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Ahn Y, Lee SM, Choi S, Choe J, Oh SY, Do KH, Seo JB. CT-guided pretreatment biopsy diagnosis in patients with thymic epithelial tumours: diagnostic accuracy and risk of seeding. Clin Radiol 2024; 79:263-271. [PMID: 38220515 DOI: 10.1016/j.crad.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/10/2023] [Accepted: 12/10/2023] [Indexed: 01/16/2024]
Abstract
AIM To investigate the diagnostic performance of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) for thymic epithelial tumours (TETs) and the complication rate after PTNB including seeding after PTNB. MATERIALS AND METHODS This retrospective study identified PTNBs for anterior mediastinal lesions between May 2007 and September 2021. The diagnostic performance for TETs and complications were investigated. The concordance of the histological grades of TETs between PTNB and surgery was evaluated. The factors associated with pleural seeding after PTNB were determined using Cox regression analysis. RESULTS Of 387 PTNBs, 235 PTNBs from 225 patients diagnosed as TETs (124 thymomas and 101 thymic carcinomas) and 150 PTNBs from 133 patients diagnosed as other than TETs were included. The sensitivity, specificity, and accuracy for TETs were 89.4% (210/235), 100% (210/210), and 93.5% (360/385), respectively, with an immediate complication rate of 4.4% (17/385). The concordance rate of the histological grades between PTNB and surgery was 73.3% (77/105) after excluding uncategorised types of thymomas. During follow-up after PTNB (median duration, 38.8 months; range, 0.3-164.6 months), no tract seeding was observed. Pleural seeding was observed in 26 patients. Thymic carcinoma (hazard ratio [HR], 5.94; 95% confidence interval [CI], 2.07-17.08; p=0.001) and incomplete resection (HR, 3.29; 95% CI, 1.20-9.02; p=0.02) were associated with pleural seeding, while the biopsy approach type (transpleural versus parasternal) was not associated (p=0.12). CONCLUSIONS Pretreatment biopsy for TETs was accurate and safe and may be considered for diagnosing TETs, particularly when the diagnosis is challenging and histological diagnosis is mandatory.
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Affiliation(s)
- Y Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - S M Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - S Choi
- Department of Cardiothoracic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - J Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - S Y Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - K-H Do
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - J B Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Huang X, Wang X, Liu Y, Wang Z, Li S, Kuang P. Contrast-enhanced CT-based radiomics differentiate anterior mediastinum lymphoma from thymoma without myasthenia gravis and calcification. Clin Radiol 2024; 79:e500-e510. [PMID: 38242804 DOI: 10.1016/j.crad.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/30/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024]
Abstract
AIM To explore the value of a radiomics model based on enhanced computed tomography (CT) in differentiating anterior mediastinal lymphoma (AML) and thymoma without myasthenia gravis (MG) and calcification. MATERIALS AND METHODS The present study analysed patients who were diagnosed histologically with AML and thymoma in three independent institutions. All pre-treatment patients underwent enhanced CT. In the training group of patients from institutions 1 (the First Affiliated Hospital of Kunming Medical University) and 3 (the Yunnan Cancer Hospital), two radiologists independently analysed the enhanced CT images and performed manual segmentation of each tumour. Radiomics features were screened using interobserver interclass coefficient (ICC) analysis, feature correlation analysis, and L1 regularisation. The discriminative efficacy of the logistic regression model was evaluated using receiver operating characteristic (ROC) analysis. Validation group of patients from institution 2 (the Second Affiliated Hospital of Zhejiang University School of Medicine) was used to validate the proposed models. RESULTS A total of 114 patients were enrolled in this study and 1,743 radiomics features were extracted from the enhanced CT images. After feature screening, the remaining 37 robust radiomics features were used to construct the model. In the training group, the AUC of the model was 0.987 (95% confidence interval [CI]: 0.976-0.999), the sensitivity, specificity, and accuracy were 0.912, 0.946, and 0.924, respectively. In the validation group, the AUC of the model was 0.798 (95% CI: 0.683-0.913), the sensitivity, specificity, and accuracy were 0.760, 0.700, and 0.743, respectively. CONCLUSION The radiomics model created provided effective information to assist in the selection of clinical strategies, thus reducing unnecessary procedures in patients with AML and guiding direct surgery in patients with thymoma to avoid biopsy.
