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Philip MM, Welch A, McKiddie F, Nath M. A systematic review and meta-analysis of predictive and prognostic models for outcome prediction using positron emission tomography radiomics in head and neck squamous cell carcinoma patients. Cancer Med 2023; 12:16181-16194. [PMID: 37353996 PMCID: PMC10469753 DOI: 10.1002/cam4.6278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND Positron emission tomography (PET) images of head and neck squamous cell carcinoma (HNSCC) patients can assess the functional and biochemical processes at cellular levels. Therefore, PET radiomics-based prediction and prognostic models have the potentials to understand tumour heterogeneity and assist clinicians with diagnosis, prognosis and management of the disease. We conducted a systematic review of published modelling information to evaluate the usefulness of PET radiomics in the prediction and prognosis of HNSCC patients. METHODS We searched bibliographic databases (MEDLINE, Embase, Web of Science) from 2010 to 2021 and considered 31 studies with pre-defined inclusion criteria. We followed the CHARMS checklist for data extraction and performed quality assessment using the PROBAST tool. We conducted a meta-analysis to estimate the accuracy of the prediction and prognostic models using the diagnostic odds ratio (DOR) and average C-statistic, respectively. RESULTS Manual segmentation method followed by 40% of the maximum standardised uptake value (SUVmax ) thresholding is a commonly used approach. The area under the receiver operating curves of externally validated prediction models ranged between 0.60-0.87, 0.65-0.86 and 0.62-0.75 for overall survival, distant metastasis and recurrence, respectively. Most studies highlighted an overall high risk of bias (outcome definition, statistical methodologies and external validation of models) and high unclear concern in terms of applicability. The meta-analysis showed the estimated pooled DOR of 6.75 (95% CI: 4.45, 10.23) for prediction models and the C-statistic of 0.71 (95% CI: 0.67, 0.74) for prognostic models. CONCLUSIONS Both prediction and prognostic models using clinical variables and PET radiomics demonstrated reliable accuracy for detecting adverse outcomes in HNSCC, suggesting the prospect of PET radiomics in clinical settings for diagnosis, prognosis and management of HNSCC patients. Future studies of prediction and prognostic models should emphasise the quality of reporting, external model validation, generalisability to real clinical scenarios and enhanced reproducibility of results.
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Affiliation(s)
| | - Andy Welch
- Institute of Education in Healthcare and Medical Sciences, University of AberdeenAberdeenUK
| | | | - Mintu Nath
- Institute of Applied Health Sciences, University of AberdeenAberdeenUK
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Quantitative Diffusion-Weighted Imaging Analyses to Predict Response to Neoadjuvant Immunotherapy in Patients with Locally Advanced Head and Neck Carcinoma. Cancers (Basel) 2022; 14:cancers14246235. [PMID: 36551718 PMCID: PMC9776484 DOI: 10.3390/cancers14246235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Neoadjuvant immune checkpoint blockade (ICB) prior to surgery may induce early pathological responses in head and neck squamous cell carcinoma (HNSCC) patients. Routine imaging parameters fail to diagnose these responses early on. Magnetic resonance (MR) diffusion-weighted imaging (DWI) has proven to be useful for detecting HNSCC tumor mass after (chemo)radiation therapy. METHODS 32 patients with stage II-IV, resectable HNSCC, treated at a phase Ib/IIa IMCISION trial (NCT03003637), were retrospectively analyzed using MR-imaging before and after two doses of single agent nivolumab (anti-PD-1) (n = 6) or nivolumab with ipilimumab (anti-CTLA-4) ICB (n = 26). The primary tumors were delineated pre- and post-treatment. A total of 32 features were derived from the delineation and correlated with the tumor regression percentage in the surgical specimen. RESULTS MR-DWI data was available for 24 of 32 patients. Smaller baseline tumor diameter (p = 0.01-0.04) and higher sphericity (p = 0.03) were predictive of having a good pathological response to ICB. Post-treatment skewness and the change in skewness between MRIs were negatively correlated with the tumor's regression (p = 0.04, p = 0.02). CONCLUSION Pre-treatment DWI tumor diameter and sphericity may be quantitative biomarkers for the prediction of an early pathological response to ICB. Furthermore, our data indicate that ADC skewness could be a marker for individual response evaluation.
