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Lococo F, Ghaly G, Chiappetta M, Flamini S, Evangelista J, Bria E, Stefani A, Vita E, Martino A, Boldrini L, Sassorossi C, Campanella A, Margaritora S, Mohammed A. Implementation of Artificial Intelligence in Personalized Prognostic Assessment of Lung Cancer: A Narrative Review. Cancers (Basel) 2024; 16:1832. [PMID: 38791910 PMCID: PMC11119930 DOI: 10.3390/cancers16101832] [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: 03/26/2024] [Revised: 05/02/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Artificial Intelligence (AI) has revolutionized the management of non-small-cell lung cancer (NSCLC) by enhancing different aspects, including staging, prognosis assessment, treatment prediction, response evaluation, recurrence/prognosis prediction, and personalized prognostic assessment. AI algorithms may accurately classify NSCLC stages using machine learning techniques and deep imaging data analysis. This could potentially improve precision and efficiency in staging, facilitating personalized treatment decisions. Furthermore, there are data suggesting the potential application of AI-based models in predicting prognosis in terms of survival rates and disease progression by integrating clinical, imaging and molecular data. In the present narrative review, we will analyze the preliminary studies reporting on how AI algorithms could predict responses to various treatment modalities, such as surgery, radiotherapy, chemotherapy, targeted therapy, and immunotherapy. There is robust evidence suggesting that AI also plays a crucial role in predicting the likelihood of tumor recurrence after surgery and the pattern of failure, which has significant implications for tailoring adjuvant treatments. The successful implementation of AI in personalized prognostic assessment requires the integration of different data sources, including clinical, molecular, and imaging data. Machine learning (ML) and deep learning (DL) techniques enable AI models to analyze these data and generate personalized prognostic predictions, allowing for a precise and individualized approach to patient care. However, challenges relating to data quality, interpretability, and the ability of AI models to generalize need to be addressed. Collaboration among clinicians, data scientists, and regulators is critical for the responsible implementation of AI and for maximizing its benefits in providing a more personalized prognostic assessment. Continued research, validation, and collaboration are essential to fully exploit the potential of AI in NSCLC management and improve patient outcomes. Herein, we have summarized the state of the art of applications of AI in lung cancer for predicting staging, prognosis, and pattern of recurrence after treatment in order to provide to the readers a large comprehensive overview of this challenging issue.
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Affiliation(s)
- Filippo Lococo
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy; (M.C.); (J.E.); (E.B.); (A.S.); (E.V.); (A.M.); (L.B.); (C.S.); (S.M.)
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (S.F.); (A.C.)
| | - Galal Ghaly
- Faculty of Medicine and Surgery, Thoracic Surgery Unit, Cairo University, Giza 12613, Egypt; (G.G.); (A.M.)
| | - Marco Chiappetta
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy; (M.C.); (J.E.); (E.B.); (A.S.); (E.V.); (A.M.); (L.B.); (C.S.); (S.M.)
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (S.F.); (A.C.)
| | - Sara Flamini
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (S.F.); (A.C.)
| | - Jessica Evangelista
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy; (M.C.); (J.E.); (E.B.); (A.S.); (E.V.); (A.M.); (L.B.); (C.S.); (S.M.)
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (S.F.); (A.C.)
| | - Emilio Bria
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy; (M.C.); (J.E.); (E.B.); (A.S.); (E.V.); (A.M.); (L.B.); (C.S.); (S.M.)
- Medical Oncology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Alessio Stefani
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy; (M.C.); (J.E.); (E.B.); (A.S.); (E.V.); (A.M.); (L.B.); (C.S.); (S.M.)
- Medical Oncology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Emanuele Vita
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy; (M.C.); (J.E.); (E.B.); (A.S.); (E.V.); (A.M.); (L.B.); (C.S.); (S.M.)
- Medical Oncology, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Antonella Martino
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy; (M.C.); (J.E.); (E.B.); (A.S.); (E.V.); (A.M.); (L.B.); (C.S.); (S.M.)
- Radiotherapy Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Luca Boldrini
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy; (M.C.); (J.E.); (E.B.); (A.S.); (E.V.); (A.M.); (L.B.); (C.S.); (S.M.)