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Affiliation(s)
- X Huang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - X Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Y Liu
- Department of Radiology, Yunnan Cancer Hospital, Kunming, China
| | - Z Wang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - S Li
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - P Kuang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Yanagihara T, Kawamura T, Maki N, Kobayashi N, Kikuchi S, Goto Y, Ichimura H, Sato Y. Practical methods to differentiate thymic malignancies by positron-emission tomography and tumor markers. Surg Today 2024:10.1007/s00595-024-02801-5. [PMID: 38411770 DOI: 10.1007/s00595-024-02801-5] [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: 08/30/2023] [Accepted: 12/24/2023] [Indexed: 02/28/2024]
Abstract
PURPOSE An accurate diagnosis of thymic malignancies is important, but challenging due to the broad range of differential diagnoses. This study aims to evaluate the efficacy of PET/CT and tumor markers for diagnosing thymic malignancies. METHODS Patients admitted to our department between January 2012 and December 2021 with primary anterior mediastinal tumors were retrospectively evaluated. We evaluated the relationship between the maximum standardized uptake value (SUVmax), tumor markers, and pathological diagnosis in four groups: thymic carcinoma, thymoma, lymphoma, and others. RESULTS In total, 139 patients were included in this study. The SUVmax was significantly higher in lymphoma, thymic carcinoma, and thymoma, in that order. The cytokeratin 19 fragment (CYFRA 21-1) was significantly higher in thymic carcinoma than in the other groups. An ROC curve analysis indicated that the optimal cut-off values of SUVmax for thymic carcinoma plus lymphoma and CYFRA 21-1 for thymic carcinoma were 7.97 (AUC = 0.934) and 2.95 (AUC = 0.768), respectively. Using a combination of cut-off values (SUVmax = 8, CYFRA 21-1 = 3), the accuracy rate for diagnosing thymic carcinoma was 91.4%. CONCLUSIONS The SUVmax and CYFRA 21-1 levels are significant indicators for the diagnosis of thymic carcinoma. Combining these indicators resulted in a more accurate diagnosis of thymic malignancies, which could facilitate the decision-making process for determining the optimal treatment strategies.
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Affiliation(s)
- Takahiro Yanagihara
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Tomoyuki Kawamura
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naoki Maki
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Naohiro Kobayashi
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Shinji Kikuchi
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukinobu Goto
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Hideo Ichimura
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba, Ibaraki, 305-8575, Japan.
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Chang CC, Lin CY, Liu YS, Chen YY, Huang WL, Lai WW, Yen YT, Ma MC, Tseng YL. Therapeutic Decision Making in Prevascular Mediastinal Tumors Using CT Radiomics and Clinical Features: Upfront Surgery or Pretreatment Needle Biopsy? Cancers (Basel) 2024; 16:773. [PMID: 38398164 PMCID: PMC10886806 DOI: 10.3390/cancers16040773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
The study aimed to develop machine learning (ML) classification models for differentiating patients who needed direct surgery from patients who needed core needle biopsy among patients with prevascular mediastinal tumor (PMT). Patients with PMT who received a contrast-enhanced computed tomography (CECT) scan and initial management for PMT between January 2010 and December 2020 were included in this retrospective study. Fourteen ML algorithms were used to construct candidate classification models via the voting ensemble approach, based on preoperative clinical data and radiomic features extracted from the CECT. The classification accuracy of clinical diagnosis was 86.1%. The first ensemble learning model was built by randomly choosing seven ML models from a set of fourteen ML models and had a classification accuracy of 88.0% (95% CI = 85.8 to 90.3%). The second ensemble learning model was the combination of five ML models, including NeuralNetFastAI, NeuralNetTorch, RandomForest with Entropy, RandomForest with Gini, and XGBoost, and had a classification accuracy of 90.4% (95% CI = 87.9 to 93.0%), which significantly outperformed clinical diagnosis (p < 0.05). Due to the superior performance, the voting ensemble learning clinical-radiomic classification model may be used as a clinical decision support system to facilitate the selection of the initial management of PMT.
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Affiliation(s)
- Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
| | - Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-Y.L.); (Y.-S.L.)
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-Y.L.); (Y.-S.L.)
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
| | - Wu-Wei Lai
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
- Division of Thoracic Surgery, Department of Surgery, An-Nan Hospital, China Medical University, Tainan 70965, Taiwan
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
- Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan
| | - Mi-Chia Ma
- Department of Statistics and Institute of Data Science, National Cheng Kung University, Tainan 701401, Taiwan
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan; (C.-C.C.); (Y.-Y.C.); (W.-L.H.); (W.-W.L.); (Y.-L.T.)