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Morland D, Triumbari EKA, Boldrini L, Gatta R, Pizzuto D, Annunziata S. Radiomics in Oncological PET Imaging: A Systematic Review—Part 1, Supradiaphragmatic Cancers. Diagnostics (Basel) 2022; 12:diagnostics12061329. [PMID: 35741138 PMCID: PMC9221970 DOI: 10.3390/diagnostics12061329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 12/10/2022] Open
Abstract
Radiomics is an upcoming field in nuclear oncology, both promising and technically challenging. To summarize the already undertaken work on supradiaphragmatic neoplasia and assess its quality, we performed a literature search in the PubMed database up to 18 February 2022. Inclusion criteria were: studies based on human data; at least one specified tumor type; supradiaphragmatic malignancy; performing radiomics on PET imaging. Exclusion criteria were: studies only based on phantom or animal data; technical articles without a clinically oriented question; fewer than 30 patients in the training cohort. A review database containing PMID, year of publication, cancer type, and quality criteria (number of patients, retrospective or prospective nature, independent validation cohort) was constructed. A total of 220 studies met the inclusion criteria. Among them, 119 (54.1%) studies included more than 100 patients, 21 studies (9.5%) were based on prospectively acquired data, and 91 (41.4%) used an independent validation set. Most studies focused on prognostic and treatment response objectives. Because the textural parameters and methods employed are very different from one article to another, it is complicated to aggregate and compare articles. New contributions and radiomics guidelines tend to help improving quality of the reported studies over the years.
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Affiliation(s)
- David Morland
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.K.A.T.); (D.P.); (S.A.)
- Service de Médecine Nucléaire, Institut Godinot, 51100 Reims, France
- Laboratoire de Biophysique, UFR de Médecine, Université de Reims Champagne-Ardenne, 51100 Reims, France
- CReSTIC (Centre de Recherche en Sciences et Technologies de l’Information et de la Communication), EA 3804, Université de Reims Champagne-Ardenne, 51100 Reims, France
- Correspondence:
| | - Elizabeth Katherine Anna Triumbari
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.K.A.T.); (D.P.); (S.A.)
| | - Luca Boldrini
- Radiotherapy Unit, Radiomics, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (L.B.); (R.G.)
| | - Roberto Gatta
- Radiotherapy Unit, Radiomics, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (L.B.); (R.G.)
- Department of Clinical and Experimental Sciences, University of Brescia, 25121 Brescia, Italy
- Department of Oncology, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - Daniele Pizzuto
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.K.A.T.); (D.P.); (S.A.)
| | - Salvatore Annunziata
- Nuclear Medicine Unit, TracerGLab, Department of Radiology, Radiotherapy and Hematology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.K.A.T.); (D.P.); (S.A.)
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Fujima N, Shimizu Y, Yoshida D, Kano S, Mizumachi T, Homma A, Yasuda K, Onimaru R, Sakai O, Kudo K, Shirato H. Multiparametric Analysis of Tumor Morphological and Functional MR Parameters Potentially Predicts Local Failure in Pharynx Squamous Cell Carcinoma Patients. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 68:354-361. [PMID: 34759158 DOI: 10.2152/jmi.68.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Purpose : To predict local control / failure by a multiparametric approach using magnetic resonance (MR)-derived tumor morphological and functional parameters in pharynx squamous cell carcinoma (SCC) patients. Materials and Methods : Twenty-eight patients with oropharyngeal and hypopharyngeal SCCs were included in this study. Quantitative morphological parameters and intratumoral characteristics on T2-weighted images, tumor blood flow from pseudo-continuous arterial spin labeling, and tumor diffusion parameters of three diffusion models from multi-b-value diffusion-weighted imaging as well as patients' characteristics were analyzed. The patients were divided into local control / failure groups. Univariate and multiparametric analysis were performed for the patient group division. Results : The value of morphological parameter of 'sphericity' and intratumoral characteristic of 'homogeneity' was revealed respectively significant for the prediction of the local control status in univariate analysis. Higher diagnostic performance was obtained with the sensitivity of 0.8, specificity of 0.75, positive predictive value of 0.89, negative predictive value of 0.6 and accuracy of 0.79 by multiparametric diagnostic model compared to results in the univariate analysis. Conclusion : A multiparametric analysis with MR-derived quantitative parameters may be useful to predict local control in pharynx SCC patients. J. Med. Invest. 68 : 354-361, August, 2021.
