells from immune surveillance. With the advances of existing technologies and emerging models for ecosystem research, the evidence for cell-cell interplay is increasing. Herein, we discuss the recent advances in understanding the interaction between tumor cells, the major components of the HNSCC tumor ecosystem, and summarize the mechanisms of how biological and abiotic factors affect the tumor ecosystem. In addition, we review the emerging ecological treatment strategy for HNSCC based on existing studies.
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Affiliation(s)
- Yingying Gong
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Lisha Bao
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Tong Xu
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xiaofen Yi
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Jinming Chen
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Shanshan Wang
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China
| | - Zongfu Pan
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang Provincial People's Hospital, Hangzhou, China.
- Clinical Research Center for Cancer of Zhejiang Province, Hangzhou, People's Republic of China.
| | - Ping Huang
- Center for Clinical Pharmacy, Cancer Center, Department of Pharmacy, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang Provincial People's Hospital, Hangzhou, China.
- Clinical Research Center for Cancer of Zhejiang Province, Hangzhou, People's Republic of China.
| | - Minghua Ge
- Otolaryngology & Head and Neck Center, Cancer Center, Department of Head and Neck Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, China.
- Key Laboratory of Endocrine Gland Diseases of Zhejiang Province, Zhejiang Provincial People's Hospital, Hangzhou, China.
- Clinical Research Center for Cancer of Zhejiang Province, Hangzhou, People's Republic of China.
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Radiomics Applications in Head and Neck Tumor Imaging: A Narrative Review. Cancers (Basel) 2023; 15:cancers15041174. [PMID: 36831517 PMCID: PMC9954362 DOI: 10.3390/cancers15041174] [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: 12/21/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Recent advances in machine learning and artificial intelligence technology have ensured automated evaluation of medical images. As a result, quantifiable diagnostic and prognostic biomarkers have been created. We discuss radiomics applications for the head and neck region in this paper. Molecular characterization, categorization, prognosis and therapy recommendation are given special consideration. In a narrative manner, we outline the fundamental technological principles, the overall idea and usual workflow of radiomic analysis and what seem to be the present and potential challenges in normal clinical practice. Clinical oncology intends for all of this to ensure informed decision support for personalized and useful cancer treatment. Head and neck cancers present a unique set of diagnostic and therapeutic challenges. These challenges are brought on by the complicated anatomy and heterogeneity of the area under investigation. Radiomics has the potential to address these barriers. Future research must be interdisciplinary and focus on the study of certain oncologic functions and outcomes, with external validation and multi-institutional cooperation in order to achieve this.
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Duggar WN, Vengaloor Thomas T, Wang Y, Rahman A, Wang H, Roberts PR, Bian L, Gatewood RT, Vijayakumar S. Preoperative Prediction and Identification of Extracapsular Extension in Head and Neck Cancer Patients: Progress and Potential. Cureus 2023; 15:e34769. [PMID: 36909098 PMCID: PMC10001423 DOI: 10.7759/cureus.34769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 02/11/2023] Open
Abstract
Background This study aimed to demonstrate both the potential and development progress in the identification of extracapsular nodal extension in head and neck cancer patients prior to surgery. Methodology A deep learning model has been developed utilizing multilayer gradient mapping-guided explainable network architecture involving a volume extractor. In addition, the gradient-weighted class activation mapping approach has been appropriated to generate a heatmap of anatomic regions indicating why the algorithm predicted extension or not. Results The prediction model shows excellent performance on the testing dataset with high values of accuracy, the area under the curve, sensitivity, and specificity of 0.926, 0.945, 0.924, and 0.930, respectively. The heatmap results show potential usefulness for some select patients but indicate the need for further training as the results may be misleading for other patients. Conclusions This work demonstrates continued progress in the identification of extracapsular nodal extension in diagnostic computed tomography prior to surgery. Continued progress stands to see the obvious potential realized where not only can unnecessary multimodality therapy be avoided but necessary therapy can be guided on a patient-specific level with information that currently is not available until postoperative pathology is complete.
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Affiliation(s)
- William N Duggar
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | | | - Yibin Wang
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Abdur Rahman
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Haifeng Wang
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Paul R Roberts
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
| | - Linkan Bian
- Industrial Systems and Engineering, Mississippi State University, Starkville, USA
| | - Ronald T Gatewood
- Radiation Oncology, University of Mississippi Medical Center, Jackson, USA
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Bladder Cancer Radiation Oncology of the Future: Prognostic Modelling, Radiomics, and Treatment Planning With Artificial Intelligence. Semin Radiat Oncol 2023; 33:70-75. [PMID: 36517196 DOI: 10.1016/j.semradonc.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Machine learning (ML) and artificial intelligence (AI) have demonstrated potential to improve the care of radiation oncology patients. Here we review recent advances applicable to the care of bladder cancer, with an eye towards studies that may suggest next steps in clinical implementation. Algorithms have been applied to clinical records, pathology, and radiology data to generate accurate predictive models for prognosis and clinical outcomes. AI has also shown increasing utility for auto-contouring and efficient creation of workflows involving multiple treatment plans. As technologies progress towards routine clinical use for bladder cancer patients, we also discuss emerging methods to improve interpretability and reliability of algorithms.
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Best DL, Jazayeri HE, McHugh JB, Udager AM, Troost JP, Powell C, Moe J. Extent of Extranodal Extension in Oral Cavity Squamous Cell Carcinoma is Not Independently Associated With Overall or Disease-Free Survival at a 2.0-mm Threshold. J Oral Maxillofac Surg 2022; 80:1978-1988. [PMID: 36179764 DOI: 10.1016/j.joms.2022.08.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The presence of extranodal extension (ENE) conveys a poor prognosis in oral cavity squamous cell carcinoma (OSCC); however, there is no consensus regarding whether the histopathologic extent of ENE (e-ENE) may be a more discriminating prognostic indicator. The purpose of this study was to assess the impact of minor ENE (<2.0 mm) versus major ENE (≥ 2.0 mm) on overall survival (OS) and disease-free survival (DFS) in OSCC. MATERIALS AND METHODS A single-institution, retrospective cohort study was designed using an electronic medical record review. Inclusion criteria included patients with OSCC and cervical node metastasis. All subjects were treated between the years 2009 and 2017 in the Michigan Medicine Department of Oral and Maxillofacial Surgery (Ann Arbor, Michigan). The primary predictor variable was e-ENE, measured as the maximum distance of tumor invasion into extranodal tissue from the outer aspect of the nodal capsule. Primary outcome variables were OS and DFS. Other covariates included demographic data, tumor staging, and histopathologic data. Descriptive statistics were performed. Kaplan-Meier survival plots for OS and DFS were performed. The data were mined for an alternative threshold at which e-ENE may impact survival using Cox proportional hazards models. RESULTS One hundred sixty eight subjects were included (91 ENE-negative, 48 minor ENE, and 29 major ENE). Most subjects were male (62%) and the mean age was 62.9 years. Mean follow-up time was 2.97 +/- 2.76 years. There was no statistically significant difference in OS or DFS between minor and major ENE. Five-year OS for minor ENE was 30.4% versus 20.7% for major ENE (P = .28). Five-year DFS for minor ENE was 26.7% versus 18.1% for major ENE (P = .30). Five-year OS and DFS was worse for subjects with ENE-positive disease versus ENE-negative disease (OS: 26.9% vs 63.1%, hazard ratio [HR]: 2.70, 95% confidence interval [CI]: [1.77, 4.10], P < .001; DFS: 23.7% vs 59.7%, HR = 2.55, 95% CI [1.71, 3.79], P < .001). At an alternative threshold of 0.9 mm e-ENE, there was greater DFS in subjects with e-ENE 0.1-0.9 mm versus e-ENE > 0.9 (40.6% vs 18.9%, respectively) (HR = 0.49, 95% CI [0.24, 0.99], P = .047). CONCLUSION There was no independent association between survival and e-ENE at a 2.0-mm threshold.