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[Mediastinal tumors : Diagnosis and treatment of the most common tumor entities]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:277-288. [PMID: 35876853 DOI: 10.1007/s00104-022-01685-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2022] [Indexed: 10/16/2022]
Abstract
The mediastinum is defined as the space formed ventrally by the sternum, dorsally by the spine, and laterally by the mediastinal pleura. A mediastinal mass is frequently an incidental finding. The wide spectrum of underlying diseases and the anatomic proximity to central structures makes diagnosis and treatment challenging. In many cases, the combination of anamnesis, physical examination, imaging and laboratory tests already provides valuable information about the tumor entity. In addition to diagnostic procedures for histological examination of an unclear mediastinal tumor, radical resection is very important for the prognosis of the patients, especially in the case of tumors of the thymus. Multimodal treatment of advanced tumors that involve adjacent structures is best performed in designated centers.
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Byrd CT, Trope WL, Bhandari P, Konsker HB, Moradi F, Lui NS, Liou DZ, Backhus LM, Berry MF, Shrager JB. Positron emission tomography/computed tomography differentiates resectable thymoma from anterior mediastinal lymphoma. J Thorac Cardiovasc Surg 2023; 165:371-381.e1. [PMID: 35568521 DOI: 10.1016/j.jtcvs.2022.02.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/16/2022] [Accepted: 02/01/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Discrete anterior mediastinal masses most often represent thymoma or lymphoma. Lymphoma treatment is nonsurgical and requires biopsy. Noninvasive thymoma is ideally resected without biopsy, which may potentiate pleural metastases. This study sought to determine if clinical criteria or positron emission tomography/computed tomography could accurately differentiate the 2, guiding a direct surgery versus biopsy decision. METHODS A total of 48 subjects with resectable thymoma and 29 subjects with anterior mediastinal lymphoma treated from 2006 to 2019 were retrospectively examined. All had pretreatment positron emission tomography/computed tomography and appeared resectable (solitary, without clear invasion or metastasis). Reliability of clinical criteria (age and B symptoms) and positron emission tomography/computed tomography maximum standardized uptake value were assessed in differentiating thymoma and lymphoma using Wilcoxon rank-sum test, chi-square test, and logistic regression. Receiver operating characteristic analysis identified the maximum standardized uptake value threshold most associated with thymoma. RESULTS There was no association between tumor type and age group (P = .183) between those with thymoma versus anterior mediastinal lymphoma. Patients with thymoma were less likely to report B symptoms (P < .001). The median maximum standardized uptake value of thymoma and lymphoma differed dramatically: 4.35 versus 18.00 (P < .001). Maximum standardized uptake value was independently associated with tumor type on multivariable regression. On receiver operating characteristic analysis, lower maximum standardized uptake value was associated with thymoma. Maximum standardized uptake value less than 12.85 was associated with thymoma with 100.00% sensitivity and 88.89% positive predictive value. Maximum standardized uptake value less than 7.50 demonstrated 100.00% positive predictive value for thymoma. CONCLUSIONS Positron emission tomography/computed tomography maximum standardized uptake value of resectable anterior mediastinal masses may help guide a direct surgery versus biopsy decision. Tumors with maximum standardized uptake value less than 7.50 are likely thymoma and thus perhaps appropriately resected without biopsy. Tumors with maximum standardized uptake value greater than 7.50 should be biopsied to rule out lymphoma. Lymphoma is likely with maximum standardized uptake value greater than 12.85.
