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Zhu N, Meng X, Wang Z, Hu Y, Zhao T, Fan H, Niu F, Han J. Radiomics in Diagnosis, Grading, and Treatment Response Assessment of Soft Tissue Sarcomas: A Systematic Review and Meta-analysis. Acad Radiol 2024:S1076-6332(24)00193-4. [PMID: 38772802 DOI: 10.1016/j.acra.2024.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/12/2024] [Accepted: 03/22/2024] [Indexed: 05/23/2024]
Abstract
RATIONALE AND OBJECTIVES To evaluate radiomics in soft tissue sarcomas (STSs) for diagnostic accuracy, grading, and treatment response assessment, with a focus on clinical relevance. METHODS In this diagnostic accuracy study, radiomics was applied using multiple MRI sequences and AI classifiers, with histopathological diagnosis as the reference standard. Statistical analysis involved meta-analysis, random-effects model, and Deeks' funnel plot asymmetry test. RESULTS Among 579 unique titles and abstracts, 24 articles were included in the systematic review, with 21 used for meta-analysis. Radiomics demonstrated a pooled sensitivity of 84% (95% CI: 80-87) and specificity of 63% (95% CI: 56-70), AUC of 0.93 for diagnosis, sensitivity of 84% (95% CI: 82-87) and specificity of 73% (95% CI: 68-77), AUC of 0.91 for grading, and sensitivity of 83% (95% CI: 67-94) and specificity of 67% (95% CI: 59-74), AUC of 0.87 for treatment response assessment. CONCLUSION Radiomics exhibits potential for accurate diagnosis, grading, and treatment response assessment in STSs, emphasizing the need for standardization and prospective trials. CLINICAL RELEVANCE STATEMENT Radiomics offers precise tools for STS diagnosis, grading, and treatment response assessment, with implications for optimizing patient care and treatment strategies in this complex malignancy.
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Affiliation(s)
- Nana Zhu
- The Department of Radiology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China; Graduate School, Tianjin Medical University, Tianjin, China
| | - Xianghong Meng
- The Department of Radiology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China
| | - Zhi Wang
- The Department of Radiology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China; Graduate School, Tianjin Medical University, Tianjin, China.
| | - Yongcheng Hu
- The Department of Radiology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China; Graduate School, Tianjin Medical University, Tianjin, China
| | - Tingting Zhao
- The Department of Radiology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China; Graduate School, Tianjin Medical University, Tianjin, China
| | - Hongxing Fan
- The Department of Radiology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China; Graduate School, Tianjin Medical University, Tianjin, China
| | - Feige Niu
- The Department of Radiology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China; Graduate School, Tianjin Medical University, Tianjin, China
| | - Jun Han
- The Department of Radiology, Tianjin Hospital, 406 Jiefang Southern Road, Tianjin, China; Graduate School, Tianjin University, Tianjin, China
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De Angelis R, Casale R, Coquelet N, Ikhlef S, Mokhtari A, Simoni P, Bali MA. The impact of radiomics in the management of soft tissue sarcoma. Discov Oncol 2024; 15:62. [PMID: 38441726 PMCID: PMC10914656 DOI: 10.1007/s12672-024-00908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Soft tissue sarcomas (STSs) are rare malignancies. Pre-therapeutic tumour grading and assessment are crucial in making treatment decisions. Radiomics is a high-throughput method for analysing imaging data, providing quantitative information beyond expert assessment. This review highlights the role of radiomic texture analysis in STSs evaluation. MATERIALS AND METHODS We conducted a systematic review according to the Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted in PubMed/MEDLINE and Scopus using the search terms: 'radiomics [All Fields] AND ("soft tissue sarcoma" [All Fields] OR "soft tissue sarcomas" [All Fields])'. Only original articles, referring to humans, were included. RESULTS A preliminary search conducted on PubMed/MEDLINE and Scopus provided 74 and 93 studies respectively. Based on the previously described criteria, 49 papers were selected, with a publication range from July 2015 to June 2023. The main domains of interest were risk stratification, histological grading prediction, technical feasibility/reproductive aspects, treatment response. CONCLUSIONS With an increasing interest over the last years, the use of radiomics appears to have potential for assessing STSs from initial diagnosis to predicting treatment response. However, additional and extensive research is necessary to validate the effectiveness of radiomics parameters and to integrate them into a comprehensive decision support system.
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Affiliation(s)
- Riccardo De Angelis
- Institut Jules Bordet, Anderlecht, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Roberto Casale
- Institut Jules Bordet, Anderlecht, Belgium.
- Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Samia Ikhlef
- Institut Jules Bordet, Anderlecht, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
| | - Ayoub Mokhtari
- Institut Jules Bordet, Anderlecht, Belgium.
- Université Libre de Bruxelles, Brussels, Belgium.
| | - Paolo Simoni
- Université Libre de Bruxelles, Brussels, Belgium
| | - Maria Antonietta Bali
- Institut Jules Bordet, Anderlecht, Belgium
- Université Libre de Bruxelles, Brussels, Belgium
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3
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Walker K, Simister SK, Carr-Ascher J, Monument MJ, Thorpe SW, Randall RL. Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas. J Surg Oncol 2024; 129:97-111. [PMID: 38010997 DOI: 10.1002/jso.27526] [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: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
In this special edition update on soft tissue sarcomas (STS), we cover classifications, emerging technologies, prognostic tools, radiation schemas, and treatment disparities in extremity and truncal STS. We discuss the importance of enhancing local control and reducing complications, including the role of innovative imaging, surgical guidance, and hypofractionated radiation. We review advancements in systemic and immunotherapeutic treatments and introduce disparities seen in this vulnerable population that must be considered to improve overall patient care.
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Affiliation(s)
- Kyle Walker
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - Samuel K Simister
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - Janai Carr-Ascher
- Department of Hematology and Oncology, University of California, Davis, Sacramento, California, USA
| | - Michael J Monument
- Department of Surgery, The University of Calgary, Calgary, Alberta, Canada
| | - Steven W Thorpe
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
| | - R Lor Randall
- Department of Orthopaedics, University of California, Davis, Sacramento, California, USA
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4
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Arthur A, Orton MR, Emsley R, Vit S, Kelly-Morland C, Strauss D, Lunn J, Doran S, Lmalem H, Nzokirantevye A, Litiere S, Bonvalot S, Haas R, Gronchi A, Van Gestel D, Ducassou A, Raut CP, Meeus P, Spalek M, Hatton M, Le Pechoux C, Thway K, Fisher C, Jones R, Huang PH, Messiou C. A CT-based radiomics classification model for the prediction of histological type and tumour grade in retroperitoneal sarcoma (RADSARC-R): a retrospective multicohort analysis. Lancet Oncol 2023; 24:1277-1286. [PMID: 37922931 PMCID: PMC10618402 DOI: 10.1016/s1470-2045(23)00462-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/12/2023] [Accepted: 09/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Retroperitoneal sarcomas are tumours with a poor prognosis. Upfront characterisation of the tumour is difficult, and under-grading is common. Radiomics has the potential to non-invasively characterise the so-called radiological phenotype of tumours. We aimed to develop and independently validate a CT-based radiomics classification model for the prediction of histological type and grade in retroperitoneal leiomyosarcoma and liposarcoma. METHODS A retrospective discovery cohort was collated at our centre (Royal Marsden Hospital, London, UK) and an independent validation cohort comprising patients recruited in the phase 3 STRASS study of neoadjuvant radiotherapy in retroperitoneal sarcoma. Patients aged older than 18 years with confirmed primary leiomyosarcoma or liposarcoma proceeding to surgical resection with available contrast-enhanced CT scans were included. Using the discovery dataset, a CT-based radiomics workflow was developed, including manual delineation, sub-segmentation, feature extraction, and predictive model building. Separate probabilistic classifiers for the prediction of histological type and low versus intermediate or high grade tumour types were built and tested. Independent validation was then performed. The primary objective of the study was to develop radiomic classification models for the prediction of retroperitoneal leiomyosarcoma and liposarcoma type and histological grade. FINDINGS 170 patients recruited between Oct 30, 2016, and Dec 23, 2020, were eligible in the discovery cohort and 89 patients recruited between Jan 18, 2012, and April 10, 2017, were eligible in the validation cohort. In the discovery cohort, the median age was 63 years (range 27-89), with 83 (49%) female and 87 (51%) male patients. In the validation cohort, median age was 59 years (range 33-77), with 46 (52%) female and 43 (48%) male patients. The highest performing model for the prediction of histological type had an area under the receiver operator curve (AUROC) of 0·928 on validation, based on a feature set of radiomics and approximate radiomic volume fraction. The highest performing model for the prediction of histological grade had an AUROC of 0·882 on validation, based on a radiomics feature set. INTERPRETATION Our validated radiomics model can predict the histological type and grade of retroperitoneal sarcomas with excellent performance. This could have important implications for improving diagnosis and risk stratification in retroperitoneal sarcomas. FUNDING Wellcome Trust, European Organisation for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group, the National Institutes for Health, and the National Institute for Health and Care Research Biomedical Research Centre at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research.