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Affiliation(s)
- Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.,The Global Station for Quantum Medical Science and Engineering, Global Institution for collaborative research and education, Sapporo, Japan
| | - Yukie Shimizu
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Daisuke Yoshida
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Takatsugu Mizumachi
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Koichi Yasuda
- The Global Station for Quantum Medical Science and Engineering, Global Institution for collaborative research and education, Sapporo, Japan.,Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Rikiya Onimaru
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Osamu Sakai
- Departments of Radiology, Otolaryngology-Head and Neck Surgery, and Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan.,The Global Station for Quantum Medical Science and Engineering, Global Institution for collaborative research and education, Sapporo, Japan
| | - Hiroki Shirato
- The Global Station for Quantum Medical Science and Engineering, Global Institution for collaborative research and education, Sapporo, Japan.,Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Fujima N, Andreu-Arasa VC, Meibom SK, Mercier GA, Truong MT, Hirata K, Yasuda K, Kano S, Homma A, Kudo K, Sakai O. Prediction of the local treatment outcome in patients with oropharyngeal squamous cell carcinoma using deep learning analysis of pretreatment FDG-PET images. BMC Cancer 2021; 21:900. [PMID: 34362317 PMCID: PMC8344209 DOI: 10.1186/s12885-021-08599-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/09/2021] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to assess the utility of deep learning analysis using pretreatment FDG-PET images to predict local treatment outcome in oropharyngeal squamous cell carcinoma (OPSCC) patients. Methods One hundred fifty-four OPSCC patients who received pretreatment FDG-PET were included and divided into training (n = 102) and test (n = 52) sets. The diagnosis of local failure and local progression-free survival (PFS) rates were obtained from patient medical records. In deep learning analyses, axial and coronal images were assessed by three different architectures (AlexNet, GoogLeNET, and ResNet). In the training set, FDG-PET images were analyzed after the data augmentation process for the diagnostic model creation. A multivariate clinical model was also created using a binomial logistic regression model from a patient’s clinical characteristics. The test data set was subsequently analyzed for confirmation of diagnostic accuracy. Assessment of local PFS rates was also performed. Results Training sessions were successfully performed with an accuracy of 74–89%. ROC curve analyses revealed an AUC of 0.61–0.85 by the deep learning model in the test set, whereas it was 0.62 by T-stage, 0.59 by clinical stage, and 0.74 by a multivariate clinical model. The highest AUC (0.85) was obtained with deep learning analysis of ResNet architecture. Cox proportional hazards regression analysis revealed deep learning-based classification by a multivariate clinical model (P < .05), and ResNet (P < .001) was a significant predictor of the treatment outcome. In the Kaplan-Meier analysis, the deep learning-based classification divided the patient’s local PFS rate better than the T-stage, clinical stage, and a multivariate clinical model. Conclusions Deep learning-based diagnostic model with FDG-PET images indicated its possibility to predict local treatment outcomes in OPSCCs. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08599-6.
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Affiliation(s)
- Noriyuki Fujima
- Departments of Radiology, Boston University School of Medicine, One Boston Medical Center Place, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA.,Research Center for Cooperative Projects, Hokkaido University Graduate School of Medicine, kita 15, nishi 7, kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - V Carlota Andreu-Arasa
- Departments of Radiology, Boston University School of Medicine, One Boston Medical Center Place, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Sara K Meibom
- Departments of Radiology, Boston University School of Medicine, One Boston Medical Center Place, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Gustavo A Mercier
- Departments of Radiology, Boston University School of Medicine, One Boston Medical Center Place, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Minh Tam Truong
- Departments of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, One Boston Medical Center Place, Boston, MA, 02118, USA
| | - Kenji Hirata
- Departments of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, kita 15, nishi 7, kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Koichi Yasuda
- Departments of Radiation Medicine, Hokkaido University Graduate School of Medicine, kita 15, nishi 7, kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Satoshi Kano
- Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, kita 15, nishi 7, kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Akihiro Homma
- Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, kita 15, nishi 7, kita-ku, Sapporo, Hokkaido, 060-8638, Japan
| | - Kohsuke Kudo
- Departments of Diagnostic Imaging, Hokkaido University Graduate School of Medicine, kita 15, nishi 7, kita-ku, Sapporo, Hokkaido, 060-8638, Japan.,The Global Station for Quantum Medical Science and Engineering, Global Institution for collaborative research and education, Sapporo, Hokkaido, 060-0808, Japan
| | - Osamu Sakai
- Departments of Radiology, Boston University School of Medicine, One Boston Medical Center Place, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA. .,Departments of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, One Boston Medical Center Place, Boston, MA, 02118, USA.