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Affiliation(s)
- Catherine T Byrd
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Winston L Trope
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Harrison B Konsker
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Farshad Moradi
- Division of Nuclear Medicine, Department of Radiology, Stanford University School of Medicine, Stanford, Calif
| | - Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
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Willner J, Zhou F, Moreira AL. Diagnostic Challenges in the Cytology of Thymic Epithelial Neoplasms. Cancers (Basel) 2022; 14:cancers14082013. [PMID: 35454918 PMCID: PMC9024685 DOI: 10.3390/cancers14082013] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 04/04/2022] [Accepted: 04/12/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary Thymic epithelial neoplasms, including thymoma, thymic carcinoma, and thymic neuroendocrine neoplasms, constitute the majority of anterior mediastinal masses. Fine needle aspirations (FNA) of mediastinal masses are infrequently encountered and are highly challenging to interpret. Thymic neoplasms display a significant degree of histologic diversity and have overlapping morphologic features with tumors from other sites. However, when properly interpreted alongside ancillary studies and radiologic findings, FNAs can yield clinically actionable results. This review aims to illustrate the usefulness and diagnostic pitfalls of thymic FNAs to assist pathologists in analyzing these specimens. Abstract Thymic epithelial neoplasms are rare tumors that constitute the majority of anterior mediastinal masses. They are classified as thymomas, thymic carcinomas, and thymic neuroendocrine neoplasms. Biopsy diagnosis is not common, and most tumors are surgically resected. Biopsy, including cytology, is indicated when a non-surgical entity is suspected or in cases of locally advanced disease. Smears of thymomas consist of round or spindle epithelial cells admixed with varying amounts of lymphocytes depending on the type of thymoma. Smears of thymic carcinoma and thymic neuroendocrine neoplasms are often indistinguishable from corresponding tumor types from other organs. Accurate cytological diagnosis can be difficult due to the histological diversity of thymomas, as well as the morphological features that certain thymic tumors share with similar tumors from other organs. However, fine needle aspiration (FNA) of anterior mediastinal masses can provide clinically actionable information and can be used to determine whether lesions require surgical, systemic, or local noninvasive treatments. Ancillary studies, namely, immunocytochemical stains, flow cytometry, and radiology, are important tools in the evaluation of thymic aspirates. This review discusses the utility and limitations of thymic FNAs and illustrates the diagnostic features and pitfalls of these specimens.
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Lin CY, Yen YT, Huang LT, Chen TY, Liu YS, Tang SY, Huang WL, Chen YY, Lai CH, Fang YHD, Chang CC, Tseng YL. An MRI-Based Clinical-Perfusion Model Predicts Pathological Subtypes of Prevascular Mediastinal Tumors. Diagnostics (Basel) 2022; 12:diagnostics12040889. [PMID: 35453937 PMCID: PMC9026802 DOI: 10.3390/diagnostics12040889] [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: 02/07/2022] [Revised: 03/18/2022] [Accepted: 03/31/2022] [Indexed: 12/10/2022] Open
Abstract
This study aimed to build machine learning prediction models for predicting pathological subtypes of prevascular mediastinal tumors (PMTs). The candidate predictors were clinical variables and dynamic contrast–enhanced MRI (DCE-MRI)–derived perfusion parameters. The clinical data and preoperative DCE–MRI images of 62 PMT patients, including 17 patients with lymphoma, 31 with thymoma, and 14 with thymic carcinoma, were retrospectively analyzed. Six perfusion parameters were calculated as candidate predictors. Univariate receiver-operating-characteristic curve analysis was performed to evaluate the performance of the prediction models. A predictive model was built based on multi-class classification, which detected lymphoma, thymoma, and thymic carcinoma with sensitivity of 52.9%, 74.2%, and 92.8%, respectively. In addition, two predictive models were built based on binary classification for distinguishing Hodgkin from non-Hodgkin lymphoma and for distinguishing invasive from noninvasive thymoma, with sensitivity of 75% and 71.4%, respectively. In addition to two perfusion parameters (efflux rate constant from tissue extravascular extracellular space into the blood plasma, and extravascular extracellular space volume per unit volume of tissue), age and tumor volume were also essential parameters for predicting PMT subtypes. In conclusion, our machine learning–based predictive model, constructed with clinical data and perfusion parameters, may represent a useful tool for differential diagnosis of PMT subtypes.
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Affiliation(s)
- Chia-Ying Lin
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-Y.L.); (L.-T.H.); (Y.-S.L.)
| | - Yi-Ting Yen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-T.Y.); (W.-L.H.); (Y.-Y.C.); (Y.-L.T.)
- Division of Trauma and Acute Care Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Li-Ting Huang
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-Y.L.); (L.-T.H.); (Y.-S.L.)
| | - Tsai-Yun Chen
- Division of Hematology and Oncology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (C.-Y.L.); (L.-T.H.); (Y.-S.L.)
| | - Shih-Yao Tang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan 704, Taiwan;
| | - Wei-Li Huang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-T.Y.); (W.-L.H.); (Y.-Y.C.); (Y.-L.T.)
| | - Ying-Yuan Chen
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-T.Y.); (W.-L.H.); (Y.-Y.C.); (Y.-L.T.)
| | - Chao-Han Lai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan;
| | - Yu-Hua Dean Fang
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Correspondence: (Y.-H.D.F.); (C.-C.C.)
| | - Chao-Chun Chang
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-T.Y.); (W.-L.H.); (Y.-Y.C.); (Y.-L.T.)