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Affiliation(s)
| | | | | | - Sharon Vit
- The Institute of Cancer Research, London, UK
| | | | - Dirk Strauss
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Jason Lunn
- The Institute of Cancer Research, London, UK
| | - Simon Doran
- The Institute of Cancer Research, London, UK
| | - Hafida Lmalem
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Axelle Nzokirantevye
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | - Saskia Litiere
- The European Organisation for Research and Treatment of Cancer, Brussels, Belgium
| | | | - Rick Haas
- The Netherlands Cancer Institute (Antoni Van Leeuwenhoekziekenhuis), Amsterdam, Netherlands
| | - Alessandro Gronchi
- Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dirk Van Gestel
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Ducassou
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Institut Claudius Regaud, Toulouse, France; Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Chandrajit P Raut
- Brigham and Women's Hospital, Boston, MA, USA; Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Mateusz Spalek
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Matthew Hatton
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | - Khin Thway
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - Cyril Fisher
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Robin Jones
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Christina Messiou
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
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Pace E, Johnson TS, Kao SC, Parikh AK, Qi J, Rajderkar DA, Reid JR, Towbin AJ, States LJ. Imaging of pediatric extragonadal pelvic soft tissue tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29966. [PMID: 36482882 PMCID: PMC10710207 DOI: 10.1002/pbc.29966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/16/2022] [Indexed: 12/13/2022]
Abstract
The most common pediatric extragonadal pelvic cancers include germ cell tumors, sacrococcygeal teratomas, and rhabdomyosarcomas (arising from the urinary bladder, prostate, paratesticular tissues, vagina, uterus, and perineum). This paper describes the radiological and nuclear medicine features of these entities and provides consensus-based recommendations for the assessment at diagnosis, during, and after treatment.
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Affiliation(s)
- Erika Pace
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, England, United Kingdom
| | - Tatum S. Johnson
- Department of Radiology, Brenner Children’s Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Simon C. Kao
- Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Ashish K. Parikh
- Department of Radiology, Emory University Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Jing Qi
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Dhanashree A. Rajderkar
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Janet R. Reid
- Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alexander J. Towbin
- Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, Ohio, USA
| | - Lisa J. States
- Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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6
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Liu CC, Abdelhafez YG, Yap SP, Acquafredda F, Schirò S, Wong AL, Sarohia D, Bateni C, Darrow MA, Guindani M, Lee S, Zhang M, Moawad AW, Ng QKT, Shere L, Elsayes KM, Maroldi R, Link TM, Nardo L, Qi J. AI-Based Automated Lipomatous Tumor Segmentation in MR Images: Ensemble Solution to Heterogeneous Data. J Digit Imaging 2023; 36:1049-1059. [PMID: 36854923 PMCID: PMC10287587 DOI: 10.1007/s10278-023-00785-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 03/02/2023] Open
Abstract
Deep learning (DL) has been proposed to automate image segmentation and provide accuracy, consistency, and efficiency. Accurate segmentation of lipomatous tumors (LTs) is critical for correct tumor radiomics analysis and localization. The major challenge of this task is data heterogeneity, including tumor morphological characteristics and multicenter scanning protocols. To mitigate the issue, we aimed to develop a DL-based Super Learner (SL) ensemble framework with different data correction and normalization methods. Pathologically proven LTs on pre-operative T1-weighted/proton-density MR images of 185 patients were manually segmented. The LTs were categorized by tumor locations as distal upper limb (DUL), distal lower limb (DLL), proximal upper limb (PUL), proximal lower limb (PLL), or Trunk (T) and grouped by 80%/9%/11% for training, validation and testing. Six configurations of correction/normalization were applied to data for fivefold-cross-validation trainings, resulting in 30 base learners (BLs). A SL was obtained from the BLs by optimizing SL weights. The performance was evaluated by dice-similarity-coefficient (DSC), sensitivity, specificity, and Hausdorff distance (HD95). For predictions of the BLs, the average DSC, sensitivity, and specificity from the testing data were 0.72 [Formula: see text] 0.16, 0.73 [Formula: see text] 0.168, and 0.99 [Formula: see text] 0.012, respectively, while for SL predictions were 0.80 [Formula: see text] 0.184, 0.78 [Formula: see text] 0.193, and 1.00 [Formula: see text] 0.010. The average HD95 of the BLs were 11.5 (DUL), 23.2 (DLL), 25.9 (PUL), 32.1 (PLL), and 47.9 (T) mm, whereas of SL were 1.7, 8.4, 15.9, 2.2, and 36.6 mm, respectively. The proposed method could improve the segmentation accuracy and mitigate the performance instability and data heterogeneity aiding the differential diagnosis of LTs in real clinical situations.
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Affiliation(s)
- Chih-Chieh Liu
- Department of Biomedical Engineering, University of California, Davis, CA, USA
| | - Yasser G Abdelhafez
- Department of Radiology, UC Davis Health, Sacramento, CA, USA
- Radiotherapy and Nuclear Medicine Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - S Paran Yap
- Department of Radiology, UC Davis Health, Sacramento, CA, USA
| | | | - Silvia Schirò
- Section of Radiology, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Andrew L Wong
- Department of Radiology, UC Davis Health, Sacramento, CA, USA
| | - Dani Sarohia
- Department of Radiology, UC Davis Health, Sacramento, CA, USA
| | - Cyrus Bateni
- Department of Radiology, UC Davis Health, Sacramento, CA, USA
| | - Morgan A Darrow
- Pathology and Laboratory Medicine, University of California Davis, Sacramento, CA, USA
| | - Michele Guindani
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Sonia Lee
- Department of Radiological Sciences, University of California, Irvine, CA, USA
| | - Michelle Zhang
- Department of Diagnostic Radiology, McGill University Health Center, Montreal, Canada
| | - Ahmed W Moawad
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Diagnostic Radiology, Mercy Catholic Medical Center, Darby, PA, USA
| | | | - Layla Shere
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Khaled M Elsayes
- Department of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Lorenzo Nardo
- Department of Radiology, UC Davis Health, Sacramento, CA, USA
| | - Jinyi Qi
- Department of Biomedical Engineering, University of California, Davis, CA, USA.