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Affiliation(s)
- David L Best
- Resident, Oral and Maxillofacial Surgery, Michigan Medicine, Ann Arbor, MI.
| | - Hossein E Jazayeri
- Resident, Oral and Maxillofacial Surgery, Michigan Medicine, Ann Arbor, MI
| | - Jonathan B McHugh
- Professor, Department of Pathology, Michigan Medicine, Ann Arbor, MI
| | - Aaron M Udager
- Clinical Associate Professor, Department of Pathology, Michigan Medicine, Ann Arbor, MI
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI
| | - Corey Powell
- Consulting for Statistics, Computing, and Analytics Research, University of Michigan, Ann Arbor, MI
| | - Justine Moe
- Assistant Professor and Residency Program Director, Oral and Maxillofacial Surgery, Associate Director, Oncology/Microvascular Surgery Fellowship, Michigan Medicine, Ann Arbor, MI
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Morey T, Hodge J, Stern C, Krishnan S, Foreman A. Correlation between radiologic and pathologic extranodal extension in HPV-associated oropharyngeal cancer: Systematic review. Head Neck 2022; 44:2875-2885. [PMID: 36071683 PMCID: PMC9826216 DOI: 10.1002/hed.27183] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023] Open
Abstract
Pretreatment determination of extranodal extension (ENE) has significant clinical implications in human papillomavirus positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC). Unfortunately there is no gold-standard imaging modality for radiological assessment of ENE in HPV+ OPSCC, leading to subjective assessments and complex decision making concerning ENE. A systematic review of diagnostic test accuracy was therefore undertaken, with five databases systemically searched to evaluate the diagnostic performance of an imaging modality for detection of ENE in HPV+ OPSCC. A meta-analysis was conducted on four CT studies using a random-effects model. While a narrative synthesis was provided for the studies using PET/CT and "CT and MRI." Out of 1772 hits, six studies were included in the review. Meta-analysis on four CT studies showed CT had an overall sensitivity of 77% and specificity of 60%. PET/CT had a sensitivity of 37.5% and specificity of 97%. "CT and MRI" had a sensitivity of 62% and specificity of 78%. Further diagnostic studies involving CT, PET/CT and MRI are ultimately required.
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Affiliation(s)
- Tristan Morey
- JBI, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - John‐Charles Hodge
- Department of Otolaryngology ‐ Head and Neck SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Cindy Stern
- JBI, Faculty of Health and Medical SciencesThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Suren Krishnan
- Department of Otolaryngology ‐ Head and Neck SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
| | - Andrew Foreman
- Department of Otolaryngology ‐ Head and Neck SurgeryRoyal Adelaide HospitalAdelaideSouth AustraliaAustralia
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Potnis KC, Ross JS, Aneja S, Gross CP, Richman IB. Artificial Intelligence in Breast Cancer Screening: Evaluation of FDA Device Regulation and Future Recommendations. JAMA Intern Med 2022; 182:1306-1312. [PMID: 36342705 PMCID: PMC10623674 DOI: 10.1001/jamainternmed.2022.4969] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Importance Contemporary approaches to artificial intelligence (AI) based on deep learning have generated interest in the application of AI to breast cancer screening (BCS). The US Food and Drug Administration (FDA) has approved several next-generation AI products indicated for BCS in recent years; however, questions regarding their accuracy, appropriate use, and clinical utility remain. Objectives To describe the current FDA regulatory process for AI products, summarize the evidence used to support FDA clearance and approval of AI products indicated for BCS, consider the advantages and limitations of current regulatory approaches, and suggest ways to improve the current system. Evidence Review Premarket notifications and other publicly available documents used for FDA clearance and approval of AI products indicated for BCS from January 1, 2017, to December 31, 2021. Findings Nine AI products indicated for BCS for identification of suggestive lesions and mammogram triage were included. Most of the products had been cleared through the 510(k) pathway, and all clearances were based on previously collected retrospective data; 6 products used multicenter designs; 7 products used enriched data; and 4 lacked details on whether products were externally validated. Test performance measures, including sensitivity, specificity, and area under the curve, were the main outcomes reported. Most of the devices used tissue biopsy as the criterion standard for BCS accuracy evaluation. Other clinical outcome measures, including cancer stage at diagnosis and interval cancer detection, were not reported for any of the devices. Conclusions and Relevance The findings of this review suggest important gaps in reporting of data sources, data set type, validation approach, and clinical utility assessment. As AI-assisted reading becomes more widespread in BCS and other radiologic examinations, strengthened FDA evidentiary regulatory standards, development of postmarketing surveillance, a focus on clinically meaningful outcomes, and stakeholder engagement will be critical for ensuring the safety and efficacy of these products.
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Affiliation(s)
| | - Joseph S Ross
- Section of General Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Sanjay Aneja
- Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, Connecticut
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, Connecticut
| | - Cary P Gross
- Section of General Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Ilana B Richman
- Section of General Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Cancer Outcomes, Public Policy, and Effectiveness Research Center, Yale School of Medicine, New Haven, Connecticut
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Santer M, Kloppenburg M, Gottfried TM, Runge A, Schmutzhard J, Vorbach SM, Mangesius J, Riedl D, Mangesius S, Widmann G, Riechelmann H, Dejaco D, Freysinger W. Current Applications of Artificial Intelligence to Classify Cervical Lymph Nodes in Patients with Head and Neck Squamous Cell Carcinoma-A Systematic Review. Cancers (Basel) 2022; 14:5397. [PMID: 36358815 PMCID: PMC9654953 DOI: 10.3390/cancers14215397] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 10/28/2022] [Accepted: 10/29/2022] [Indexed: 07/22/2023] Open
Abstract
Locally-advanced head and neck squamous cell carcinoma (HNSCC) is mainly defined by the presence of pathologic cervical lymph nodes (LNs) with or without extracapsular spread (ECS). Current radiologic criteria to classify LNs as non-pathologic, pathologic, or pathologic with ECS are primarily shape-based. However, significantly more quantitative information is contained within imaging modalities. This quantitative information could be exploited for classification of LNs in patients with locally-advanced HNSCC by means of artificial intelligence (AI). Currently, various reviews exploring the role of AI in HNSCC are available. However, reviews specifically addressing the current role of AI to classify LN in HNSCC-patients are sparse. The present work systematically reviews original articles that specifically explore the role of AI to classify LNs in locally-advanced HNSCC applying Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Study Quality Assessment Tool of National Institute of Health (NIH). Between 2001 and 2022, out of 69 studies a total of 13 retrospective, mainly monocentric, studies were identified. The majority of the studies included patients with oropharyngeal and oral cavity (9 and 7 of 13 studies, respectively) HNSCC. Histopathologic findings were defined as reference in 9 of 13 studies. Machine learning was applied in 13 studies, 9 of them applying deep learning. The mean number of included patients was 75 (SD ± 72; range 10-258) and of LNs was 340 (SD ± 268; range 21-791). The mean diagnostic accuracy for the training sets was 86% (SD ± 14%; range: 43-99%) and for testing sets 86% (SD ± 5%; range 76-92%). Consequently, all of the identified studies concluded AI to be a potentially promising diagnostic support tool for LN-classification in HNSCC. However, adequately powered, prospective, and randomized control trials are urgently required to further assess AI's role in LN-classification in locally-advanced HNSCC.
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Affiliation(s)
- Matthias Santer
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Marcel Kloppenburg
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Timo Maria Gottfried
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Annette Runge
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Joachim Schmutzhard
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Samuel Moritz Vorbach
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Julian Mangesius
- Department of Radiation-Oncology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - David Riedl
- University Hospital of Psychiatry II, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Ludwig-Boltzmann Institute for Rehabilitation Research, 1100 Vienna, Austria
| | - Stephanie Mangesius
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Gerlig Widmann
- Department of Radiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Daniel Dejaco
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Wolfgang Freysinger
- Department of Otorhinolaryngology-Head and Neck Surgery, Medical University of Innsbruck, 6020 Innsbruck, Austria
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Nakagawa J, Fujima N, Hirata K, Tang M, Tsuneta S, Suzuki J, Harada T, Ikebe Y, Homma A, Kano S, Minowa K, Kudo K. Utility of the deep learning technique for the diagnosis of orbital invasion on CT in patients with a nasal or sinonasal tumor. Cancer Imaging 2022; 22:52. [PMID: 36138422 PMCID: PMC9502604 DOI: 10.1186/s40644-022-00492-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background In nasal or sinonasal tumors, orbital invasion beyond periorbita by the tumor is one of the important criteria in the selection of the surgical procedure. We investigated the usefulness of the convolutional neural network (CNN)-based deep learning technique for the diagnosis of orbital invasion, using computed tomography (CT) images. Methods A total of 168 lesions with malignant nasal or sinonasal tumors were divided into a training dataset (n = 119) and a test dataset (n = 49). The final diagnosis (invasion-positive or -negative) was determined by experienced radiologists who carefully reviewed all of the CT images. In a CNN-based deep learning analysis, a slice of the square target region that included the orbital bone wall was extracted and fed into a deep-learning training session to create a diagnostic model using transfer learning with the Visual Geometry Group 16 (VGG16) model. The test dataset was subsequently tested in CNN-based diagnostic models and by two other radiologists who were not specialized in head and neck radiology. At approx. 2 months after the first reading session, two radiologists again reviewed all of the images in the test dataset, referring to the diagnoses provided by the trained CNN-based diagnostic model. Results The diagnostic accuracy was 0.92 by the CNN-based diagnostic models, whereas the diagnostic accuracies by the two radiologists at the first reading session were 0.49 and 0.45, respectively. In the second reading session by two radiologists (diagnosing with the assistance by the CNN-based diagnostic model), marked elevations of the diagnostic accuracy were observed (0.94 and 1.00, respectively). Conclusion The CNN-based deep learning technique can be a useful support tool in assessing the presence of orbital invasion on CT images, especially for non-specialized radiologists.