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6
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Fujima N, Andreu-Arasa VC, Meibom SK, Mercier GA, Salama AR, Truong MT, Sakai O. Prediction of the treatment outcome using machine learning with FDG-PET image-based multiparametric approach in patients with oral cavity squamous cell carcinoma. Clin Radiol 2021; 76:711.e1-711.e7. [PMID: 33934877 DOI: 10.1016/j.crad.2021.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 03/26/2021] [Indexed: 12/15/2022]
Abstract
AIM To investigate the value of machine learning-based multiparametric analysis using 2-[18F]-fluoro-2-deoxy-d-glucose positron-emission tomography (FDG-PET) images to predict treatment outcome in patients with oral cavity squamous cell carcinoma (OCSCC). MATERIALS AND METHODS Ninety-nine patients with OCSCC who received pretreatment integrated FDG-PET/computed tomography (CT) were included. They were divided into the training (66 patients) and validation (33 patients) cohorts. The diagnosis of local control or local failure was obtained from patient's medical records. Conventional FDG-PET parameters, including the maximum and mean standardised uptake values (SUVmax and SUVmean), metabolic tumour volume (MTV), and total lesion glycolysis (TLG), quantitative tumour morphological parameters, intratumoural histogram, and texture parameters, as well as T-stage and clinical stage, were evaluated by a machine learning analysis. The diagnostic ability of T-stage, clinical stage, and conventional FDG-PET parameters (SUVmax, SUVmean, MTV, and TLG) was also assessed separately. RESULTS In support-vector machine analysis of the training dataset, the final selected parameters were T-stage, SUVmax, TLG, morphological irregularity, entropy, and run-length non-uniformity. In the validation dataset, the diagnostic performance of the created algorithm was as follows: sensitivity 0.82, specificity 0.7, positive predictive value 0.86, negative predictive value 0.64, and accuracy 0.79. In a univariate analysis using conventional FDG-PET parameters, T-stage and clinical stage, diagnostic accuracy of each variable was revealed as follows: 0.61 in T-stage, 0.61 in clinical stage, 0.64 in SUVmax, 0.61 in SUVmean, 0.64 in MTV, and 0.7 in TLG. CONCLUSION A machine-learning-based approach to analysing FDG-PET images by multiparametric analysis might help predict local control or failure in patients with OCSCC.
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Affiliation(s)
- N Fujima
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, USA; Research Center for Cooperative Projects, Hokkaido University Graduate School of Medicine, Japan
| | - V C Andreu-Arasa
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, USA
| | - S K Meibom
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, USA
| | - G A Mercier
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, USA
| | - A R Salama
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, USA; Department of Oral & Maxillofacial Surgery, Boston Medical Center, Boston University Henry M. Goldman School of Dental Medicine, USA
| | - M T Truong
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, USA
| | - O Sakai
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, USA; Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, USA; Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, USA.
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A Systematic Review of PET Textural Analysis and Radiomics in Cancer. Diagnostics (Basel) 2021; 11:diagnostics11020380. [PMID: 33672285 PMCID: PMC7926413 DOI: 10.3390/diagnostics11020380] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Although many works have supported the utility of PET radiomics, several authors have raised concerns over the robustness and replicability of the results. This study aimed to perform a systematic review on the topic of PET radiomics and the used methodologies. Methods: PubMed was searched up to 15 October 2020. Original research articles based on human data specifying at least one tumor type and PET image were included, excluding those that apply only first-order statistics and those including fewer than 20 patients. Each publication, cancer type, objective and several methodological parameters (number of patients and features, validation approach, among other things) were extracted. Results: A total of 290 studies were included. Lung (28%) and head and neck (24%) were the most studied cancers. The most common objective was prognosis/treatment response (46%), followed by diagnosis/staging (21%), tumor characterization (18%) and technical evaluations (15%). The average number of patients included was 114 (median = 71; range 20–1419), and the average number of high-order features calculated per study was 31 (median = 26, range 1–286). Conclusions: PET radiomics is a promising field, but the number of patients in most publications is insufficient, and very few papers perform in-depth validations. The role of standardization initiatives will be crucial in the upcoming years.