- Correspondence: (Y.-H.D.F.); (C.-C.C.)
| | - Yau-Lin Tseng
- Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan; (Y.-T.Y.); (W.-L.H.); (Y.-Y.C.); (Y.-L.T.)
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Quantitative Histogram Analysis of T2-Weighted and Diffusion-Weighted Magnetic Resonance Images for Prediction of Malignant Thymic Epithelial Tumors. J Comput Assist Tomogr 2021; 45:795-801. [PMID: 34347704 DOI: 10.1097/rct.0000000000001197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the value of histogram analysis for differentiating a high-risk thymic epithelial tumor (TET) from a low-risk TET using T2-weighted images and the apparent diffusion coefficient (ADC). METHODS Forty-nine patients with histopathologically proven TET after thymectomy were enrolled in this study and retrospectively classified as having low-risk TET (low-risk thymoma) or high-risk TET (high-risk thymoma or thymic carcinoma). Twelve parameters were obtained from the quantitative histogram analysis. The histogram parameters were compared using the Mann-Whitney U test. Diagnostic efficacy was estimated by receiver-operating characteristic curve analysis. RESULTS Twenty-five patients were classified as having low-risk TET and 24 as having high-risk TET. The mean ADC value showed diagnostic efficacy for differentiating high-risk TET from low-risk TET, with an area under the curve of 0.7, and was better than when using conventional methods alone. CONCLUSION The ADC-based histogram analysis could help to differentiate between high-risk and low-risk TETs.
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Kirienko M, Ninatti G, Cozzi L, Voulaz E, Gennaro N, Barajon I, Ricci F, Carlo-Stella C, Zucali P, Sollini M, Balzarini L, Chiti A. Computed tomography (CT)-derived radiomic features differentiate prevascular mediastinum masses as thymic neoplasms versus lymphomas. Radiol Med 2020; 125:951-960. [PMID: 32306201 DOI: 10.1007/s11547-020-01188-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/30/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We aimed to assess the ability of radiomics, applied to not-enhanced computed tomography (CT), to differentiate mediastinal masses as thymic neoplasms vs lymphomas. METHODS The present study was an observational retrospective trial. Inclusion criteria were pathology-proven thymic neoplasia or lymphoma with mediastinal localization, availability of CT. Exclusion criteria were age < 16 years and mediastinal lymphoma lesion < 4 cm. We selected 108 patients (M:F = 47:61, median age 48 years, range 17-79) and divided them into a training and a validation group. Radiomic features were used as predictors in linear discriminant analysis. We built different radiomic models considering segmentation software and resampling setting. Clinical variables were used as predictors to build a clinical model. Scoring metrics included sensitivity, specificity, accuracy and area under the curve (AUC). Wilcoxon paired test was used to compare the AUCs. RESULTS Fifty-five patients were affected by thymic neoplasia and 53 by lymphoma. In the validation analysis, the best radiomics model sensitivity, specificity, accuracy and AUC resulted 76.2 ± 7.0, 77.8 ± 5.5, 76.9 ± 6.0 and 0.84 ± 0.06, respectively. In the validation analysis of the clinical model, the same metrics resulted 95.2 ± 7.0, 88.9 ± 8.9, 92.3 ± 8.5 and 0.98 ± 0.07, respectively. The AUCs of the best radiomic and the clinical model not differed. CONCLUSIONS We developed and validated a CT-based radiomic model able to differentiate mediastinal masses on non-contrast-enhanced images, as thymic neoplasms or lymphoma. The proposed method was not affected by image postprocessing. Therefore, the present image-derived method has the potential to noninvasively support diagnosis in patients with prevascular mediastinal masses with major impact on management of asymptomatic cases.