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Affiliation(s)
- Junichi Nakagawa
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.,Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.
| | - Kenji Hirata
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.,Department of Nuclear Medicine, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.,Clinical AI Human Resources Development Program, Faculty of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Minghui Tang
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.,Clinical AI Human Resources Development Program, Faculty of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Jun Suzuki
- Department of Radiology, Teine Keijinkai Hospital, 1-40, Maeda 1-12, Teine-ku, Sapporo, Hokkaido, 006-8555, Japan
| | - Taisuke Harada
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.,Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan
| | - Yohei Ikebe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.,Center for Cause of Death investigation, Faculty of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita ku, Sapporo, 060-8638, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita ku, Sapporo, 060-8638, Japan
| | - Kazuyuki Minowa
- Faculty of Dental Medicine, Department of Radiology, Hokkaido University, N13 W7, Kita-ku, Sapporo, Hokkaido, 060-8586, Japan
| | - Kohsuke Kudo
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.,Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8648, Japan.,Clinical AI Human Resources Development Program, Faculty of Medicine, Hokkaido University, N15 W7, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan.,Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, N14 W5, Kita-Ku, Sapporo, Hokkaido, 060-8638, Japan
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Artificial Intelligence Meets Whole Slide Images: Deep Learning Model Shapes an Immune-Hot Tumor and Guides Precision Therapy in Bladder Cancer. JOURNAL OF ONCOLOGY 2022; 2022:8213321. [PMID: 36245985 PMCID: PMC9553530 DOI: 10.1155/2022/8213321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/30/2022]
Abstract
Background To construct and validate a deep learning cluster from whole slide images (WSI) for depicting the immunophenotypes and functional heterogeneity of the tumor microenvironment (TME) in patients with bladder cancer (BLCA) and to explore an artificial intelligence (AI) score to explore the underlying biological pathways in the developed WSI cluster. Methods In this study, the WSI cluster was constructed based on a deep learning procedure. Further rerecognition of TME features in pathological images was applied based on a neural network. Then, we integrated the TCGA cohort and several external testing cohorts to explore and validate this novel WSI cluster and a corresponding quantitative indicator, the AI score. Finally, correlations between the AI cluster (AI score) and classical BLCA molecular subtypes, immunophenotypes, functional heterogeneity, and potential therapeutic method in BLCA were assessed. Results The WSI cluster was identified associated with clinical survival (P < 0.001) and was proved as an independent predictor (P = 0.031), which could also predict the immunology and the clinical significance of BLCA. Rerecognition of pathological images established a robust 3-year survival prediction model (with an average classification accuracy of 86%, AUC of 0.95) for BLCA patients combining TME features and clinical features. In addition, an AI score was constructed to quantify the underlying logic of the WSI cluster (AUC = 0.838). Finally, we hypothesized that high AI score shapes an immune-hot TME in BLCA. Thus, treatment options including immune checkpoint blockade (ICB), chemotherapy, and ERBB therapy can be used for the treatment of BLCA patients in WSI cluster1 (high AI score subtype). Conclusions In general, we showed that deep learning can predict prognosis and may aid in the precision medicine for BLCA directly from H&E histology, which is more economical and efficient.
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Zhu Y, Meng Z, Fan X, Duan Y, Jia Y, Dong T, Wang Y, Song J, Tian J, Wang K, Nie F. Deep learning radiomics of dual-modality ultrasound images for hierarchical diagnosis of unexplained cervical lymphadenopathy. BMC Med 2022; 20:269. [PMID: 36008835 PMCID: PMC9410737 DOI: 10.1186/s12916-022-02469-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Accurate diagnosis of unexplained cervical lymphadenopathy (CLA) using medical images heavily relies on the experience of radiologists, which is even worse for CLA patients in underdeveloped countries and regions, because of lack of expertise and reliable medical history. This study aimed to develop a deep learning (DL) radiomics model based on B-mode and color Doppler ultrasound images for assisting radiologists to improve their diagnoses of the etiology of unexplained CLA. METHODS Patients with unexplained CLA who received ultrasound examinations from three hospitals located in underdeveloped areas of China were retrospectively enrolled. They were all pathologically confirmed with reactive hyperplasia, tuberculous lymphadenitis, lymphoma, or metastatic carcinoma. By mimicking the diagnosis logic of radiologists, three DL sub-models were developed to achieve the primary diagnosis of benign and malignant, the secondary diagnosis of reactive hyperplasia and tuberculous lymphadenitis in benign candidates, and of lymphoma and metastatic carcinoma in malignant candidates, respectively. Then, a CLA hierarchical diagnostic model (CLA-HDM) integrating all sub-models was proposed to classify the specific etiology of each unexplained CLA. The assistant effectiveness of CLA-HDM was assessed by comparing six radiologists between without and with using the DL-based classification and heatmap guidance. RESULTS A total of 763 patients with unexplained CLA were enrolled and were split into the training cohort (n=395), internal testing cohort (n=171), and external testing cohorts 1 (n=105) and 2 (n=92). The CLA-HDM for diagnosing four common etiologies of unexplained CLA achieved AUCs of 0.873 (95% CI: 0.838-0.908), 0.837 (95% CI: 0.789-0.889), and 0.840 (95% CI: 0.789-0.898) in the three testing cohorts, respectively, which was systematically more accurate than all the participating radiologists. With its assistance, the accuracy, sensitivity, and specificity of six radiologists with different levels of experience were generally improved, reducing the false-negative rate of 2.2-10% and the false-positive rate of 0.7-3.1%. CONCLUSIONS Multi-cohort testing demonstrated our DL model integrating dual-modality ultrasound images achieved accurate diagnosis of unexplained CLA. With its assistance, the gap between radiologists with different levels of experience was narrowed, which is potentially of great significance for benefiting CLA patients in underdeveloped countries and regions worldwide.
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Affiliation(s)
- Yangyang Zhu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China.,CAS Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Zheling Meng
- CAS Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China
| | - Xiao Fan
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China
| | - Yin Duan
- Department of Ultrasound, Gansu Provincial Cancer Hospital, Lanzhou, China
| | - Yingying Jia
- Department of Ultrasound, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Tiantian Dong
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China
| | - Yanfang Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China
| | - Juan Song
- Department of Ultrasound, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine and Engineering, Beihang University, Beijing, China
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,School of Artificial Intelligence, University of Chinese Academy of Sciences, Beijing, China.
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, 730030, China. .,Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China. .,Gansu Province Medical Engineering Research Center for Intelligence Ultrasound, Lanzhou, China.