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7
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Lee S, Lee SY, Jung JY, Nam Y, Jeon HJ, Jung CK, Shin SH, Chung YG. Ensemble learning-based radiomics with multi-sequence magnetic resonance imaging for benign and malignant soft tissue tumor differentiation. PLoS One 2023; 18:e0286417. [PMID: 37256875 DOI: 10.1371/journal.pone.0286417] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
Many previous studies focused on differentiating between benign and malignant soft tissue tumors using radiomics model based on various magnetic resonance imaging (MRI) sequences, but it is still unclear how to set up the input radiomic features from multiple MRI sequences. Here, we evaluated two types of radiomics models generated using different feature incorporation strategies. In order to differentiate between benign and malignant soft tissue tumors (STTs), we compared the diagnostic performance of an ensemble of random forest (R) models with single-sequence MRI inputs to R models with pooled multi-sequence MRI inputs. One-hundred twenty-five STT patients with preoperative MRI were retrospectively included and consisted of training (n = 100) and test (n = 25) sets. MRI included T1-weighted (T1-WI), T2-weighted (T2-WI), contrast-enhanced (CE)-T1-WI, diffusion-weighted images (DWIs, b = 800 sec/mm2) and apparent diffusion coefficient (ADC) maps. After tumor segmentation on each sequence, 100 original radiomic features were extracted from each sequence image and divided into three-feature sets: T features from T1- and T2-WI, CE features from CE-T1-WI, and D features from DWI and ADC maps. Four radiomics models were built using Lasso and R with four combinations of three-feature sets as inputs: T features (R-T), T+CE features (R-C), T+D features (R-D), and T+CE+D features (R-A) (Type-1 model). An ensemble model was built by soft voting of five, single-sequence-based R models (Type-2 model). AUC, sensitivity, specificity, and accuracy of each model was calculated with five-fold cross validation. In Type-1 model, AUC, sensitivity, specificity, and accuracy were 0.752, 71.8%, 61.1%, and 67.2% in R-T; 0.756, 76.1%, 70.4%, and 73.6% in R-C; 0.750, 77.5%, 63.0%, and 71.2% in R-D; and 0.749, 74.6%, 61.1%, and 68.8% R-A models, respectively. AUC, sensitivity, specificity, and accuracy of Type-2 model were 0.774, 76.1%, 68.5%, and 72.8%. In conclusion, an ensemble method is beneficial to incorporate features from multi-sequence MRI and showed diagnostic robustness for differentiating malignant STTs.
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Affiliation(s)
- Seungeun Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoonho Nam
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Seoul, Gyeonggi-do, Republic of Korea
| | - Hyeon Jun Jeon
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Seoul, Gyeonggi-do, Republic of Korea
| | - Chan-Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Lee S, Jung JY, Nam Y, Jung CK, Lee SY, Lee J, Shin SH, Chung YG. Diagnosis of Marginal Infiltration in Soft Tissue Sarcoma by Radiomics Approach Using T2-Weighted Dixon Sequence. J Magn Reson Imaging 2023; 57:752-760. [PMID: 35808915 DOI: 10.1002/jmri.28331] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Determination of preoperative soft tissue sarcoma (STS) margin is crucial for patient prognosis. PURPOSE To evaluate diagnostic performance of radiomics model using T2-weighted Dixon sequence for infiltration degree of STS margin. STUDY TYPE Retrospective. POPULATION Seventy-two STS patients consisted of training (n = 58) and test (n = 14) sets. FIELD STRENGTH/SEQUENCE A 3.0 T; T2-weighted Dixon images. ASSESSMENT Pathologic result of marginal infiltration in STS (circumscribed margin; n = 27, group 1, focally infiltrative margin; n = 31, group 2-A, diffusely infiltrative margin; n = 14, group 2-B) was the reference standard. Radiomic volume and shape (VS) and other (T2) features were extracted from entire tumor volume and margin, respectively. Twelve radiomics models were generated using four combinations of classifier algorithms (R, SR, LR, LSR) and three different inputs (VS, T2, VS + T2 [VST2] features) to differentiate the three groups. Three radiologists (reader 1, 2, 3) analyzed the marginal infiltration with 6-scale confidence score. STATISTICAL TESTS Area under the receiver operating characteristic curve (AUC) and concordance rate. RESULTS Averaged AUCs of R, SR, LR, LSR models were 0.438, 0.466, 0.438, 0.466 using VS features, 0.596, 0.584, 0.814, 0.815 using T2 features, and 0.581, 0.587, 0.821, 0.821 using VST2 features, respectively. The LR and LSR models constructed with T2 or VST2 features showed higher AUC and concordance rate compared to radiologists' analysis (AUC; 0.730, 0.675, 0.706, concordance rate; 0.46, 0.43, 0.47 in reader 1, 2, 3). DATA CONCLUSION Radiomics model constructed with features from tumor margin on T2-weighted Dixon sequence is a promising method for differentiating infiltration degree of STS margin. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Seungeun Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoonho Nam
- Division of Biomedical Engineering, Hankuk University of Foreign Studies, Gyeonggi-do, Republic of Korea
| | - Chan-Kwon Jung
- Department of Pathology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jooyeon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Applied Statistics, Hanyang University, Seoul, Republic of Korea
| | - Seung-Han Shin
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yang-Guk Chung
- Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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9
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Pavlidis ET, Pavlidis TE. New trends in the surgical management of soft tissue sarcoma: The role of preoperative biopsy. World J Clin Oncol 2023; 14:89-98. [PMID: 36908679 PMCID: PMC9993143 DOI: 10.5306/wjco.v14.i2.89] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 12/26/2022] [Accepted: 01/10/2023] [Indexed: 02/21/2023] Open
Abstract
Soft tissue sarcoma (STS) accounts for 1% of all malignant neoplasms in adults. Their diagnosis and management constitute a challenging target. They originate from the mesenchyme, and 50 subtypes with various cytogenetic profiles concerning soft tissue and bones have been recognized. These tumors mainly affect middle-aged adults but may be present at any age. Half of the patients have metastatic disease at the time of diagnosis and require systemic therapy. Tumors above 3-5 cm in size must be suspected of potential malignancy. A thorough history, clinical examination and imaging that must precede biopsy are necessary. Modern imaging techniques include ultrasound, computed tomography (CT), new magnetic resonance imaging (MRI), and positron emission tomography/CT. MRI findings may distinguish low-grade from high-grade STS based on a diagnostic score (tumor heterogeneity, intratumoral and peritumoral enhancement). A score ≥ 2 indicates a high-grade lesion, and a score ≤ 1 indicates a low-grade lesion. For disease staging, abdominal imaging is recommended to detect early abdominal or retroperitoneal metastases. Liquid biopsy by detecting genomic material in serum is a novel diagnostic tool. A preoperative biopsy is necessary for diagnosis, prognosis and optimal planning of surgical intervention. Core needle biopsy is the most indicative and effective. Its correct performance influences surgical management. An unsuccessful biopsy means the dissemination of cancer cells into healthy anatomical structures that ultimately affect resectability and survival. Complete therapeutic excision (R0) with an acceptable resection margin of 1 cm is the method of choice. However, near significant structures, i.e., vessels, nerves, an R2 resection (macroscopic margin involvement) preserving functionality but having a risk of local recurrence can be an acceptable choice, after informing the patient, to prevent an unavoidable amputation. For borderline resectability of the tumor, neoadjuvant chemo/radiotherapy has a place. Likewise, after surgical excision, adjuvant therapy is indicated, but chemotherapy in nonmetastatic disease is still debatable. The five-year survival rate reaches up to 55%. Reresection is considered after positive or uncertain resection margins. Current strategies are based on novel chemotherapeutic agents, improved radiotherapy applications to limit local side effects and targeted biological therapy or immunotherapy, including vaccines. Young age is a risk factor for distant metastasis within 6 mo following primary tumor resection. Neoadjuvant radiotherapy lasting 5-6 wk and surgical resection are indicated for high-grade STS (grade 2 or 3). Wide surgical excision alone may be acceptable for patients older than 70 years. However, locally advanced disease requires a multidisciplinary task of decision-making for amputation or limb salvage.