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Ihara-Nishishita A, Norikane T, Mitamura K, Yamamoto Y, Fujimoto K, Takami Y, Ibuki E, Kudomi N, Hoshikawa H, Toyohara J, Nishiyama Y. Texture indices of 4'-[methyl- 11C]-thiothymidine uptake predict p16 status in patients with newly diagnosed oropharyngeal squamous cell carcinoma: comparison with 18F-FDG uptake. Eur J Hybrid Imaging 2020; 4:20. [PMID: 34191155 PMCID: PMC8218132 DOI: 10.1186/s41824-020-00090-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background In oropharyngeal squamous cell carcinoma (OPSCC), human papillomavirus (HPV)/p16 status is important as a prognostic biomarker. Purpose We evaluated the relationship between 4′-[methyl-11C]-thiothymidine (11C-4DST) and 18F-FDG PET texture indices and p16 status in patients with newly diagnosed OPSCC. Methods We retrospectively reviewed the collected data of 256 consecutive, previously untreated patients with primary head and neck tumors enrolled between November 2011 and October 2019. Complete data on both 11C-4DST and 18F-FDG PET/CT studies before therapy, patients with OPSCC, and p16 status were available for 34 patients. Six of them were excluded because they did not exhibit sufficient 11C-4DST and/or 18F-FDG tumor uptake to perform textural analysis. Finally, 28 patients with newly diagnosed OPSCC were investigated. The maximum standardized uptake value (SUVmax) and 6 texture indices (homogeneity, entropy, short-run emphasis, long-run emphasis, low gray-level zone emphasis, and high gray-level zone emphasis) were derived from PET images. The presence of p16 expression in tumor specimens was examined by immunohistochemistry and compared with the PET parameters. Results Using 11C-4DST, the expression of p16 was associated with a higher homogeneity (P = 0.012), lower short-run emphasis (P = 0.005), higher long-run emphasis (P = 0.009), and lower high-gray-level-zone emphasis (P = 0.042) values. There was no significant difference between 18F-FDG PET parameters and p16 status. Conclusion Texture indices of the primary tumor on 11C-4DST PET, but not 18F-FDG PET, may be of value in predicting the condition’s p16 status in patients with newly diagnosed OPSCC.
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Affiliation(s)
- Ayumi Ihara-Nishishita
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Takashi Norikane
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Katsuya Mitamura
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yuka Yamamoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan.
| | - Kengo Fujimoto
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Yasukage Takami
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Emi Ibuki
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Nobuyuki Kudomi
- Department of Medical Physics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hiroshi Hoshikawa
- Department of Otolaryngology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Jun Toyohara
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
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9
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Fujima N, Andreu-Arasa VC, Meibom SK, Mercier GA, Salama AR, Truong MT, Sakai O. Deep learning analysis using FDG-PET to predict treatment outcome in patients with oral cavity squamous cell carcinoma. Eur Radiol 2020; 30:6322-6330. [PMID: 32524219 DOI: 10.1007/s00330-020-06982-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 04/20/2020] [Accepted: 05/26/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To assess the utility of deep learning analysis using 18F-fluorodeoxyglucose (FDG) uptake by positron emission tomography (PET/CT) to predict disease-free survival (DFS) in patients with oral cavity squamous cell carcinoma (OCSCC). METHODS One hundred thirteen patients with OCSCC who received pretreatment FDG-PET/CT were included. They were divided into training (83 patients) and test (30 patients) sets. The diagnosis of treatment control/failure and the DFS rate were obtained from patients' medical records. In deep learning analyses, three planes of axial, coronal, and sagittal FDG-PET images were assessed by ResNet-101 architecture. In the training set, image analysis was performed for the diagnostic model creation. The test data set was subsequently analyzed for confirmation of diagnostic accuracy. T-stage, clinical stage, and conventional FDG-PET parameters (the maximum and mean standardized uptake value (SUVmax and SUVmean), heterogeneity index, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were also assessed with determining the optimal cutoff from training dataset and then validated their diagnostic ability from test dataset. RESULTS In dividing into patients with treatment control and failure, the highest diagnostic accuracy of 0.8 was obtained using deep learning classification, with a sensitivity of 0.8, specificity of 0.8, positive predictive value of 0.89, and negative predictive value of 0.67. In the Kaplan-Meier analysis, the DFS rate was significantly different only with the analysis of deep learning-based classification (p < .01). CONCLUSIONS Deep learning-based diagnosis with FDG-PET images may predict treatment outcome in patients with OCSCC. KEY POINTS • Deep learning-based diagnosis of FDG-PET images showed the highest diagnostic accuracy to predict the treatment outcome in patients with oral cavity squamous cell carcinoma. • Deep learning-based diagnosis was shown to differentiate patients between good and poor disease-free survival more clearly than conventional T-stage, clinical stage, and conventional FDG-PET-based parameters.