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Huang W, Wang K, Huang W, He Z, Zhang J, Zhang B, Xiong Z, Gillen KM, Li W, Chen F, Yang X, Zhang S, Tian J. Carbonic anhydrase IX stratifies patient prognosis and identifies nodal status in animal models of nasopharyngeal carcinoma using a targeted imaging strategy. Eur J Nucl Med Mol Imaging 2022; 49:4427-4439. [PMID: 35925443 DOI: 10.1007/s00259-022-05922-6] [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: 03/01/2022] [Accepted: 07/12/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE Accurate identification of nodal status enables adequate neck irradiation for nasopharyngeal carcinoma (NPC). However, most conventional techniques are unable to pick up occult metastases, leading to underestimation of tumor extensions. Here we investigate the clinical significance of carbonic anhydrase IX (CAIX) in human NPC samples, and develop a CAIX-targeted imaging strategy to identify occult lymph node metastases (LNMs) and extranodal extension (ENE) in animal studies. METHODS A total of 211 NPC samples are performed CAIX staining, and clinical outcomes are analyzed. The metastatic murine models are generated by foot pad injection of NPC cells, and a CAIX-targeted imaging agent (CAIX-800) is intravenously administered. We adopt fluorescence molecular tomography and ultrasonography (US)-guided spectroscopic photoacoustic (sPA) imaging to perform in vivo studies. Histological and immunohistochemical characterization are carried out via node-by-node analysis. RESULTS For clinical samples, 90.1% (91/101) primary tumors, 73.3% (66/90) metastases, and 100% (20/20) local recurrences are CAIX positive. In metastases group, 84.7% (61/72) nodal metastases and 22.2% (4/18) organ metastases are CAIX positive. CAIX expression in primary tumors is significantly associated with NPC stage and prognosis. For animal studies, CAIX-800-based fluorescence imaging achieves 81.3% sensitivity and 93.8% specificity in detecting occult LNMs in vivo, with a minimum detectable diameter of 1.7 mm. Coupled with CAIX-800, US-guided sPA imaging could not only detect subcapsular deposits of metastatic cancer cells 2 weeks earlier than conventional techniques, but also successfully track pathological ENE. CONCLUSION CAIX remarkably expresses in human NPCs and stratifies patient prognosis. In preclinical studies, CAIX-800-based imaging successfully identifies occult LNMs and tracks early stage of pathological ENE. This attractive method shows potential in clinic, allowing medical workers to longitudinally monitor nodal status and helping to reduce unnecessary nodal biopsy for patients with NPC. The schematic diagram for the study. CAIX, carbonic anhydrase IX; NPC, nasopharyngeal carcinoma; US, ultrasonography; sPA, spectroscopic photoacoustic.
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Affiliation(s)
- Wenhui Huang
- College of Medicine and Biological Information Engineering, Northeastern University, 110057, Shenyang, China.,CAS Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, No. 95 Zhongguancun East Road, Haidian District, Beijing, 100190, China.,Medical Imaging Center, the First Affiliated Hospital, Jinan University, No. 613, Huangpu West Road, Tianhe District, 510632, Guangzhou, China
| | - Kun Wang
- CAS Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, No. 95 Zhongguancun East Road, Haidian District, Beijing, 100190, China
| | - Weiyuan Huang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), 570311, Haikou, China
| | - Zicong He
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, No. 613, Huangpu West Road, Tianhe District, 510632, Guangzhou, China
| | - Jingming Zhang
- Department of Nuclear Medicine, Peking University First Hospital, No. 8, Xishiku Road, Xicheng District, Beijing, 100034, China
| | - Bin Zhang
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, No. 613, Huangpu West Road, Tianhe District, 510632, Guangzhou, China
| | - Zhiyuan Xiong
- Department of Chemical and Bio-Molecular Engineering, The University of Melbourne, Victoria 3010, Melbourne, Australia
| | - Kelly McCabe Gillen
- Department of Radiology, Weill Medical College of Cornell University, 407 E 61st Street, New York, NY, USA
| | - Wenzhe Li
- State Key Laboratory of Natural and Biomimetic Drugs, Peking University, 100191, Beijing, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), 570311, Haikou, China
| | - Xing Yang
- Department of Nuclear Medicine, Peking University First Hospital, No. 8, Xishiku Road, Xicheng District, Beijing, 100034, China.
| | - Shuixing Zhang
- Medical Imaging Center, the First Affiliated Hospital, Jinan University, No. 613, Huangpu West Road, Tianhe District, 510632, Guangzhou, China.
| | - Jie Tian
- College of Medicine and Biological Information Engineering, Northeastern University, 110057, Shenyang, China. .,CAS Key Laboratory of Molecular Imaging, the State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, No. 95 Zhongguancun East Road, Haidian District, Beijing, 100190, China. .,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, 100191, Beijing, China.
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Wang Y, Lombardo E, Avanzo M, Zschaek S, Weingärtner J, Holzgreve A, Albert NL, Marschner S, Fanetti G, Franchin G, Stancanello J, Walter F, Corradini S, Niyazi M, Lang J, Belka C, Riboldi M, Kurz C, Landry G. Deep learning based time-to-event analysis with PET, CT and joint PET/CT for head and neck cancer prognosis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 222:106948. [PMID: 35752119 DOI: 10.1016/j.cmpb.2022.106948] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/07/2022] [Accepted: 06/08/2022] [Indexed: 05/02/2023]
Abstract
OBJECTIVES Recent studies have shown that deep learning based on pre-treatment positron emission tomography (PET) or computed tomography (CT) is promising for distant metastasis (DM) and overall survival (OS) prognosis in head and neck cancer (HNC). However, lesion segmentation is typically required, resulting in a predictive power susceptible to variations in primary and lymph node gross tumor volume (GTV) segmentation. This study aimed at achieving prognosis without GTV segmentation, and extending single modality prognosis to joint PET/CT to allow investigating the predictive performance of combined- compared to single-modality inputs. METHODS We employed a 3D-Resnet combined with a time-to-event outcome model to incorporate censoring information. We focused on the prognosis of DM and OS for HNC patients. For each clinical endpoint, five models with PET and/or CT images as input were compared: PET-GTV, PET-only, CT-GTV, CT-only, and PET/CT-GTV models, where -GTV indicates that the corresponding images were masked using the GTV contour. Publicly available delineated CT and PET scans from 4 different Canadian hospitals (293) and the MAASTRO clinic (74) were used for training by 3-fold cross-validation (CV). For independent testing, we used 110 patients from a collaborating institution. The predictive performance was evaluated via Harrell's Concordance Index (HCI) and Kaplan-Meier curves. RESULTS In a 5-year time-to-event analysis, all models could produce CV HCIs with median values around 0.8 for DM and 0.7 for OS. The best performance was obtained with the PET-only model, achieving a median testing HCI of 0.82 for DM and 0.69 for OS. Compared with the PET/CT-GTV model, the PET-only still had advantages of up to 0.07 in terms of testing HCI. The Kaplan-Meier curves and corresponding log-rank test results also demonstrated significant stratification capability of our models for the testing cohort. CONCLUSION Deep learning-based DM and OS time-to-event models showed predictive capability and could provide indications for personalized RT. The best predictive performance achieved by the PET-only model suggested GTV segmentation might be less relevant for PET-based prognosis.
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Affiliation(s)
- Yiling Wang
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Elia Lombardo
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Michele Avanzo
- Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Medical Physics, Aviano, Italy
| | - Sebastian Zschaek
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Radiation Oncology, Berlin, Germany
| | - Julian Weingärtner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Radiation Oncology, Berlin, Germany
| | - Adrien Holzgreve
- University Hospital, LMU Munich, Nuclear Medicine, Munich, Germany
| | | | - Sebastian Marschner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Giuseppe Fanetti
- Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Radiation Oncology, Aviano, Italy
| | - Giovanni Franchin
- Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Radiation Oncology, Aviano, Italy
| | - Joseph Stancanello
- ELEKTA SAS, Clinical Applications Development, Boulogne-Billancourt, France
| | - Franziska Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Corradini
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Maximilian Niyazi
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Jinyi Lang
- Sichuan Cancer Hospital, School of Medicine, University of Electronic Science and Technology of China, Radiation Oncology, Radiation Oncology Key Laboratory of Sichuan Province, Chengdu, China
| | - Claus Belka
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany; German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany
| | - Marco Riboldi
- Department of Medical Physics, Ludwig-Maximilians-Universität München, Garching, Germany
| | - Christopher Kurz
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - Guillaume Landry
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany.
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Hoebers F, Yu E, O'Sullivan B, Postma AA, Palm WM, Bartlett E, Lee J, Stock S, Koyfman S, Su J, Xu W, Huang SH. Augmenting inter-rater concordance of radiologic extranodal extension in HPV-positive oropharyngeal carcinoma: A multicenter study. Head Neck 2022; 44:2361-2369. [PMID: 35766141 DOI: 10.1002/hed.27130] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/23/2022] [Accepted: 06/16/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess intra- and inter-institutional concordance and identify methods to increase precision in radiologic extranodal extension (rENE) ascertainment in HPV+ oropharyngeal carcinoma. METHODS Six radiologists, blinded to clinical outcomes, from three centers assessed rENE in two phases: Phase-I (20 cases) utilized each individual's a priori appreciation of the literature. Phase-II (30 additional cases) was performed after deliberating experience and consolidating operating definitions. Intra- and inter-institutional Kappa were calculated at >50% and >75% certainty levels, respectively. RESULTS The Phase-I intra-institutional kappa was 0.76, 0.32, and 0.44 at >50% certainty and improved to 0.89, 0.61, and 0.66 at >75% certainty. Inter-institutional Fleiss' kappa also improved with higher certainty (from 0.40 to 0.57, p = 0.039). The Phase-II inter-rater kappa was significantly higher than Phase-I at the same certainty level (both p < 0.001). CONCLUSION A learning curve exists for rENE assessment. Strategies to augment reliability include high certainty for declaration, consolidated operating definitions, and sharing experience among radiologists.