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Affiliation(s)
- Efstathios T Pavlidis
- 2nd Propedeutic Department of Surgery, Hippocration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
| | - Theodoros E Pavlidis
- 2nd Propedeutic Department of Surgery, Hippocration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki 54642, Greece
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Bianchi G, Laranga R, Spinnato P, Ostetto F, Bubbico E, Righi A, Donati DM. Sensitivity, Specificity, and Predictive Values of Tru-Cut ® Biopsy in Grading Primary Localized Myxoid Liposarcomas of the Extremities. Cancers (Basel) 2023; 15:cancers15051391. [PMID: 36900184 PMCID: PMC10000105 DOI: 10.3390/cancers15051391] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
(1) Background: Histological diagnosis and tumor grading are major prognostic and predictive factors in soft tissue sarcomas (STS), as they dictate the treatment strategies with a direct impact on patient survival. This study aims to investigate the grading accuracy, sensitivity, and specificity of Tru-Cut® biopsy (TCB) in primary localized myxoid liposarcomas (MLs) of the extremities and its impact on patient prognosis. (2) Methods: Patients with ML undergoing TCB and a subsequent tumor resection between 2007 and 2021 were evaluated. Concordance between the preoperative assessment and definitive histology was calculated with a weighted Cohen's kappa coefficient. Sensitivity, specificity, and diagnostic accuracy were calculated. (3) Results: Of 144 biopsies, the histological grade concordance rate was 63% (Kappa 0.2819). Neoadjuvant chemotherapy and/or radiotherapy impacted concordance with a downgrading effect in high-grade tumors. Among forty patients not treated in neoadjuvant settings, the sensitivity of TCB was 57%, the specificity was 100%, and the overall predictive values of positive and negative TCB were 100% and 50%, respectively. Misdiagnosis did not impact overall survival. (4) Conclusions: TCB may underestimate ML grading due to tumor heterogeneity. Neoadjuvant ChT and/or radiotherapy are associated with pathological downgrading; however, discordance in diagnosis does not modify patient prognosis because systemic treatment decision-making also includes other variables.
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Affiliation(s)
- Giuseppe Bianchi
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Roberta Laranga
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Correspondence:
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Federico Ostetto
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Elisa Bubbico
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
| | - Alberto Righi
- Anatomy and Pathological Histology, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy
| | - Davide Maria Donati
- 3rd Orthopaedic and Traumatologic Clinic Prevalently Oncologic, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, 40123 Bologna, Italy
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Crombé A, Matcuk GR, Fadli D, Sambri A, Patel DB, Paioli A, Kind M, Spinnato P. Role of Imaging in Initial Prognostication of Locally Advanced Soft Tissue Sarcomas. Acad Radiol 2023; 30:322-340. [PMID: 35534392 DOI: 10.1016/j.acra.2022.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/21/2022] [Accepted: 04/06/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although imaging is central in the initial staging of patients with soft tissue sarcomas (STS), it remains underused and few radiological features are currently used in practice for prognostication and to help guide the best therapeutic strategy. Yet, several prognostic qualitative and quantitative characteristics from magnetic resonance imaging (MRI) and positron emission tomography (PET) have been identified over these last decades. OBJECTIVE After an overview of the current validated prognostic features based on baseline imaging and their integration into prognostic tools, such as nomograms used by clinicians, the aim of this review is to summarize more complex and innovative MRI, PET, and radiomics features, and to highlight their role to predict indirectly (through histologic grade) or directly the patients' outcomes.
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Affiliation(s)
- Amandine Crombé
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, 229, cours de l'Argonne, F-33076, Bordeaux, France; Department of musculoskeletal imaging, Pellegrin University Hospital, 2, place Amélie Raba-Léon, F-33000, Bordeaux, France; Models in Oncology (MONC) Team, INRIA Bordeaux Sud-Ouest, CNRS UMR 5251, Institut de Mathématiques de Bordeaux & Bordeaux University, 351 cours de la libération, F-33400 Talence, France.
| | - George R Matcuk
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | - David Fadli
- Department of musculoskeletal imaging, Pellegrin University Hospital, 2, place Amélie Raba-Léon, F-33000, Bordeaux, France
| | - Andrea Sambri
- Alma Mater Studiorum, University of Bologna, Bologna, Italy; IRCCS Policlinico di Sant'Orsola, Bologna, Italy
| | - Dakshesh B Patel
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Anna Paioli
- Osteoncology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Michele Kind
- Department of Diagnostic and Interventional Oncological Imaging, Institut Bergonié, Regional Comprehensive Cancer of Nouvelle-Aquitaine, 229, cours de l'Argonne, F-33076, Bordeaux, France
| | - Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Radiomics and Deep Learning for Disease Detection in Musculoskeletal Radiology: An Overview of Novel MRI- and CT-Based Approaches. Invest Radiol 2023; 58:3-13. [PMID: 36070548 DOI: 10.1097/rli.0000000000000907] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ABSTRACT Radiomics and machine learning-based methods offer exciting opportunities for improving diagnostic performance and efficiency in musculoskeletal radiology for various tasks, including acute injuries, chronic conditions, spinal abnormalities, and neoplasms. While early radiomics-based methods were often limited to a smaller number of higher-order image feature extractions, applying machine learning-based analytic models, multifactorial correlations, and classifiers now permits big data processing and testing thousands of features to identify relevant markers. A growing number of novel deep learning-based methods describe magnetic resonance imaging- and computed tomography-based algorithms for diagnosing anterior cruciate ligament tears, meniscus tears, articular cartilage defects, rotator cuff tears, fractures, metastatic skeletal disease, and soft tissue tumors. Initial radiomics and deep learning techniques have focused on binary detection tasks, such as determining the presence or absence of a single abnormality and differentiation of benign versus malignant. Newer-generation algorithms aim to include practically relevant multiclass characterization of detected abnormalities, such as typing and malignancy grading of neoplasms. So-called delta-radiomics assess tumor features before and after treatment, with temporal changes of radiomics features serving as surrogate markers for tumor responses to treatment. New approaches also predict treatment success rates, surgical resection completeness, and recurrence risk. Practice-relevant goals for the next generation of algorithms include diagnostic whole-organ and advanced classification capabilities. Important research objectives to fill current knowledge gaps include well-designed research studies to understand how diagnostic performances and suggested efficiency gains of isolated research settings translate into routine daily clinical practice. This article summarizes current radiomics- and machine learning-based magnetic resonance imaging and computed tomography approaches for musculoskeletal disease detection and offers a perspective on future goals and objectives.
