Influence of age on radiomic features in 18F-FDG PET in normal breast tissue and in breast cancer tumors

PET-Derived Radiomics and Artificial Intelligence in Breast Cancer: A Systematic Review

Breast cancer (BC) is a heterogeneous malignancy that still represents the second cause of cancer-related death among women worldwide. Due to the heterogeneity of BC, the correct identification of valuable biomarkers able to predict tumor biology and the best treatment approaches are still far from clear. Although molecular imaging with positron emission tomography/computed tomography (PET/CT) has improved the characterization of BC, these methods are not free from drawbacks. In recent years, radiomics and artificial intelligence (AI) have been playing an important role in the detection of several features normally unseen by the human eye in medical images. The present review provides a summary of the current status of radiomics and AI in different clinical settings of BC. A systematic search of PubMed, Web of Science and Scopus was conducted, including all articles published in English that explored radiomics and AI analyses of PET/CT images in BC. Several studies have demonstrated the potential role of such new features for the staging and prognosis as well as the assessment of biological characteristics. Radiomics and AI features appear to be promising in different clinical settings of BC, although larger prospective trials are needed to confirm and to standardize this evidence.

Radiomics in Oncological PET Imaging: A Systematic Review—Part 1, Supradiaphragmatic Cancers

Radiomics is an upcoming field in nuclear oncology, both promising and technically challenging. To summarize the already undertaken work on supradiaphragmatic neoplasia and assess its quality, we performed a literature search in the PubMed database up to 18 February 2022. Inclusion criteria were: studies based on human data; at least one specified tumor type; supradiaphragmatic malignancy; performing radiomics on PET imaging. Exclusion criteria were: studies only based on phantom or animal data; technical articles without a clinically oriented question; fewer than 30 patients in the training cohort. A review database containing PMID, year of publication, cancer type, and quality criteria (number of patients, retrospective or prospective nature, independent validation cohort) was constructed. A total of 220 studies met the inclusion criteria. Among them, 119 (54.1%) studies included more than 100 patients, 21 studies (9.5%) were based on prospectively acquired data, and 91 (41.4%) used an independent validation set. Most studies focused on prognostic and treatment response objectives. Because the textural parameters and methods employed are very different from one article to another, it is complicated to aggregate and compare articles. New contributions and radiomics guidelines tend to help improving quality of the reported studies over the years.

Radiomics in PET Imaging:: A Practical Guide for Newcomers

Radiomics has undergone considerable development in recent years. In PET imaging, very promising results concerning the ability of handcrafted features to predict the biological characteristics of lesions and to assess patient prognosis or response to treatment have been reported in the literature. This article presents a checklist for designing a reliable radiomic study, gives an overview of the steps of the pipeline, and outlines approaches for data harmonization. Tips are provided for critical reading of the content of articles. The advantages and limitations of handcrafted radiomics compared with deep-learning approaches for the characterization of PET images are also discussed.

The impact of the variation of imaging parameters on the robustness of Computed Tomography radiomic features: A review

The field of radiomics is at the forefront of personalized medicine. However, there is concern that high variation in imaging parameters will impact robustness of radiomic features and subsequently the performance of the predictive models built upon them. Therefore, our review aims to evaluate the impact of imaging parameters on the robustness of radiomic features. We also provide insights into the validity and discrepancy of different methodologies applied to investigate the robustness of radiomic features. We selected 47 papers based on our predefined inclusion criteria and grouped these papers by the imaging parameter under investigation: (i) scanner parameters, (ii) acquisition parameters and (iii) reconstruction parameters. Our review highlighted that most of the imaging parameters are disruptive parameters, and shape along with First order statistics were reported as the most robust radiomic features against variation in imaging parameters. This review identified inconsistencies related to the methodology of the reviewed studies such as the metrics used for robustness, the feature extraction techniques, the reporting style, and their outcome inclusion. We hope this review will aid the scientific community in conducting research in a way that is more reproducible and avoids the pitfalls of previous analyses.

A Systematic Review of PET Textural Analysis and Radiomics in Cancer

Background: Although many works have supported the utility of PET radiomics, several authors have raised concerns over the robustness and replicability of the results. This study aimed to perform a systematic review on the topic of PET radiomics and the used methodologies. Methods: PubMed was searched up to 15 October 2020. Original research articles based on human data specifying at least one tumor type and PET image were included, excluding those that apply only first-order statistics and those including fewer than 20 patients. Each publication, cancer type, objective and several methodological parameters (number of patients and features, validation approach, among other things) were extracted. Results: A total of 290 studies were included. Lung (28%) and head and neck (24%) were the most studied cancers. The most common objective was prognosis/treatment response (46%), followed by diagnosis/staging (21%), tumor characterization (18%) and technical evaluations (15%). The average number of patients included was 114 (median = 71; range 20–1419), and the average number of high-order features calculated per study was 31 (median = 26, range 1–286). Conclusions: PET radiomics is a promising field, but the number of patients in most publications is insufficient, and very few papers perform in-depth validations. The role of standardization initiatives will be crucial in the upcoming years.

Evaluating Focal 18F-FDG Uptake in Thyroid Gland with Radiomics

Purpose

The aim of this study was to evaluate the ability of ¹⁸F-FDG PET/CT texture analysis to predict the exact pathological outcome of thyroid incidentalomas.