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Affiliation(s)
- Frank Hoebers
- Department of Radiation Oncology (Maastro), Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Eugene Yu
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Alida A Postma
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,School for Mental Health and Sciences, Maastricht University, Maastricht, the Netherlands
| | - Walter M Palm
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Eric Bartlett
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Lee
- Department of Neuroradiology and Head and Neck Imaging, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Sarah Stock
- Department of Neuroradiology and Head and Neck Imaging, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Shlomo Koyfman
- Department of Radiation Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio, USA
| | - Jie Su
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Wei Xu
- Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head & Neck Surgery, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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McDowell L, Chua MLK, Beadle BM, Ma DJ, Mierzwa M, Thomson DJ, Margalit DN. A Bit More Here and a Little Less There: The Trials (and Tribulations) of Adjuvant and Neoadjuvant Head and Neck Studies in 2021. Int J Radiat Oncol Biol Phys 2022; 113:243-251. [PMID: 35569469 DOI: 10.1016/j.ijrobp.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
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Mo A, Velten C, Jiang JM, Tang J, Ohri N, Kalnicki S, Mirhaji P, Nemoto K, Aasman B, Garg M, Guha C, Brodin NP, Kabarriti R. Improving Adjuvant Liver-Directed Treatment Recommendations for Unresectable Hepatocellular Carcinoma: An Artificial Intelligence-Based Decision-Making Tool. JCO Clin Cancer Inform 2022; 6:e2200024. [PMID: 35671414 PMCID: PMC9225499 DOI: 10.1200/cci.22.00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Liver-directed therapy after transarterial chemoembolization (TACE) can lead to improvement in survival for selected patients with unresectable hepatocellular carcinoma (HCC). However, there is uncertainty in the appropriate application and modality of therapy in current clinical practice guidelines. The aim of this study was to develop a proof-of-concept, machine learning (ML) model for treatment recommendation in patients previously treated with TACE and select patients who might benefit from additional treatment with combination stereotactic body radiotherapy (SBRT) or radiofrequency ablation (RFA). METHODS This retrospective observational study was based on data from an urban, academic hospital system selecting for patients diagnosed with stage I-III HCC from January 1, 2008, to December 31, 2018, treated with TACE, followed by adjuvant RFA, SBRT, or no additional liver-directed modality. A feedforward, ML ensemble model provided a treatment recommendation on the basis of pairwise assessments evaluating each potential treatment option and estimated benefit in survival. RESULTS Two hundred thirty-seven patients met inclusion criteria, of whom 54 (23%) and 49 (21%) received combination of TACE and SBRT or TACE and RFA, respectively. The ML model suggested a different consolidative modality in 32.7% of cases among patients who had previously received combination treatment. Patients treated in concordance with model recommendations had significant improvement in progression-free survival (hazard ratio 0.5; P = .007). The most important features for model prediction were cause of cirrhosis, stage of disease, and albumin-bilirubin grade (a measure of liver function). CONCLUSION In this proof-of-concept study, an ensemble ML model was able to provide treatment recommendations for HCC who had undergone prior TACE. Additional treatment in line with model recommendations was associated with significant improvement in progression-free survival, suggesting a potential benefit for ML-guided medical decision making.
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Affiliation(s)
- Allen Mo
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Christian Velten
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.,Institute for Onco-Physics, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Julie M Jiang
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Justin Tang
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Shalom Kalnicki
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Parsa Mirhaji
- Department of Systems & Computational Biology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.,Center for Health Data Innovation, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Kei Nemoto
- Center for Health Data Innovation, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Boudewijn Aasman
- Center for Health Data Innovation, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Madhur Garg
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Chandan Guha
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.,Institute for Onco-Physics, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - N Patrik Brodin
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY.,Institute for Onco-Physics, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
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Blasco MA, Noel CW, Truong T, Huang SH, Goldstein DP, Irish JC, Gilbert R, Hosni A, Hope A, O'Sullivan B, Waldron J, Perez-Ordonez B, Weinreb I, Smith SM, Bartlett E, Yu E, de Almeida JR. Radiologic-pathologic correlation of major versus minor extranodal extension in oral cavity cancer. Head Neck 2022; 44:1422-1429. [PMID: 35315548 DOI: 10.1002/hed.27036] [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: 11/17/2021] [Revised: 02/12/2022] [Accepted: 03/09/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND To evaluate the diagnostic performance of radiologic extranodal extension (rENE) in predicting major (>2 mm) and minor (≤2 mm) pathologic ENE (pENE). METHODS All oral cavity squamous cell carcinoma patients who underwent neck dissection with pathological nodal disease (pN+) between 2010 and 2015 were reviewed. Preoperative computed tomography and/or magnetic resonance imaging were reviewed by two head and neck neuroradiologists. RESULTS Three hundred and thirty-four patients were included. The sensitivity and specificity of rENE were 37% [95% CI 29-44] and 98% [95% CI 96-100], respectively. Sensitivity for pENE improved in the subset of patients with major ENE (48% [95% CI 38-57]). The presence of rENE was associated with inferior 3-year overall survival: 26% [95% CI 17-41] versus 60% [95% CI 54-67]. CONCLUSIONS This large cohort study demonstrates high specificity, but low sensitivity for preoperative imaging in the detection of pENE in OCSCC. Patients with rENE demonstrated poor OS. pENE in the absence of rENE is still an adverse risk factor.
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Affiliation(s)
- Michael A Blasco
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Christopher W Noel
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Tra Truong
- Department of Pathology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Shao Hui Huang
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - David P Goldstein
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan C Irish
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ralph Gilbert
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Brian O'Sullivan
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - John Waldron
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.,Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Bayardo Perez-Ordonez
- Department of Pathology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Ilan Weinreb
- Department of Pathology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Stephen M Smith
- Department of Pathology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eric Bartlett
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Yu
- Department of Neuroradiology and Head and Neck Imaging, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery/Surgical Oncology, Princess Margaret Cancer Centre-University Health Network, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Parikh RB, Basen-Enquist KM, Bradley C, Estrin D, Levy M, Lichtenfeld JL, Malin B, McGraw D, Meropol NJ, Oyer RA, Sheldon LK, Shulman LN. Digital Health Applications in Oncology: An Opportunity to Seize. J Natl Cancer Inst 2022; 114:1338-1339. [PMID: 35640986 PMCID: PMC9384132 DOI: 10.1093/jnci/djac108] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/13/2022] [Accepted: 05/03/2022] [Indexed: 11/23/2022] Open
Abstract
Digital health advances have transformed many clinical areas including psychiatric and cardiovascular care. However, digital health innovation is relatively nascent in cancer care, which represents the fastest growing area of health-care spending. Opportunities for digital health innovation in oncology include patient-facing technologies that improve patient experience, safety, and patient-clinician interactions; clinician-facing technologies that improve their ability to diagnose pathology and predict adverse events; and quality of care and research infrastructure to improve clinical workflows, documentation, decision support, and clinical trial monitoring. The COVID-19 pandemic and associated shifts of care to the home and community dramatically accelerated the integration of digital health technologies into virtually every aspect of oncology care. However, the pandemic has also exposed potential flaws in the digital health ecosystem, namely in clinical integration strategies; data access, quality, and security; and regulatory oversight and reimbursement for digital health technologies. Stemming from the proceedings of a 2020 workshop convened by the National Cancer Policy Forum of the National Academies of Sciences, Engineering, and Medicine, this article summarizes the current state of digital health technologies in medical practice and strategies to improve clinical utility and integration. These recommendations, with calls to action for clinicians, health systems, technology innovators, and policy makers, will facilitate efficient yet safe integration of digital health technologies into cancer care.