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Giraudo C, Fichera G, Del Fiore P, Mocellin S, Brunello A, Rastrelli M, Stramare R. Tumor cellularity beyond the visible in soft tissue sarcomas: Results of an ADC-based, single center, and preliminary radiomics study. Front Oncol 2022; 12:879553. [DOI: 10.3389/fonc.2022.879553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeSoft tissue sarcomas represent approximately 1% of all malignancies, and diagnostic radiology plays a significant role in the overall management of this rare group of tumors. Recently, quantitative imaging and, in particular, radiomics demonstrated to provide significant novel information, for instance, in terms of prognosis and grading. The aim of this study was to evaluate the prognostic role of radiomic variables extracted from apparent diffusion coefficient (ADC) maps collected at diagnosis in patients with soft tissue sarcomas in terms of overall survival and metastatic spread as well as to assess the relationship between radiomics and the tumor grade.MethodsPatients with histologically proven soft tissue sarcomas treated in our tertiary center from 2016 to 2019 who underwent an Magnetic Resonance (MR) scan at diagnosis including diffusion-weighted imaging were included in this retrospective institution review board–approved study. Each primary lesion was segmented using the b50 images; the volumetric region of interest was then applied on the ADC map. A total of 33 radiomic features were extracted, and highly correlating features were selected by factor analysis. In the case of feature/s showing statistically significant results, the diagnostic accuracy was computed. The Spearman correlation coefficient was used to evaluate the relationship between the tumor grade and radiomic features selected by factor analysis. All analyses were performed applying p<0.05 as a significant level.ResultsA total of 36 patients matched the inclusion criteria (15 women; mean age 58.9 ± 15 years old). The most frequent histotype was myxofibrosarcoma (16.6%), and most of the patients were affected by high-grade lesions (77.7%). Seven patients had pulmonary metastases, and, altogether, eight were deceased. Only the feature Imc1 turned out to be a predictor of metastatic spread (p=0.045 after Bonferroni correction) with 76.7% accuracy. The value -0.16 showed 73.3% sensitivity and 71.4% specificity, and patients with metastases showed lower values (mean Imc1 of metastatic patients -0.31). None of the examined variables was a predictor of the overall outcome (p>0.05, each). A moderate statistically significant correlation emerged only between Imc1 and the tumor grade (r=0.457, p=0.005).ConclusionsIn conclusion, the radiomic feature Imc1 acts as a predictor of metastatic spread in patients with soft tissue sarcomas and correlates with the tumor grade.
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Shah AA, Alturise F, Alkhalifah T, Khan YD. Deep Learning Approaches for Detection of Breast Adenocarcinoma Causing Carcinogenic Mutations. Int J Mol Sci 2022; 23:ijms231911539. [PMID: 36232840 PMCID: PMC9570286 DOI: 10.3390/ijms231911539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/16/2022] Open
Abstract
Genes are composed of DNA and each gene has a specific sequence. Recombination or replication within the gene base ends in a permanent change in the nucleotide collection in a DNA called mutation and some mutations can lead to cancer. Breast adenocarcinoma starts in secretary cells. Breast adenocarcinoma is the most common of all cancers that occur in women. According to a survey within the United States of America, there are more than 282,000 breast adenocarcinoma patients registered each 12 months, and most of them are women. Recognition of cancer in its early stages saves many lives. A proposed framework is developed for the early detection of breast adenocarcinoma using an ensemble learning technique with multiple deep learning algorithms, specifically: Long Short-Term Memory (LSTM), Gated Recurrent Units (GRU), and Bi-directional LSTM. There are 99 types of driver genes involved in breast adenocarcinoma. This study uses a dataset of 4127 samples including men and women taken from more than 12 cohorts of cancer detection institutes. The dataset encompasses a total of 6170 mutations that occur in 99 genes. On these gene sequences, different algorithms are applied for feature extraction. Three types of testing techniques including independent set testing, self-consistency testing, and a 10-fold cross-validation test is applied to validate and test the learning approaches. Subsequently, multiple deep learning approaches such as LSTM, GRU, and bi-directional LSTM algorithms are applied. Several evaluation metrics are enumerated for the validation of results including accuracy, sensitivity, specificity, Mathew’s correlation coefficient, area under the curve, training loss, precision, recall, F1 score, and Cohen’s kappa while the values obtained are 99.57, 99.50, 99.63, 0.99, 1.0, 0.2027, 99.57, 99.57, 99.57, and 99.14 respectively.
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Affiliation(s)
- Asghar Ali Shah
- Department of Computer Science, University of Management and Technology, Lahore 54770, Pakistan
| | - Fahad Alturise
- Department of Computer, College of Science and Arts in Ar Rass, Qassim University, Ar Rass 58892, Qassim, Saudi Arabia
| | - Tamim Alkhalifah
- Department of Computer, College of Science and Arts in Ar Rass, Qassim University, Ar Rass 58892, Qassim, Saudi Arabia
- Correspondence:
| | - Yaser Daanial Khan
- Department of Computer Science, University of Management and Technology, Lahore 54770, Pakistan
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BAYSAL B, ANARAT FB, DOGAN MB, ZENGİNKİNET T, CELİK A, TOKSOZ AN, SARI T, ÖZKAN K. Concordance of histopathological and radiological grading in soft tissue sarcomas. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1153412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: The grade of the tumor is essential for planning the treatment strategy in soft-tissue sarcomas (STS). The goal of this study is to determine magnetic resonance imaging features related to histopathological grade and aggressiveness of STS.
Material and Method: This retrospective single-center study involved preoperative contrast-enhanced MRI examinations of 64 patients with STS. MRI findings evaluated were; heterogeneity, necrosis, hemorrhage, and relationship with surrounding tissue in T1-weighted (T1W), T2-weighted (T2W), and T1W post-contrast sequences of the lesion. Histological grade was determined with the Fédération Nationale des Centres de Lutte Contre Le Cancer (FNCLCC) grading system, and the aggressiveness of the lesion was measured with the Ki-67 index.
Results: Sixty-four patients (mean age 45.5±21.6, M/F ratio 34/30) with STS were included. 33 (51.6%) patients graded as FNCLCC grade 3. On MRI examinations, the absence of necrosis was significantly associated with FNCLCC grade 1 and a low Ki-67 index (p
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Affiliation(s)
| | | | | | | | - Aykut CELİK
- ISTANBUL MEDENIYET UNIVERSITY, SCHOOL OF MEDICINE
| | | | - Tarık SARI
- ISTANBUL MEDENIYET UNIVERSITY, SCHOOL OF MEDICINE
| | - Korhan ÖZKAN
- ISTANBUL MEDENIYET UNIVERSITY, SCHOOL OF MEDICINE
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Arthur A, Johnston EW, Winfield JM, Blackledge MD, Jones RL, Huang PH, Messiou C. Virtual Biopsy in Soft Tissue Sarcoma. How Close Are We? Front Oncol 2022; 12:892620. [PMID: 35847882 PMCID: PMC9286756 DOI: 10.3389/fonc.2022.892620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/31/2022] [Indexed: 12/13/2022] Open
Abstract
A shift in radiology to a data-driven specialty has been unlocked by synergistic developments in imaging biomarkers (IB) and computational science. This is advancing the capability to deliver “virtual biopsies” within oncology. The ability to non-invasively probe tumour biology both spatially and temporally would fulfil the potential of imaging to inform management of complex tumours; improving diagnostic accuracy, providing new insights into inter- and intra-tumoral heterogeneity and individualised treatment planning and monitoring. Soft tissue sarcomas (STS) are rare tumours of mesenchymal origin with over 150 histological subtypes and notorious heterogeneity. The combination of inter- and intra-tumoural heterogeneity and the rarity of the disease remain major barriers to effective treatments. We provide an overview of the process of successful IB development, the key imaging and computational advancements in STS including quantitative magnetic resonance imaging, radiomics and artificial intelligence, and the studies to date that have explored the potential biological surrogates to imaging metrics. We discuss the promising future directions of IBs in STS and illustrate how the routine clinical implementation of a virtual biopsy has the potential to revolutionise the management of this group of complex cancers and improve clinical outcomes.