Methods

¹⁸F-FDG PET/CT images between March 2010 and September 2018 were retrospectively reviewed in patients with focal ¹⁸F-FDG uptake in the thyroid gland and who underwent fine needle aspiration biopsy from this area. The focal uptake in the thyroid gland was drawn in 3D with 40% SUVmax threshold. Features were extracted from volume of interest (VOI) using the LIFEx package. The features obtained were compared in benign and malignant groups, and statistically significant variables were evaluated by receiver operating curve (ROC) analysis. The correlation between the variables with area under curve (AUC) value over 0.7 was examined; variables with correlation coefficient less than 0.6 were evaluated with machine learning algorithms.

Results

Sixty patients (70% train set, 30% test set) were included in the study. In univariate analysis, a statistically significant difference was observed in 6 conventional parameters, 5 first-, and 16 second-order features between benign and malignant groups in train set (p < 0.05). The feature with the highest benign-malignant discriminating power was GLRLM_RLNU (AUC:0.827). AUC value of SUVmax was calculated as 0.758. GLRLM_RLNU and SUVmax were evaluated to build a model to predict the exact pathology outcome. Random forest algorithm showed the best accuracy and AUC (78.6% and 0.849, respectively).

Conclusion

In the differentiation of benign-malignant thyroid incidentalomas, GLRLM_RLNU and SUVmax combination may be more useful than SUVmax to predict the outcome.

PET/CT radiomics in breast cancer: Mind the step

The aim of the present review was to assess the current status of positron emission tomography/computed tomography (PET/CT) radiomics research in breast cancer, and in particular to analyze the strengths and weaknesses of the published papers in order to identify challenges and suggest possible solutions and future research directions. Various combinations of the terms "breast", "radiomic", "PET", "radiomics", "texture", and "textural" were used for the literature search, extended until 8 July 2019, within the PubMed/MEDLINE database. Twenty-six articles fulfilling the inclusion/exclusion criteria were retrieved in full text and analyzed. The studies had technical and clinical objectives, including diagnosis, biological characterization (correlation with histology, molecular subtypes and IHC marker expression), prediction of response to neoadjuvant chemotherapy, staging, and outcome prediction. We reviewed and discussed the selected investigations following the radiomics workflow steps related to the clinical, technical, analysis, and reporting issues. Most of the current evidence on the clinical role of PET/CT radiomics in breast cancer is at the feasibility level. Harmonized methods in image acquisition, post-processing and features calculation, predictive models and classifiers trained and validated on sufficiently representative datasets, adherence to consensus guidelines, and transparent reporting will give validity and generalizability to the results.

Radiomics robustness assessment and classification evaluation: A two-stage method demonstrated on multivendor FFDM

PURPOSE

Radiomic texture analysis is typically performed on images acquired under specific, homogeneous imaging conditions. These controlled conditions may not be representative of the range of imaging conditions implemented clinically. We aim to develop a two-stage method of radiomic texture analysis that incorporates the reproducibility of individual texture features across imaging conditions to guide the development of texture signatures which are robust across mammography unit vendors.

METHODS

Full-field digital mammograms were retrospectively collected for women who underwent screening mammography on both a Hologic Lorad Selenia and GE Senographe 2000D system. Radiomic features were calculated on manually placed regions of interest in each image. In stage one (robustness assessment), we identified a set of nonredundant features that were reproducible across the two different vendors. This was achieved through hierarchical clustering and application of robustness metrics. In stage two (classification evaluation), we performed stepwise feature selection and leave-one-out quadratic discriminant analysis (QDA) to construct radiomic signatures. We refer to this two-state method as robustness assessment, classification evaluation (RACE). These radiomic signatures were used to classify the risk of breast cancer through receiver operator characteristic (ROC) analysis, using the area under the ROC curve as a figure of merit in the task of distinguishing between women with and without high-risk factors present. Generalizability was investigated by comparing the classification performance of a feature set on the images from which they were selected (intravendor) to the classification performance on images from the vendor on which it was not selected (intervendor). Intervendor and intravendor performances were also compared to the performance obtained by implementing ComBat, a feature-level harmonization method and to the performance by implementing ComBat followed by RACE.

RESULTS

Generalizability, defined as the difference between intervendor and intravendor classification performance, was shown to monotonically decrease as the number of clusters used in stage one increased (Mann-Kendall P < 0.001). Intravendor performance was not shown to be statistically different from ComBat harmonization while intervendor performance was significantly higher than ComBat. No significant difference was observed between either of the single methods and the use of ComBat followed by RACE.

CONCLUSIONS

A two-stage method for robust radiomic signature construction is proposed and demonstrated in the task of breast cancer risk assessment. The proposed method was used to assess generalizability of radiomic texture signatures at varying levels of feature robustness criteria. The results suggest that generalizability of feature sets monotonically decreases as reproducibility of features decreases. This trend suggests that considerations of feature robustness in feature selection methodology could improve classifier generalizability in multifarious full-field digital mammography datasets collected on various vendor units. Additionally, harmonization methods such as ComBat may hold utility in classification schemes and should continue to be investigated.