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Affiliation(s)
- Ravi B Parikh
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania, USA
| | - Karen M Basen-Enquist
- Center for Energy Balance in Cancer Prevention and Survivorship, The University of Texas MD Anderson Cancer Center, Texas Medical Center, Houston, Texas, USA
| | - Cathy Bradley
- University of Colorado Cancer Center, Aurora, Colorado, USA
| | | | - Mia Levy
- Division of Hematology, Oncology and Cell Therapy, Rush University, Chicago, Illinois, USA
| | | | - Bradley Malin
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | | | - Randall A Oyer
- Ann B. Barshinger Cancer Institute, Lancaster, Pennsylvania, USA
| | - Lisa Kennedy Sheldon
- College of Nursing and Health Sciences, University of Massachusetts, Boston, Massachusetts, USA
| | - Lawrence N Shulman
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Zhang W, Peng J, Zhao S, Wu W, Yang J, Ye J, Xu S. Deep learning combined with radiomics for the classification of enlarged cervical lymph nodes. J Cancer Res Clin Oncol 2022; 148:2773-2780. [PMID: 35562596 DOI: 10.1007/s00432-022-04047-5] [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: 11/21/2021] [Accepted: 04/27/2022] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate the application of deep learning combined with traditional radiomics methods for classifying enlarged cervical lymph nodes. METHODS The clinical and computed tomography (CT) imaging data of 276 patients with enlarged cervical lymph nodes (150 with lymph-node metastasis, 65 with lymphoma, and 61 with benign lymphadenopathy) who were treated at the hospital from January 2015 to January 2021 were retrospectively analysed. The patients were randomly divided into a training group and a test group at a ratio of 8:2. The radiomics features were extracted using one-by-one convolution and neural network activation, filtered with the least absolute shrinkage and selection operator (LASSO) model, and used to construct a discrimination model with PyTorch. Then, the performance of the model was compared with the radiologists' diagnostic performance. The neural network model was evaluated using the area under the receiver-operator characteristic curve (AUC), and the accuracy, sensitivity, and specificity were analysed. RESULTS A total of 102 features, comprising five traditional radiomic features and 97 deep learning features, were selected with LASSO and used to construct a discrimination model, which achieved a total accuracy of 87.50%. The AUC value, specificity, and sensitivity were, respectively, 0.92, 92.30%, and 90.00% for metastatic lymph nodes, 0.87, 95.45%, and 83.33% for benign lymphadenopathy, and 0.88, 90.47%, and 85.71% for lymphoma. The accuracies of the radiologists' diagnoses were 62.68% and 62.68%. The diagnostic performance of the model was significantly different from that of the radiologists (p < 0.05). CONCLUSION CT-based deep learning combined with the traditional radiomics methods has a high diagnostic value for the classification of cervical enlarged lymph nodes.
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Affiliation(s)
- Wentao Zhang
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jian Peng
- The Center for Clinical Molecular Medical Detection, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Shan Zhao
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wenli Wu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Junjun Yang
- Key Laboratory of Optoelectronic Technology, The Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Junyong Ye
- Key Laboratory of Optoelectronic Technology, The Ministry of Education, Chongqing University, Chongqing, 400044, China
| | - Shengsheng Xu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Huang J, Wu Z, Xu J. Effects of Biofilm Nano-Composite Drugs OMVs-MSN-5-FU on Cervical Lymph Node Metastases From Oral Squamous Cell Carcinoma. Front Oncol 2022; 12:881910. [PMID: 35515126 PMCID: PMC9062107 DOI: 10.3389/fonc.2022.881910] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
This work was developed to the effects of biofilm composite nano-drug delivery system (OMVs-MSN-5-FU) on lymph node metastasis from oral squamous cell carcinoma. Mesoporous silica nanoparticles loaded with 5-FU (MSN-5-FU) were prepared first. Subsequently, the outer membrane vesicles (OMV) of Escherichia coli were collected to wrap MSN-5-FU, and then OMVs-MSN-5-FU was prepared. It was then immersed in artificial gastric juice and artificial intestinal juice to explore the drug release rate. Next, the effects of different concentrations of the nano-drug delivery systems on the proliferation activity of oral squamous carcinoma cell line KOSC-2 cl3-43 were analyzed. Tumor-bearing nude mice models were prepared by injecting human tongue squamous cell carcinoma cells Tca8113 into BALB/c-nu nude mice. They were injected with the OMVs-MSN-5-FU nano drug carrier system, and peri-carcinoma tissue and cervical lymph node tissue were harvested to observe morphological changes by Hematoxylin - eosin (HE) staining. The scanning electron microscope (SEM) results showed that all MSN, MSN-5-FU, OMV, and OMV-MSN-5-FU were spherical and uniformly distributed, with particle sizes of about 60nm, 80nm, 90nm, and 140nm, respectively. Among them, OMV had a directional core-shell structure. The cumulative drug release rates of artificial gastric juice in 48 hours were 61.2 ± 2.3% and 26.5 ± 3.1%, respectively. The 48 hours cumulative drug release rates of artificial intestinal juice were 70.5 ± 6.3% and 32.1 ± 3.8%, respectively. The cumulative release of MSN-5-FU was always higher than OMV-MSN-5-FU. The cumulative release of MSN-5-FU was always higher than OMV-MSN-5-FU. After injection of OMVS-MSN-5-FU, the number of cancer cells was significantly reduced and cervical lymph node metastasis was significantly controlled. HE staining results showed that OMVS-MSN-5-FU injection reduced the number of stained cells. Dense lymphocytes were clearly observed in the cortex of neck lymphocytes. The OMVs-MSN-5-FU drug delivery system can slow down the drug release rate, significantly inhibit the proliferation activity of oral squamous cancer cells, and control the metastasis of cancer cells to cervical lymph nodes.
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Affiliation(s)
- Jian Huang
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Zhiyuan Wu
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, Fuzhou, China
| | - Junwu Xu
- Department of Oral and Maxillofacial Surgery, Fujian Provincial Hospital, Fuzhou, China
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Yu AC, Mohajer B, Eng J. External Validation of Deep Learning Algorithms for Radiologic Diagnosis: A Systematic Review. Radiol Artif Intell 2022; 4:e210064. [PMID: 35652114 DOI: 10.1148/ryai.210064] [Citation(s) in RCA: 83] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/09/2022] [Accepted: 04/12/2022] [Indexed: 01/17/2023]
Abstract
Purpose To assess generalizability of published deep learning (DL) algorithms for radiologic diagnosis. Materials and Methods In this systematic review, the PubMed database was searched for peer-reviewed studies of DL algorithms for image-based radiologic diagnosis that included external validation, published from January 1, 2015, through April 1, 2021. Studies using nonimaging features or incorporating non-DL methods for feature extraction or classification were excluded. Two reviewers independently evaluated studies for inclusion, and any discrepancies were resolved by consensus. Internal and external performance measures and pertinent study characteristics were extracted, and relationships among these data were examined using nonparametric statistics. Results Eighty-three studies reporting 86 algorithms were included. The vast majority (70 of 86, 81%) reported at least some decrease in external performance compared with internal performance, with nearly half (42 of 86, 49%) reporting at least a modest decrease (≥0.05 on the unit scale) and nearly a quarter (21 of 86, 24%) reporting a substantial decrease (≥0.10 on the unit scale). No study characteristics were found to be associated with the difference between internal and external performance. Conclusion Among published external validation studies of DL algorithms for image-based radiologic diagnosis, the vast majority demonstrated diminished algorithm performance on the external dataset, with some reporting a substantial performance decrease.Keywords: Meta-Analysis, Computer Applications-Detection/Diagnosis, Neural Networks, Computer Applications-General (Informatics), Epidemiology, Technology Assessment, Diagnosis, Informatics Supplemental material is available for this article. © RSNA, 2022.