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Affiliation(s)
- Noriyuki Fujima
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA.,Research Center for Cooperative Projects, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - V Carlota Andreu-Arasa
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Sara K Meibom
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Gustavo A Mercier
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA
| | - Andrew R Salama
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, USA.,Department of Oral & Maxillofacial Surgery, Boston Medical Center, Boston University Henry M. Goldman School of Dental Medicine, Boston, USA
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Osamu Sakai
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Avenue, Boston, MA, 02118, USA. .,Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, USA. .,Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA.
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10
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Chen L, Wang H, Zeng H, Zhang Y, Ma X. Evaluation of CT-based radiomics signature and nomogram as prognostic markers in patients with laryngeal squamous cell carcinoma. Cancer Imaging 2020; 20:28. [PMID: 32321585 PMCID: PMC7178759 DOI: 10.1186/s40644-020-00310-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/15/2020] [Indexed: 02/05/2023] Open
Abstract
Background The aim of this study was to evaluate the prognostic value of radiomics signature and nomogram based on contrast-enhanced computed tomography (CT) in patients after surgical resection of laryngeal squamous cell carcinoma (LSCC). Methods All patients (n = 136) were divided into the training cohort (n = 96) and validation cohort (n = 40). The LASSO regression method was performed to construct radiomics signature from CT texture features. Then a radiomics nomogram incorporating the radiomics signature and clinicopathologic factors was established to predict overall survival (OS). The validation of nomogram was evaluated by calibration curve, concordance index (C-index) and decision curve. Results Based on three selected texture features, the radiomics signature showed high C-indexes of 0.782 (95%CI: 0.656–0.909) and 0.752 (95%CI, 0.614–0.891) in the two cohorts. The radiomics nomogram had significantly better discrimination capability than cancer staging in the training cohort (C-index, 0.817 vs. 0.682; P = 0.009) and validation cohort (C-index, 0.913 vs. 0.699; P = 0.019), as well as a good agreement between predicted and actual survival in calibration curves. Decision curve analysis also suggested improved clinical utility of radiomics nomogram. Conclusions Radiomics signature and nomogram showed favorable prediction accuracy for OS, which might facilitate the individualized risk stratification and clinical decision-making in LSCC patients.
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Affiliation(s)
- Linyan Chen
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center, No.37, Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Haiyang Wang
- Department of Otolaryngology, Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Hao Zeng
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center, No.37, Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Yi Zhang
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center, No.37, Guoxue Alley, Chengdu, 610041, People's Republic of China
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, and Collaborative Innovation Center, No.37, Guoxue Alley, Chengdu, 610041, People's Republic of China.