- Radiotherapy Unit, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy
| | - Carolina Sassorossi
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy; (M.C.); (J.E.); (E.B.); (A.S.); (E.V.); (A.M.); (L.B.); (C.S.); (S.M.)
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (S.F.); (A.C.)
| | - Annalisa Campanella
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (S.F.); (A.C.)
| | - Stefano Margaritora
- Faculty of Medicine and Surgery, Catholic University of Sacred Heart, 00168 Rome, Italy; (M.C.); (J.E.); (E.B.); (A.S.); (E.V.); (A.M.); (L.B.); (C.S.); (S.M.)
- Thoracic Surgery, A. Gemelli University Hospital Foundation IRCCS, 00168 Rome, Italy; (S.F.); (A.C.)
| | - Abdelrahman Mohammed
- Faculty of Medicine and Surgery, Thoracic Surgery Unit, Cairo University, Giza 12613, Egypt; (G.G.); (A.M.)
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Yoshiyasu N, Kojima F, Hayashi K, Yamada D, Bando T. Low-Dose CT Screening of Persistent Subsolid Lung Nodules: First-Order Features in Radiomics. Thorac Cardiovasc Surg 2023. [PMID: 37607686 DOI: 10.1055/a-2158-1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Nondisappearing subsolid nodules requiring follow-up are often detected during lung cancer screening, but changes in their invasiveness can be overlooked owing to slow growth. We aimed to develop a method for automatic identification of invasive tumors among subsolid nodules during multiple health checkups using radiomics technology based on low-dose computed tomography (LD-CT) and examine its effectiveness. METHODS We examined patients who underwent LD-CT screening from 2014 to 2019 and had lung adenocarcinomas resected after 5-year follow-ups. They were categorized into the invasive or less-invasive group; the annual growth/change rate (Δ) of the nodule voxel histogram using three-dimensional CT (e.g., tumor volume, solid volume percentage, mean CT value, variance, kurtosis, skewness, and entropy) was assessed. A discriminant model was designed through multivariate regression analysis with internal validation to compare its efficacy with that of a volume doubling time of < 400 days. RESULTS The study included 47 tumors (23 invasive, 24 less invasive), with no significant difference in the initial tumor volumes. Δskewness was identified as an independent predictor of invasiveness (adjusted odds ratio, 0.021; p = 0.043), and when combined with Δvariance, it yielded high accuracy in detecting invasive lesions (88% true-positive, 80% false-positive). The detection model indicated surgery 2 years earlier than the volume doubling time, maintaining accuracy (median 3 years vs.1 year before actual surgery, p = 0.011). CONCLUSION LD-CT radiomics showed promising potential in ensuring timely detection and monitoring of subsolid nodules that warrant follow-up over time.
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Affiliation(s)
- Nobuyuki Yoshiyasu
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Fumitsugu Kojima
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Kuniyoshi Hayashi
- Graduate School of Public Health, St. Luke's International University, Tokyo, Japan
| | - Daisuke Yamada
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Toru Bando
- Department of Thoracic Surgery, St. Luke's International Hospital, Tokyo, Japan
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Gao J, Qi Q, Li H, Wang Z, Sun Z, Cheng S, Yu J, Zeng Y, Hong N, Wang D, Wang H, Yang F, Li X, Li Y. Artificial-intelligence-based computed tomography histogram analysis predicting tumor invasiveness of lung adenocarcinomas manifesting as radiological part-solid nodules. Front Oncol 2023; 13:1096453. [PMID: 36910632 PMCID: PMC9996279 DOI: 10.3389/fonc.2023.1096453] [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: 11/12/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Background Tumor invasiveness plays a key role in determining surgical strategy and patient prognosis in clinical practice. The study aimed to explore artificial-intelligence-based computed tomography (CT) histogram indicators significantly related to the invasion status of lung adenocarcinoma appearing as part-solid nodules (PSNs), and to construct radiomics models for prediction of tumor invasiveness. Methods We identified surgically resected lung adenocarcinomas manifesting as PSNs in Peking University People's Hospital from January 2014 to October 2019. Tumors were categorized as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC) by comprehensive pathological assessment. The whole cohort was randomly assigned into a training (70%, n=832) and a validation cohort (30%, n=356) to establish and