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Affiliation(s)
- Alice C Yu
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287
| | - Bahram Mohajer
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287
| | - John Eng
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans St, Baltimore, MD 21287
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Joel MZ, Umrao S, Chang E, Choi R, Yang DX, Duncan JS, Omuro A, Herbst R, Krumholz HM, Aneja S. Using Adversarial Images to Assess the Robustness of Deep Learning Models Trained on Diagnostic Images in Oncology. JCO Clin Cancer Inform 2022; 6:e2100170. [PMID: 35271304 PMCID: PMC8932490 DOI: 10.1200/cci.21.00170] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Deep learning (DL) models have rapidly become a popular and cost-effective tool for image classification within oncology. A major limitation of DL models is their vulnerability to adversarial images, manipulated input images designed to cause misclassifications by DL models. The purpose of the study is to investigate the robustness of DL models trained on diagnostic images using adversarial images and explore the utility of an iterative adversarial training approach to improve the robustness of DL models against adversarial images. Exploring vulnerabilities of deep learning algorithms to adversarial images across oncologic imaging modalities.![]()
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Affiliation(s)
- Marina Z Joel
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Sachin Umrao
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Enoch Chang
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Rachel Choi
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - Daniel X Yang
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT
| | - James S Duncan
- Department of Biomedical Engineering, Yale University, New Haven, CT
| | - Antonio Omuro
- Department of Neurology, Yale School of Medicine, New Haven, CT
| | - Roy Herbst
- Department of Medicine, Yale School of Medicine, New Haven, CT
| | - Harlan M Krumholz
- Department of Medicine, Yale School of Medicine, New Haven, CT.,Center for Outcomes Research and Evaluation at Yale (CORE), New Haven, CT
| | - Sanjay Aneja
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT.,Center for Outcomes Research and Evaluation at Yale (CORE), New Haven, CT
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Tang H, Li G, Liu C, Huang D, Zhang X, Qiu Y, Liu Y. Diagnosis of lymph node metastasis in head and neck squamous cell carcinoma using deep learning. Laryngoscope Investig Otolaryngol 2022; 7:161-169. [PMID: 35155794 PMCID: PMC8823170 DOI: 10.1002/lio2.742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/04/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To build an automatic pathological diagnosis model to assess the lymph node metastasis status of head and neck squamous cell carcinoma (HNSCC) based on deep learning algorithms. STUDY DESIGN A retrospective study. METHODS A diagnostic model integrating two-step deep learning networks was trained to analyze the metastasis status in 85 images of HNSCC lymph nodes. The diagnostic model was tested in a test set of 21 images with metastasis and 29 images without metastasis. All images were scanned from HNSCC lymph node sections stained with hematoxylin-eosin (HE). RESULTS In the test set, the overall accuracy, sensitivity, and specificity of the diagnostic model reached 86%, 100%, and 75.9%, respectively. CONCLUSIONS Our two-step diagnostic model can be used to automatically assess the status of HNSCC lymph node metastasis with high sensitivity. LEVEL OF EVIDENCE NA.
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Affiliation(s)
- Haosheng Tang
- Department of Otolaryngology‐Head and Neck Surgery, Xiangya HospitalCentral South UniversityChangshaHunanChina
- Otolaryngology Major Disease Research Key Laboratory of Hunan ProvinceChangshaHunanChina
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan ProvinceChangshaHunanChina
| | - Guo Li
- Department of Otolaryngology‐Head and Neck Surgery, Xiangya HospitalCentral South UniversityChangshaHunanChina
- Otolaryngology Major Disease Research Key Laboratory of Hunan ProvinceChangshaHunanChina
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan ProvinceChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital)ChangshaHunanChina
| | - Chao Liu
- Department of Otolaryngology‐Head and Neck Surgery, Xiangya HospitalCentral South UniversityChangshaHunanChina
- Otolaryngology Major Disease Research Key Laboratory of Hunan ProvinceChangshaHunanChina
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan ProvinceChangshaHunanChina
| | - Donghai Huang
- Department of Otolaryngology‐Head and Neck Surgery, Xiangya HospitalCentral South UniversityChangshaHunanChina
- Otolaryngology Major Disease Research Key Laboratory of Hunan ProvinceChangshaHunanChina
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan ProvinceChangshaHunanChina
| | - Xin Zhang
- Department of Otolaryngology‐Head and Neck Surgery, Xiangya HospitalCentral South UniversityChangshaHunanChina
- Otolaryngology Major Disease Research Key Laboratory of Hunan ProvinceChangshaHunanChina
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan ProvinceChangshaHunanChina
| | - Yuanzheng Qiu
- Department of Otolaryngology‐Head and Neck Surgery, Xiangya HospitalCentral South UniversityChangshaHunanChina
- Otolaryngology Major Disease Research Key Laboratory of Hunan ProvinceChangshaHunanChina
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan ProvinceChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital)ChangshaHunanChina
| | - Yong Liu
- Department of Otolaryngology‐Head and Neck Surgery, Xiangya HospitalCentral South UniversityChangshaHunanChina
- Otolaryngology Major Disease Research Key Laboratory of Hunan ProvinceChangshaHunanChina
- Clinical Research Center for Laryngopharyngeal and Voice Disorders in Hunan ProvinceChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders (Xiangya Hospital)ChangshaHunanChina
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47
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Zhang Y, Luo X, Yu J, Qian K, Zhu H. An Immune Feature-Based, Three-Gene Scoring System for Prognostic Prediction of Head-and-Neck Squamous Cell Carcinoma. Front Oncol 2022; 11:739182. [PMID: 35087741 PMCID: PMC8786713 DOI: 10.3389/fonc.2021.739182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022] Open
Abstract
Head-and-neck squamous cell carcinoma (HNSCC) is characterized by a high frequency of neck lymph node metastasis (LNM), a key prognostic factor. Therefore, identifying the biological processes during LNM of HNSCC has significant clinical implications for risk stratification. This study performed Gene Ontology enrichment analysis of differentially expressed genes between tumors with LNM and those without LNM and identified the involvement of immune response in the lymphatic metastasis of HNSCC. We further identified greater infiltrations of CD8+ T cells in tumors than in adjacent normal tissues through immunochemistry in the patient cohort (n = 62), indicating the involvement of CD8+ T cells in the antitumor immunity. Hierarchical clustering analysis was conducted to initially identify the candidate genes relevant to lymphocyte-mediated antitumor response. The candidate genes were applied to construct a LASSO Cox regression analysis model. Three genes were eventually screened out as progression-related differentially expressed candidates in HNSCC and a risk scoring system was established based on LASSO Cox regression model to predict the outcome in patients with HNSCC. The score was calculated using the formula: 0.0636 × CXCL11 - 0.4619 × CXCR3 + 0.2398 × CCR5. Patients with high scores had significantly worse overall survival than those with low scores (p < 0.001). The risk score showed good performance in characterizing tumor-infiltrating lymphocytes and provided a theoretical basis for stratifying patients receiving immune therapies. Additionally, a nomogram including the risk score, age, and TNM stage was constructed. The prediction model displayed marginally better discrimination ability and higher agreement in predicting the survival of patients with HNSCC compared with the TNM stage.
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Affiliation(s)
- Yamin Zhang
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.,School of Stomatology, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Hangzhou, China
| | - Xiayan Luo
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Jing Yu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Kejia Qian
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Huiyong Zhu
- Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China
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48
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Chen Q, Kuai Y, Wang S, Zhu X, Wang H, Liu W, Cheng L, Yang D. Deep Learning-Based Classification of Epithelial-Mesenchymal Transition for Predicting Response to Therapy in Clear Cell Renal Cell Carcinoma. Front Oncol 2022; 11:782515. [PMID: 35141144 PMCID: PMC8819137 DOI: 10.3389/fonc.2021.782515] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/31/2021] [Indexed: 12/12/2022] Open
Abstract
Epithelial-mesenchymal transition (EMT) profoundly impacts prognosis and immunotherapy of clear cell renal cell carcinoma (ccRCC). However, not every patient is tested for EMT status because this requires additional genetic studies. In this study, we developed an EMT gene signature to classify the H&E-stained slides from The Cancer Genome Atlas (TCGA) into epithelial and mesenchymal subtypes, then we trained a deep convolutional neural network to classify ccRCC which according to our EMT subtypes accurately and automatically and to further predict genomic data and prognosis. The clinical significance and multiomics analysis of the EMT signature was investigated. Patient cohorts from TCGA (n = 252) and whole slide images were used for training, testing, and validation using an algorithm to predict the EMT subtype. Our approach can robustly distinguish features predictive of the EMT subtype in H&E slides. Visualization techniques also detected EMT-associated histopathological features. Moreover, EMT subtypes were characterized by distinctive genomes, metabolic states, and immune components. Deep learning convolutional neural networks could be an extremely useful tool for predicting the EMT molecular classification of ccRCC tissue. The underlying multiomics information can be crucial in applying the appropriate and tailored targeted therapy to the patient.