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11
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Unterrainer M, Eze C, Ilhan H, Marschner S, Roengvoraphoj O, Schmidt-Hegemann NS, Walter F, Kunz WG, Rosenschöld PMA, Jeraj R, Albert NL, Grosu AL, Niyazi M, Bartenstein P, Belka C. Recent advances of PET imaging in clinical radiation oncology. Radiat Oncol 2020; 15:88. [PMID: 32317029 PMCID: PMC7171749 DOI: 10.1186/s13014-020-01519-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/19/2020] [Indexed: 12/25/2022] Open
Abstract
Radiotherapy and radiation oncology play a key role in the clinical management of patients suffering from oncological diseases. In clinical routine, anatomic imaging such as contrast-enhanced CT and MRI are widely available and are usually used to improve the target volume delineation for subsequent radiotherapy. Moreover, these modalities are also used for treatment monitoring after radiotherapy. However, some diagnostic questions cannot be sufficiently addressed by the mere use standard morphological imaging. Therefore, positron emission tomography (PET) imaging gains increasing clinical significance in the management of oncological patients undergoing radiotherapy, as PET allows the visualization and quantification of tumoral features on a molecular level beyond the mere morphological extent shown by conventional imaging, such as tumor metabolism or receptor expression. The tumor metabolism or receptor expression information derived from PET can be used as tool for visualization of tumor extent, for assessing response during and after therapy, for prediction of patterns of failure and for definition of the volume in need of dose-escalation. This review focuses on recent and current advances of PET imaging within the field of clinical radiotherapy / radiation oncology in several oncological entities (neuro-oncology, head & neck cancer, lung cancer, gastrointestinal tumors and prostate cancer) with particular emphasis on radiotherapy planning, response assessment after radiotherapy and prognostication.
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Affiliation(s)
- M Unterrainer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. .,Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany. .,German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany.
| | - C Eze
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - H Ilhan
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - S Marschner
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - O Roengvoraphoj
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - N S Schmidt-Hegemann
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - F Walter
- Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - W G Kunz
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - P Munck Af Rosenschöld
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, and Lund University, Lund, Sweden
| | - R Jeraj
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, USA
| | - N L Albert
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - A L Grosu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,German Cancer Consortium (DKTK), partner Site Freiburg, Freiburg, Germany
| | - M Niyazi
- German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
| | - P Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.,German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Belka
- German Cancer Consortium (DKTK), partner site Munich; and German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Radiation Oncology, University Hospital, LMU Munich, Munich, Germany
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12
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Fujima N, Andreu-Arasa VC, Meibom SK, Mercier GA, Truong MT, Sakai O. Prediction of the human papillomavirus status in patients with oropharyngeal squamous cell carcinoma by FDG-PET imaging dataset using deep learning analysis: A hypothesis-generating study. Eur J Radiol 2020; 126:108936. [PMID: 32171912 DOI: 10.1016/j.ejrad.2020.108936] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/22/2020] [Accepted: 03/02/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To assess the diagnostic accuracy of imaging-based deep learning analysis to differentiate between human papillomavirus (HPV) positive and negative oropharyngeal squamous cell carcinomas (OPSCCs) using FDG-PET images. METHODS One hundred and twenty patients with OPSCC who underwent pretreatment FDG-PET/CT were included and divided into the training 90 patients and validation 30 patients cohorts. In the training session, 2160 FDG-PET images were analyzed after data augmentation process by a deep learning technique to create a diagnostic model to discriminate between HPV-positive and HPV-negative OPSCCs. Validation cohort data were subsequently analyzed for confirmation of diagnostic accuracy in determining HPV status by the deep learning-based diagnosis model. In addition, two radiologists evaluated the validation cohort image-data to determine the HPV status based on each tumor's imaging findings. RESULTS In deep learning analysis with training session, the diagnostic model using training dataset was successfully created. In the validation session, the deep learning diagnostic model revealed sensitivity of 0.83, specificity of 0.83, positive predictive value of 0.88, negative predictive value of 0.77, and diagnostic accuracy of 0.83, while the visual assessment by two radiologists revealed 0.78, 0.5, 0.7, 0.6, and 0.67 (reader 1), and 0.56, 0.67, 0.71, 0.5, and 0.6 (reader 2), respectively. Chi square test showed a significant difference between deep learning- and radiologist-based diagnostic accuracy (reader 1: P = 0.016, reader 2: P = 0.008). CONCLUSIONS Deep learning diagnostic model with FDG-PET imaging data can be useful as one of supportive tools to determine the HPV status in patients with OPSCC.
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Affiliation(s)
- Noriyuki Fujima
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Research Center for Cooperative Projects, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - V Carlota Andreu-Arasa
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Sara K Meibom
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Gustavo A Mercier
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States
| | - Osamu Sakai
- Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States; Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA, United States.
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