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Affiliation(s)
- Margarita Kirienko
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, Milano, Italy
| | - Gaia Ninatti
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, Milano, Italy
| | - Luca Cozzi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, Milano, Italy.,Radiotherapy, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, via Manzoni, 56, 20089, Rozzano, Milano, Italy
| | - Emanuele Voulaz
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, Milano, Italy.,Thoracic Surgery, Humanitas Clinical and Research Center - IRCCS, via Manzoni, 56, 20089, Rozzano, Milano, Italy
| | - Nicolò Gennaro
- Training Program in Radiology, Humanitas University, via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, Milano, Italy
| | - Isabella Barajon
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, Milano, Italy
| | - Francesca Ricci
- Department of Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, via Manzoni, 56, 20089, Rozzano, Milano, Italy
| | - Carmelo Carlo-Stella
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, Milano, Italy.,Department of Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, via Manzoni, 56, 20089, Rozzano, Milano, Italy
| | - Paolo Zucali
- Department of Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, via Manzoni, 56, 20089, Rozzano, Milano, Italy
| | - Martina Sollini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, Milano, Italy. .,Nuclear Medicine, Diagnostic Imaging Department, Humanitas Clinical and Research Center - IRCCS, via Manzoni, 56, 20089, Rozzano, Milano, Italy.
| | - Luca Balzarini
- Radiology, Diagnostic Imaging Department, Humanitas Clinical and Research Center - IRCCS, via Manzoni, 56, 20089, Rozzano, Milano, Italy
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini, 4, 20090, Pieve Emanuele, Milano, Italy.,Nuclear Medicine, Diagnostic Imaging Department, Humanitas Clinical and Research Center - IRCCS, via Manzoni, 56, 20089, Rozzano, Milano, Italy
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11
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Verification of the diagnostic strategy for anterior mediastinal tumors. Int J Clin Oncol 2018; 24:385-393. [DOI: 10.1007/s10147-018-1362-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
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12
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Padda SK, Keijzers M, Wakelee HA. Pretreatment biopsy for thymic epithelial tumors-does histology subtype matter for treatment strategy? J Thorac Dis 2016; 8:1895-900. [PMID: 27618984 DOI: 10.21037/jtd.2016.06.77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Sukhmani K Padda
- Department of Medicine (Oncology), Stanford University/Stanford Cancer Institute, Stanford, CA, USA
| | - Marlies Keijzers
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Heather A Wakelee
- Department of Medicine (Oncology), Stanford University/Stanford Cancer Institute, Stanford, CA, USA
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13
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Marchevsky A, Marx A, Strobel P, Suster S, Venuta F, Marino M, Yousem S, Zakowski M. [Policies and reporting guidelines for small biopsy specimens of mediastinal masses]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:104-9. [PMID: 24581160 PMCID: PMC6131233 DOI: 10.3779/j.issn.1009-3419.2014.02.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Alberto Marchevsky
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, California
| | - Alex Marx
- Department of Pathology, University Medical Center Mannheim, Mannheim, Germany
| | - Philipp Strobel
- Department of Pathology, University Medical Center Mannheim, Mannheim, Germany
| | - Saul Suster
- Department of Pathology 3nd Laboratory Medicine, Medical College of Wisconsin, Mil-waukee, Wisconsin
| | - Federico Venuta
- Department of Thoracic Surgery, University of Rome La Sapienza, Rome, Italy
| | - Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Samuel Yousem
- Department of Pathology, UPMC-Presbyterian University Hospital, Pittsburgh, Pennsylvania
| | - Maureen Zakowski
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
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14
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Port-site recurrence after complete resection of stage I thymoma by video-assisted thoracoscopic surgery: report of a case. Surg Today 2013; 45:232-4. [DOI: 10.1007/s00595-013-0781-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
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15
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Nonsuppressing normal thymus on chemical shift magnetic resonance imaging in a young woman. J Thorac Imaging 2013; 27:W196-8. [PMID: 22487991 DOI: 10.1097/rti.0b013e318249936a] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A previously healthy 21-year-old woman presented with syncope and arrhythmia. A computed tomographic coronary angiogram was solely remarkable for an anterior mediastinal mass. Mediastinal magnetic resonance imaging of the reported mass revealed mildly prominent thymic tissue for age, with no suppression on out-of-phase chemical shift magnetic resonance imaging. Thymoma and lymphoma could not be excluded. After diagnosis and stabilization of her arrhythmia, the patient underwent median sternotomy and radical thymectomy, with pathology revealing normal thymus. This case suggests that nonsuppression of mildly prominent, homogenous thymic soft tissue in young women may not be sufficient to warrant diagnostic intervention and instead may warrant close follow-up.