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Affiliation(s)
- Qiwei Chen
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian, China
- School of Information Science and Technology of Dalian Maritime University, Dalian, China
| | - Yue Kuai
- School of Information and Communication Engineering, Dalian University of Technology, Dalian, China
| | - Shujing Wang
- Department of Biochemistry and Molecular Biology, Dalian Medical University, Dalian, China
| | - Xinqing Zhu
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Hongyu Wang
- School of Information and Communication Engineering, Dalian University of Technology, Dalian, China
| | - Wenlong Liu
- School of Information and Communication Engineering, Dalian University of Technology, Dalian, China
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Deyong Yang
- Department of Urology, First Affiliated Hospital of Dalian Medical University, Dalian, China
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Fu S, Lai H, Huang M, Li Q, Liu Y, Zhang J, Huang J, Chen X, Duan C, Li X, Wang T, He X, Yan J, Lu L. Multi-task deep learning network to predict future macrovascular invasion in hepatocellular carcinoma. EClinicalMedicine 2021; 42:101201. [PMID: 34917908 PMCID: PMC8668827 DOI: 10.1016/j.eclinm.2021.101201] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/22/2021] [Accepted: 10/28/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Models predicting future macrovascular invasion in hepatocellular carcinoma are constructed to assist timely interventions. METHODS A total of 366 HCC cases were retrospectively collected from five Chinese hospitals between April 2007 and November 2016: the training dataset comprised 281 patients from four hospitals; the external validation dataset comprised 85 patients from another hospital. Multi-task deep learning network-based models were constructed to predict future macrovascular invasion. The discrimination, calibration, and decision curves were compared to identify the best model. We compared the time to macrovascular invasion and overall survival using the best model and related image heterogeneity scores (H-score). Then, we determined the need for a segmentation subnet or the replacement deep learning algorithm by logistic regression in screening clinical/radiological factors. Finally, an applet was constructed for future application. FINDINGS The best model combined clinical/radiological factors and radiomic features. It achieved best discrimination (areas under the curve: 0·877 in the training dataset and 0·836 in the validation dataset), calibration, and decision curve. Its performance was not affected by the treatments and disease stages. The subgroups had statistical significance for time to macrovascular invasion (training: hazard ratio [HR] = 0·073, 95% confidence interval [CI]: 0·032-0·167, p < 0·001 and validation: HR = 0·090, 95%CI: 0·022-0·366, p < 0·001) and overall survival (training: HR = 0·344, 95%CI: 0·246-0·547, p < 0·001 and validation: HR = 0·489, 95%CI: 0·279 - 0·859, p = 0·003). Similar results were achieved when the patients were subdivided by the H-score. The subnet for segmentation and end-to-end deep learning algorithms improved the performance of the model. INTERPRETATION Our multi-task deep learning network-based model successfully predicted future macrovascular invasion. In high-risk populations, besides the current first-line treatments, more therapies may be explored for macrovascular invasion.
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Key Words
- AUC, AUC areas under curve
- BCLC, Barcelona Clinic Liver Cancer
- CI, confidence interval
- CT, computed tomography
- Clinical factors
- HCC, hepatocellular carcinoma
- HR, hazard ratio
- Hepatocellular carcinoma
- IDI, integrated discrimination improvement
- MTnet, multi-task deep learning neural network
- Macrovascular invasion
- Multi-task deep learning
- NRI, net reclassification improvement
- OS, overall survival
- PD, disease progression
- ROC, receiver operating characteristic
- Radiological characteristics
- TACE, transarterial chemoembolization
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Affiliation(s)
- Sirui Fu
- Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai hospital affiliated to Jinan University), Zhuhai, China
| | - Haoran Lai
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Meiyan Huang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
- Guangdong Province Engineering Laboratory for Medical Imaging and Diagnostic Technology, Southern Medical University, Guangzhou, China
- Corresponding author: Prof. Meiyan Huang, School of Biomedical Engineering, Southern Medical University, No. 1023-1063 Shatai Road, 510515 Guangzhou, Guangdong, China, Tel.: +86-020-62789343
| | - Qiyang Li
- Department of Radiology, Shenzhen People's Hospital, Shenzhen, China
| | - Yao Liu
- Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai hospital affiliated to Jinan University), Zhuhai, China
| | - Jiawei Zhang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Jianwen Huang
- Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai hospital affiliated to Jinan University), Zhuhai, China
| | - Xiumei Chen
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Xiaoqun Li
- Department of Interventional Treatment, Zhongshan City People's Hospital, Zhongshan, China
| | - Tao Wang
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
| | - Xiaofeng He
- Interventional Diagnosis and Treatment Department, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jianfeng Yan
- Department of Radiology, Yangjiang People's hospital, Yangjiang, China
| | - Ligong Lu
- Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai hospital affiliated to Jinan University), Zhuhai, China
- School of Biomedical Engineering, Southern Medical University, Guangzhou, China
- Co-corresponding author: Prof. Ligong Lu, Zhuhai Interventional Medical Centre, Zhuhai People's Hospital (Zhuhai hospital affiliated with Jinan University), No. 79 Kangning Road, 519000 Zhuhai, Guangdong Province, China; Tel.: +86-0756-2158211
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50
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Kowalchuk RO, Van Abel KM, Yin LX, Garcia J, Harmsen WS, Moore EJ, Price DL, Chintakuntlawar AV, Price KR, Lester SC, Neben Wittich M, Patel SH, Foote RL, Ma DM, Nagelschneider AA, Routman DM. Correlation between radiographic and pathologic lymph node involvement and extranodal extension via CT and PET in HPV-associated oropharyngeal cancer. Oral Oncol 2021; 123:105625. [PMID: 34814068 DOI: 10.1016/j.oraloncology.2021.105625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/27/2021] [Accepted: 11/09/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE/OBJECTIVES Extranodal extension (ENE) and more than 4 pathologically involved lymph nodes (pN2) are critical prognostic factors in HPV-associated oropharyngeal cancer (HPV(+) OPSCC). We analyze a patient cohort with HPV(+) OPSCC to determine the sensitivity and specificity of CT and PET/CT in identifying involvement of more than 4 lymph nodes (rN2) compared to pN2 and radiographic ENE (rENE) compared to pathologic ENE (pENE). MATERIALS/METHODS The dataset consisted of 261 patients enrolled in two prospective clinical trials. All imaging studies were independently reviewed by a blinded neuroradiologist, classifying the presence or absence of rENE and rN2. Secondary analyses included correlations of imaging accuracy and pathologic size of the primary tumor. RESULTS CT demonstrated sensitivity of 59%, specificity of 92%, positive predictive value (PPV) of 53%, negative predictive value (NPV) of 94%, and accuracy of 88% for pN2. PET/CT showed similar results. Patients with up to 4 involved lymph nodes (rN0-1) had a 93-94% chance of remaining pN0-1. CT and PET/CT identified an equal number of involved nodes in 81% of patients. CT demonstrated sensitivity of 54%, specificity of 71%, PPV of 72%, NPV of 53%, and accuracy of 62% for pENE. PET/CT showed similar outcomes. Notably, when multiple radiographic criteria were used to identify rENE, PPV increased for both CT (84%) and PET/CT (79%). CONCLUSION Patients with rN0-1 had a 93-94% chance of remaining pN0-1, suggesting rN0-1 could effectively stratify patients for clinical trials and treatment de-escalation. While CT and PET/CT were highly correlated, both showed low sensitivity for identifying pENE.
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Affiliation(s)
- Roman O Kowalchuk
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN 55905, United States
| | - Kathryn M Van Abel
- Mayo Clinic, Department of Otolaryngology, Rochester, MN 55905, United States
| | - Linda X Yin
- Mayo Clinic, Department of Otolaryngology, Rochester, MN 55905, United States
| | - Joaquin Garcia
- Mayo Clinic, Department of Pathology, Rochester, MN 55905, United States
| | - William S Harmsen
- Mayo Clinic, Department of Statistics, Rochester, MN 55905, United States
| | - Eric J Moore
- Mayo Clinic, Department of Otolaryngology, Rochester, MN 55905, United States
| | - Daniel L Price
- Mayo Clinic, Department of Otolaryngology, Rochester, MN 55905, United States
| | | | - Katharine R Price
- Mayo Clinic, Department of Medical Oncology, MN 55905, United States
| | - Scott C Lester
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN 55905, United States
| | | | - Samir H Patel
- Mayo Clinic, Department of Radiation Oncology, Scottsdale, AZ 85259, United States
| | - Robert L Foote
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN 55905, United States
| | - Daniel M Ma
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN 55905, United States
| | | | - David M Routman
- Mayo Clinic, Department of Radiation Oncology, Rochester, MN 55905, United States.
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