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Affiliation(s)
- Amani Arthur
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
| | - Edward W. Johnston
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, Sutton, United Kingdom
- *Correspondence: Paul H. Huang, ; Christina Messiou,
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, United Kingdom
- Sarcoma Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- *Correspondence: Paul H. Huang, ; Christina Messiou,
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Militello C, Rundo L, Dimarco M, Orlando A, Woitek R, D'Angelo I, Russo G, Bartolotta TV. 3D DCE-MRI Radiomic Analysis for Malignant Lesion Prediction in Breast Cancer Patients. Acad Radiol 2022; 29:830-840. [PMID: 34600805 DOI: 10.1016/j.acra.2021.08.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a radiomic model, with radiomic features extracted from breast Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) from a 1.5T scanner, for predicting the malignancy of masses with enhancement. Images were acquired using an 8-channel breast coil in the axial plane. The rationale behind this study is to show the feasibility of a radiomics-powered model that could be integrated into the clinical practice by exploiting only standard-of-care DCE-MRI with the goal of reducing the required image pre-processing (ie, normalization and quantitative imaging map generation). MATERIALS AND METHODS 107 radiomic features were extracted from a manually annotated dataset of 111 patients, which was split into discovery and test sets. A feature calibration and pre-processing step was performed to find only robust non-redundant features. An in-depth discovery analysis was performed to define a predictive model: for this purpose, a Support Vector Machine (SVM) was trained in a nested 5-fold cross-validation scheme, by exploiting several unsupervised feature selection methods. The predictive model performance was evaluated in terms of Area Under the Receiver Operating Characteristic (AUROC), specificity, sensitivity, PPV and NPV. The test was performed on unseen held-out data. RESULTS The model combining Unsupervised Discriminative Feature Selection (UDFS) and SVMs on average achieved the best performance on the blinded test set: AUROC = 0.725±0.091, sensitivity = 0.709±0.176, specificity = 0.741±0.114, PPV = 0.72±0.093, and NPV = 0.75±0.114. CONCLUSION In this study, we built a radiomic predictive model based on breast DCE-MRI, using only the strongest enhancement phase, with promising results in terms of accuracy and specificity in the differentiation of malignant from benign breast lesions.
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Pediatric Sarcomas: The Next Generation of Molecular Studies. Cancers (Basel) 2022; 14:cancers14102515. [PMID: 35626119 PMCID: PMC9139929 DOI: 10.3390/cancers14102515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary There has been an incredible amount of discovery in pediatric sarcomas, but much remains to be accomplished. Clinical challenges include diagnostic heterogeneity and the poor outcome of patients with high risk, metastatic, and relapsed disease. The emergence of single cell sequencing has allowed the ability to document tumor cell heterogeneity in amazing detail, but it does not allow the ability to visualize spatial orientation. This problem has been solved by spatial multi-omics, which can be used to map tumors and visualize the distribution of critical transcripts, mutations, and proteins. However, these tools only offer observational data. High-throughput functional genomics provides a powerful way to highlight oncogenic drivers and potential therapy opportunities. Research has been hamstrung by a need for annotated specimens, particularly in post-therapy, relapsed, and metastatic disease, and initial biopsies offer only limited data opportunities. Data complexity, variability, and inconsistency present problems best approached with AI/machine learning. We stand on the threshold of a revolution in cancer cell biology that has the potential for translation into more effective and more directed therapies, particularly for previously recalcitrant diseases. Abstract Pediatric sarcomas constitute one of the largest groups of childhood cancers, following hematopoietic, neural, and renal lesions. Partly because of their diversity, they continue to offer challenges in diagnosis and treatment. In spite of the diagnostic, nosologic, and therapeutic gains made with genetic technology, newer means for investigation are needed. This article reviews emerging technology being used to study human neoplasia and how these methods might be applicable to pediatric sarcomas. Methods reviewed include single cell RNA sequencing (scRNAseq), spatial multi-omics, high-throughput functional genomics, and clustered regularly interspersed short palindromic sequence-Cas9 (CRISPR-Cas9) technology. In spite of these advances, the field continues to be challenged by a dearth of properly annotated materials, particularly from recurrences and metastases and pre- and post-treatment samples.
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Bone and Soft Tissue Tumors. Radiol Clin North Am 2022; 60:339-358. [DOI: 10.1016/j.rcl.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Demircioğlu A. Evaluation of the dependence of radiomic features on the machine learning model. Insights Imaging 2022; 13:28. [PMID: 35201534 PMCID: PMC8873309 DOI: 10.1186/s13244-022-01170-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background In radiomic studies, several models are often trained with different combinations of feature selection methods and classifiers. The features of the best model are usually considered relevant to the problem, and they represent potential biomarkers. Features selected from statistically similarly performing models are generally not studied. To understand the degree to which the selected features of these statistically similar models differ, 14 publicly available datasets, 8 feature selection methods, and 8 classifiers were used in this retrospective study. For each combination of feature selection and classifier, a model was trained, and its performance was measured with AUC-ROC. The best-performing model was compared to other models using a DeLong test. Models that were statistically similar were compared in terms of their selected features. Results Approximately 57% of all models analyzed were statistically similar to the best-performing model. Feature selection methods were, in general, relatively unstable (0.58; range 0.35–0.84). The features selected by different models varied largely (0.19; range 0.02–0.42), although the selected features themselves were highly correlated (0.71; range 0.4–0.92). Conclusions Feature relevance in radiomics strongly depends on the model used, and statistically similar models will generally identify different features as relevant. Considering features selected by a single model is misleading, and it is often not possible to directly determine whether such features are candidate biomarkers. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01170-2.
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Affiliation(s)
- Aydin Demircioğlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45157, Essen, Germany.
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Abstract
OBJECTIVES A critical problem in radiomic studies is the high dimensionality of the datasets, which stems from small sample sizes and many generic features extracted from the volume of interest. Therefore, feature selection methods are used, which aim to remove redundant as well as irrelevant features. Because there are many feature selection algorithms, it is key to understand their performance in the context of radiomics. MATERIALS AND METHODS A total of 29 feature selection algorithms and 10 classifiers were evaluated on 10 publicly available radiomic datasets. Feature selection methods were compared for training times, for the stability of the selected features, and for ranking, which measures the pairwise similarity of the methods. In addition, the predictive performance of the algorithms was measured by utilizing the area under the receiver operating characteristic curve of the best-performing classifier. RESULTS Feature selections differed largely in training times as well as stability and similarity. No single method was able to outperform another one consistently in predictive performance. CONCLUSION Our results indicated that simpler methods are more stable than complex ones and do not perform worse in terms of area under the receiver operating characteristic curve. Analysis of variance, least absolute shrinkage and selection operator, and minimum redundancy, maximum relevance ensemble appear to be good choices for radiomic studies in terms of predictive performance, as they outperformed most other feature selection methods.