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16
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17
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Klopfleisch R, Sperling C, Kershaw O, Gruber AD. Does the taking of biopsies affect the metastatic potential of tumours? A systematic review of reports on veterinary and human cases and animal models. Vet J 2011; 190:e31-e42. [PMID: 21723757 DOI: 10.1016/j.tvjl.2011.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 04/08/2011] [Accepted: 04/09/2011] [Indexed: 02/06/2023]
Abstract
Clinicians and pathologists are sporadically asked by owners whether the taking of tumour biopsies may affect the behaviour of the tumour, including its potential to metastasise. Unfortunately, systematic studies on this subject are unavailable in veterinary medicine, and the aim of this study was to estimate the risk of adverse effects of biopsy taking on tumour progression in animals. A systematic review of veterinary and human case reports and clinical studies as well as experimental animal models of biopsy-induced tumour metastasis was undertaken. There were only two veterinary case reports of needle tract metastases (NTM) following the taking of needle biopsies from urogenital and pulmonary tumours. Seventeen experimental studies found a high incidence of NTM but only a rat osteosarcoma and a hamster squamous carcinoma model showed an increased incidence of distant or regional metastases after incision or excision biopsy. In human medicine, the occurrence of NTM has been reported after the taking of biopsies from mesotheliomas (15%), melanomas (11%) and gall bladder tumours (11%), liver metastases of colon carcinomas (4%) and mammary carcinomas (4%) but an incidence of only <1% for all other tumours. Circulating tumour cells increased immediately after the taking of biopsies from human squamous cell, prostate, breast and hepatocellular carcinomas. Although no increased risk of biopsy-induced distant metastasis has been reported for any type of tumour, this is inconclusive due to a lack of non-biopsied control groups in human studies. Reports of biopsy-induced metastasis in animal tumours indicate that the taking of transcutaneous biopsies from urogenital tumours may be associated with a risk of NTM. However, there is no evidence of a general increase in risk of distant metastases in any tumour type in people or animals. The overall risk therefore appears to be negligible when compared to the valuable information obtained from biopsies in veterinary practice.
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Affiliation(s)
- R Klopfleisch
- Freie Universität Berlin, Institute of Veterinary Pathology, Robert-von-Ostertag-Strasse 15, 14163 Berlin, Germany.
| | - C Sperling
- Freie Universität Berlin, Institute of Veterinary Pathology, Robert-von-Ostertag-Strasse 15, 14163 Berlin, Germany
| | - O Kershaw
- Freie Universität Berlin, Institute of Veterinary Pathology, Robert-von-Ostertag-Strasse 15, 14163 Berlin, Germany
| | - A D Gruber
- Freie Universität Berlin, Institute of Veterinary Pathology, Robert-von-Ostertag-Strasse 15, 14163 Berlin, Germany
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Thymic epithelial tumours: a population-based study of the incidence, diagnostic procedures and therapy. Eur J Cancer 2008; 44:123-30. [PMID: 18068351 DOI: 10.1016/j.ejca.2007.11.004] [Citation(s) in RCA: 179] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2007] [Revised: 10/22/2007] [Accepted: 11/07/2007] [Indexed: 12/14/2022]
Abstract
The population-based incidence, diagnostic procedures, therapy and survival of thymic epithelial tumours were determined using the Netherlands National Pathological Archives and the Netherlands Cancer Registry. Excess mortality compared to the Netherlands standard population was estimated by relative survival analysis. Between 1994 and 2003, 537 thymic epithelial tumours were diagnosed. The incidence of all thymic epithelial tumours was 3.2/1,000,000. Diagnosis was obtained by primary resection in 56% of cases. Survival data were available for 232 cases. Not only thymic carcinomas (type C) but also thymomas (types B1-B3) were associated with excess mortality. Cases that underwent resection (78%) had a better survival than non-operated cases (median survival >10 years versus 1.1 years, p<0.001). Amongst the surgically treated cases (n=180), the completeness of resection did not predict survival (p=0.53). Thymic epithelial tumours are rare. Excess mortality was observed in the majority of tumours. Surgery offers the best perspectives, even if the resection is incomplete.
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19
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Detterbeck FC. Does an Anecdote Substantiate Dogma? Ann Thorac Surg 2006; 81:1182; author reply 1182-3. [PMID: 16488769 DOI: 10.1016/j.athoracsur.2005.05.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Revised: 03/16/2005] [Accepted: 05/09/2005] [Indexed: 11/26/2022]
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