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Boudabbous S, Hamard M, Saiji E, Gorican K, Poletti PA, Becker M, Neroladaki A. What morphological MRI features enable differentiation of low-grade from high-grade soft tissue sarcoma? BJR Open 2022; 4:20210081. [PMID: 36105415 PMCID: PMC9459866 DOI: 10.1259/bjro.20210081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 04/12/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Objective: To assess the diagnostic performance of morphological MRI features separately and in combination for distinguishing low- from high-grade soft tissue sarcoma (STS). Methods and materials: We retrospectively analysed pre-treatment MRI examinations with T1, T2 with and without fat suppression (FS) and contrast-enhanced T1 obtained in 64 patients with STS categorized histologically as low (n = 21) versus high grade (n = 43). Two musculoskeletal radiologists blinded to histology evaluated MRI features. Diagnostic performance was calculated for each reader and for MRI features showing significant association with histology (p < 0.05). Logistic regression analysis was performed to develop a diagnostic model to identify high-grade STS. Results: Among all evaluated MRI features, only six features had adequate interobserver reproducibility (kappa>0.5). Multivariate logistic regression analysis revealed a significant association with tumour grade for lesion heterogeneity on FS images, intratumoural enhancement≥51% of tumour volume and peritumoural enhancement for both readers (p < 0.05). For both readers, the presence of each of the three features yielded odds ratios for high grade versus low grade from 4.4 to 9.1 (p < 0.05). The sum of the positive features for each reader independent of reader expertise yielded areas under the curve (AUCs) > 0.8. The presence of ≥2 positive features indicated a high risk for high-grade sarcoma, whereas ≤1 positive feature indicated a low-to-moderate risk Conclusion: A diagnostic MRI score based on tumour heterogeneity, intratumoural and peritumoural enhancement enables identification of lesions that are likely to be high-grade as opposed to low-grade STS. Advances in knowledge: Tumour heterogeneity in Fat Suppression sequence, intratumoural and peritumoural enhancement is identified as signs of high-grade sarcoma.
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Affiliation(s)
- Sana Boudabbous
- Division of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Marion Hamard
- Division of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Essia Saiji
- Division of Radiology, Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Karel Gorican
- Division of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Pierre-Alexandre Poletti
- Division of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Minerva Becker
- Division of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Angeliki Neroladaki
- Division of Clinical Pathology, Diagnostic Department, Geneva University Hospitals, University of Geneva, Geneva, Switzerland
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23
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Fang S, Yang Y, Xu N, Tu Y, Yin Z, Zhang Y, Liu Y, Duan Z, Liu W, Wang S. An Update in Imaging Evaluation of Histopathological Grade of Soft Tissue Sarcomas Using Structural and Quantitative Imaging and Radiomics. J Magn Reson Imaging 2021; 55:1357-1375. [PMID: 34637568 DOI: 10.1002/jmri.27954] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/22/2022] Open
Abstract
Over the past two decades, considerable efforts have been made to develop non-invasive methods for determining tumor grade or surrogates for predicting the biological behavior, aiding early treatment decisions, and providing prognostic information. The development of new imaging tools, such as diffusion-weighted imaging, diffusion kurtosis imaging, perfusion imaging, and magnetic resonance spectroscopy have provided leverage in the diagnosis of soft tissue sarcomas. Artificial intelligence is a new technology used to study and simulate human thinking and abilities, which can extract and analyze advanced and quantitative image features from medical images with high throughput for an in-depth characterization of the spatial heterogeneity of tumor tissues. This article reviews the current imaging modalities used to predict the histopathological grade of soft tissue sarcomas and highlights the advantages and limitations of each modality. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Shaobo Fang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Yanyu Yang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Nan Xu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Yun Tu
- Department of Radiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhenzhen Yin
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Yu Zhang
- Department of Medical Imaging, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Yajie Liu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Zhiqing Duan
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Wenyu Liu
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
| | - Shaowu Wang
- Department of Radiology, The Second Hospital, Dalian Medical University, Dalian, China
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24
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Nardone V, Boldrini L, Grassi R, Franceschini D, Morelli I, Becherini C, Loi M, Greto D, Desideri I. Radiomics in the Setting of Neoadjuvant Radiotherapy: A New Approach for Tailored Treatment. Cancers (Basel) 2021; 13:cancers13143590. [PMID: 34298803 PMCID: PMC8303203 DOI: 10.3390/cancers13143590] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/11/2022] Open
Abstract
Simple Summary This review based on a literature search aims at showing the impact of Texture Analysis in the prediction of response to neoadjuvant radiotherapy and/or chemoradiotherapy. The manuscript explores radiomics approaches in different fields of neoadjuvant radiotherapy, including esophageal cancer, lung cancer, sarcoma and rectal cancer in order to shed a light in the setting of neoadjuvant radiotherapy that can be used to tailor the best subsequent therapeutical strategy. Abstract Introduction: Neoadjuvant radiotherapy is currently used mainly in locally advanced rectal cancer and sarcoma and in a subset of non-small cell lung cancer and esophageal cancer, whereas in other diseases it is under investigation. The evaluation of the efficacy of the induction strategy is made possible by performing imaging investigations before and after the neoadjuvant therapy and is usually challenging. In the last decade, texture analysis (TA) has been developed to help the radiologist to quantify and identify the parameters related to tumor heterogeneity, which cannot be appreciated by the naked eye. The aim of this narrative is to review the impact of TA on the prediction of response to neoadjuvant radiotherapy and or chemoradiotherapy. Materials and Methods: Key references were derived from a PubMed query. Hand searching and ClinicalTrials.gov were also used. Results: This paper contains a narrative report and a critical discussion of radiomics approaches in different fields of neoadjuvant radiotherapy, including esophageal cancer, lung cancer, sarcoma, and rectal cancer. Conclusions: Radiomics can shed a light on the setting of neoadjuvant therapies that can be used to tailor subsequent approaches or even to avoid surgery in the future. At the same, these results need to be validated in prospective and multicenter trials.
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Affiliation(s)
- Valerio Nardone
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (V.N.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Luca Boldrini
- Radiation Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Roberta Grassi
- Department of Precision Medicine, University of Campania “L. Vanvitelli”, 80138 Naples, Italy; (V.N.); (R.G.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, 20122 Milan, Italy
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Milan, Italy;
| | - Ilaria Morelli
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy;
- Correspondence: ; Tel.: +39-055-7947719
| | - Carlotta Becherini
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy;
| | - Mauro Loi
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, 50139 Florence, Italy; (M.L.); (D.G.); (I.D.)
| | - Daniela Greto
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, 50139 Florence, Italy; (M.L.); (D.G.); (I.D.)
| | - Isacco Desideri
- Radiation Oncology Unit, Azienda Ospedaliero Universitaria Careggi, 50139 Florence, Italy; (M.L.); (D.G.); (I.D.)
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy
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25
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Navarro F, Dapper H, Asadpour R, Knebel C, Spraker MB, Schwarze V, Schaub SK, Mayr NA, Specht K, Woodruff HC, Lambin P, Gersing AS, Nyflot MJ, Menze BH, Combs SE, Peeken JC. Development and External Validation of Deep-Learning-Based Tumor Grading Models in Soft-Tissue Sarcoma Patients Using MR Imaging. Cancers (Basel) 2021; 13:2866. [PMID: 34201251 PMCID: PMC8227009 DOI: 10.3390/cancers13122866] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 05/27/2021] [Accepted: 06/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In patients with soft-tissue sarcomas, tumor grading constitutes a decisive factor to determine the best treatment decision. Tumor grading is obtained by pathological work-up after focal biopsies. Deep learning (DL)-based imaging analysis may pose an alternative way to characterize STS tissue. In this work, we sought to non-invasively differentiate tumor grading into low-grade (G1) and high-grade (G2/G3) STS using DL techniques based on MR-imaging. METHODS Contrast-enhanced T1-weighted fat-saturated (T1FSGd) MRI sequences and fat-saturated T2-weighted (T2FS) sequences were collected from two independent retrospective cohorts (training: 148 patients, testing: 158 patients). Tumor grading was determined following the French Federation of Cancer Centers Sarcoma Group in pre-therapeutic biopsies. DL models were developed using transfer learning based on the DenseNet 161 architecture. RESULTS The T1FSGd and T2FS-based DL models achieved area under the receiver operator characteristic curve (AUC) values of 0.75 and 0.76 on the test cohort, respectively. T1FSGd achieved the best F1-score of all models (0.90). The T2FS-based DL model was able to significantly risk-stratify for overall survival. Attention maps revealed relevant features within the tumor volume and in border regions. CONCLUSIONS MRI-based DL models are capable of predicting tumor grading with good reproducibility in external validation.
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Affiliation(s)
- Fernando Navarro
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany; (F.N.); (H.D.); (R.A.); (S.E.C.)
- Department of Informatics, Technical University of Munich (TUM), Boltzmannstr. 3, 85748 Garching, Germany;
- TranslaTUM—Central Institute for Translational Cancer Research, Einsteinstraße 25, 81675 Munich, Germany
| | - Hendrik Dapper
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany; (F.N.); (H.D.); (R.A.); (S.E.C.)
| | - Rebecca Asadpour
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany; (F.N.); (H.D.); (R.A.); (S.E.C.)
| | - Carolin Knebel
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany;
| | - Matthew B. Spraker
- Department of Radiation Oncology, Washington University in St. Louis, 4511 Forest Park Ave, St. Louis, MO 63108, USA;
| | - Vincent Schwarze
- Department of Radiology, Grosshadern Campus, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany; (V.S.); (A.S.G.)
| | - Stephanie K. Schaub
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St, 356043, Seattle, WA 98195, USA; (S.K.S.); (N.A.M.); (M.J.N.)
| | - Nina A. Mayr
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St, 356043, Seattle, WA 98195, USA; (S.K.S.); (N.A.M.); (M.J.N.)
| | - Katja Specht
- Department of Pathology, Technical University of Munich (TUM), Trogerstr. 18, 81675 Munich, Germany;
| | - Henry C. Woodruff
- Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (H.C.W.); (P.L.)
- Department of Radiology and Nuclear Imaging, GROW—School for Oncology and Developmental Biology, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Philippe Lambin
- Department of Precision Medicine, GROW—School for Oncology and Developmental Biology, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, The Netherlands; (H.C.W.); (P.L.)
- Department of Radiology and Nuclear Imaging, GROW—School for Oncology and Developmental Biology, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Alexandra S. Gersing
- Department of Radiology, Grosshadern Campus, Ludwig-Maximilians-University Munich, Marchioninistraße 15, 81377 Munich, Germany; (V.S.); (A.S.G.)
- Department of Radiology, Klinikum rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany
| | - Matthew J. Nyflot
- Department of Radiation Oncology, University of Washington, 1959 NE Pacific St, 356043, Seattle, WA 98195, USA; (S.K.S.); (N.A.M.); (M.J.N.)
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Seattle, WA 98105, USA
| | - Bjoern H. Menze
- Department of Informatics, Technical University of Munich (TUM), Boltzmannstr. 3, 85748 Garching, Germany;
- Department for Quantitative Biomedicine, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
| | - Stephanie E. Combs
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany; (F.N.); (H.D.); (R.A.); (S.E.C.)
- Department for Quantitative Biomedicine, University of Zurich, Winterthurerstrasse 190, CH-8057 Zurich, Switzerland
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Ingolstaedter Landstr. 1, 85764 Munich, Germany
| | - Jan C. Peeken
- Department of Radiation Oncology, Klinikum Rechts der Isar, Technical University of Munich (TUM), Ismaninger Straße 22, 81675 Munich, Germany; (F.N.); (H.D.); (R.A.); (S.E.C.)
- Department of Radiology and Nuclear Imaging, GROW—School for Oncology and Developmental Biology, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
- Institute of Radiation Medicine (IRM), Department of Radiation Sciences (DRS), Ingolstaedter Landstr. 1, 85764 Munich, Germany
- Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site, 85764 Munich, Germany
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26
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Gitto S, Cuocolo R, Albano D, Morelli F, Pescatori LC, Messina C, Imbriaco M, Sconfienza LM. CT and MRI radiomics of bone and soft-tissue sarcomas: a systematic review of reproducibility and validation strategies. Insights Imaging 2021; 12:68. [PMID: 34076740 PMCID: PMC8172744 DOI: 10.1186/s13244-021-01008-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/05/2021] [Indexed: 02/07/2023] Open
Abstract
Background Feature reproducibility and model validation are two main challenges of radiomics. This study aims to systematically review radiomic feature reproducibility and predictive model validation strategies in studies dealing with CT and MRI radiomics of bone and soft-tissue sarcomas. The ultimate goal is to promote achieving a consensus on these aspects in radiomic workflows and facilitate clinical transferability. Results Out of 278 identified papers, forty-nine papers published between 2008 and 2020 were included. They dealt with radiomics of bone (n = 12) or soft-tissue (n = 37) tumors. Eighteen (37%) studies included a feature reproducibility analysis. Inter-/intra-reader segmentation variability was the theme of reproducibility analysis in 16 (33%) investigations, outnumbering the analyses focused on image acquisition or post-processing (n = 2, 4%). The intraclass correlation coefficient was the most commonly used statistical method to assess reproducibility, which ranged from 0.6 and 0.9. At least one machine learning validation technique was used for model development in 25 (51%) papers, and K-fold cross-validation was the most commonly employed. A clinical validation of the model was reported in 19 (39%) papers. It was performed using a separate dataset from the primary institution (i.e., internal validation) in 14 (29%) studies and an independent dataset related to different scanners or from another institution (i.e., independent validation) in 5 (10%) studies. Conclusions The issues of radiomic feature reproducibility and model validation varied largely among the studies dealing with musculoskeletal sarcomas and should be addressed in future investigations to bring the field of radiomics from a preclinical research area to the clinical stage.
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Affiliation(s)
- Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Renato Cuocolo
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli "Federico II", Naples, Italy.,Laboratory of Augmented Reality for Health Monitoring (ARHeMLab), Dipartimento di Ingegneria Elettrica e delle Tecnologie dell'Informazione, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | | | - Lorenzo Carlo Pescatori
- Assistance Publique - Hôpitaux de Paris (AP-HP), Service d'Imagerie Médicale, CHU Henri Mondor, Créteil, France
| | - Carmelo Messina
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Massimo Imbriaco
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Naples, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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27
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Chianca V, Albano D, Messina C, Vincenzo G, Rizzo S, Del Grande F, Sconfienza LM. An update in musculoskeletal tumors: from quantitative imaging to radiomics. Radiol Med 2021; 126:1095-1105. [PMID: 34009541 DOI: 10.1007/s11547-021-01368-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/02/2021] [Indexed: 02/08/2023]
Abstract
In the last two decades, relevant progress has been made in the diagnosis of musculoskeletal tumors due to the development of new imaging tools, such as diffusion-weighted imaging, diffusion kurtosis imaging, magnetic resonance spectroscopy, and diffusion tensor imaging. Another important role has been played by the development of artificial intelligence software based on complex algorithms, which employ computing power in the detection of specific tumor types. The aim of this article is to report the most advanced imaging techniques focusing on their advantages in clinical practice.
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Affiliation(s)
- Vito Chianca
- Clinica di Radiologia EOC IIMSI, Lugano, Switzerland. .,Ospedale Evangelico Betania, Napoli, Italy. .,Master in Oncologic Imaging, Diagnostic and Interventional Radiology Department of Translational Research, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Sezione di Scienze Radiologiche, Dipartimento Di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Palermo, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Dipartimento di Scienze Biomediche Per La Salute, Università degli Studi di Milano, Milano, Italy
| | | | | | | | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.,Dipartimento di Scienze Biomediche Per La Salute, Università degli Studi di Milano, Milano, Italy
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