validate the prediction model. An artificial-intelligence-based algorithm (InferRead CT Lung) was applied to extract CT histogram parameters for each pulmonary nodule. For feature selection, multivariate regression models were built to identify factors associated with tumor invasiveness. Logistic regression classifier was used for radiomics model building. The predictive performance of the model was then evaluated by ROC and calibration curves. Results In total, 299 AIS/MIAs and 889 IACs were included. In the training cohort, multivariate logistic regression analysis demonstrated that age [odds ratio (OR), 1.020; 95% CI, 1.004-1.037; p=0.017], smoking history (OR, 1.846; 95% CI, 1.058-3.221; p=0.031), solid mean density (OR, 1.014; 95% CI, 1.004-1.024; p=0.008], solid volume (OR, 5.858; 95% CI, 1.259-27.247; p = 0.037), pleural retraction sign (OR, 3.179; 95% CI, 1.057-9.559; p = 0.039), variance (OR, 0.570; 95% CI, 0.399-0.813; p=0.002), and entropy (OR, 4.606; 95% CI, 2.750-7.717; p<0.001) were independent predictors for IAC. The areas under the curve (AUCs) in the training and validation cohorts indicated a better discriminative ability of the histogram model (AUC=0.892) compared with the clinical model (AUC=0.852) and integrated model (AUC=0.886). Conclusion We developed an AI-based histogram model, which could reliably predict tumor invasiveness in lung adenocarcinoma manifesting as PSNs. This finding would provide promising value in guiding the precision management of PSNs in the daily practice.
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Affiliation(s)
- Jian Gao
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Qingyi Qi
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Hao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Zhenfan Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Zewen Sun
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Sida Cheng
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Jie Yu
- Department of Thoracic Surgery, Qingdao Women and Children's Hospital, Qingdao, China
| | - Yaqi Zeng
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Nan Hong
- Department of Radiology, Peking University People's Hospital, Beijing, China
| | - Dawei Wang
- Institute of Advanced Research, Infervision Medical Technology Co., Ltd, Beijing, China
| | - Huiyang Wang
- Institute of Advanced Research, Infervision Medical Technology Co., Ltd, Beijing, China
| | - Feng Yang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
| | - Yun Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China.,Thoracic Oncology Institute, Peking University People's Hospital, Beijing, China
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Chiu HY, Chao HS, Chen YM. Application of Artificial Intelligence in Lung Cancer. Cancers (Basel) 2022; 14:cancers14061370. [PMID: 35326521 PMCID: PMC8946647 DOI: 10.3390/cancers14061370] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Lung cancer is the leading cause of malignancy-related mortality worldwide. AI has the potential to help to treat lung cancer from detection, diagnosis and decision making to prognosis prediction. AI could reduce the labor work of LDCT, CXR, and pathology slides reading. AI as a second reader in LDCT and CXR reading reduces the effort of radiologists and increases the accuracy of nodule detection. Introducing AI to WSI in digital pathology increases the Kappa value of the pathologist and help to predict molecular phenotypes with radiomics and H&E staining. By extracting radiomics from image data and WSI from the histopathology field, clinicians could use AI to predict tumor properties such as gene mutation and PD-L1 expression. Furthermore, AI could help clinicians in decision-making by predicting treatment response, side effects, and prognosis prediction in medical treatment, surgery, and radiotherapy. Integrating AI in the future clinical workflow would be promising. Abstract Lung cancer is the leading cause of malignancy-related mortality worldwide due to its heterogeneous features and diagnosis at a late stage. Artificial intelligence (AI) is good at handling a large volume of computational and repeated labor work and is suitable for assisting doctors in analyzing image-dominant diseases like lung cancer. Scientists have shown long-standing efforts to apply AI in lung cancer screening via CXR and chest CT since the 1960s. Several grand challenges were held to find the best AI model. Currently, the FDA have approved several AI programs in CXR and chest CT reading, which enables AI systems to take part in lung cancer detection. Following the success of AI application in the radiology field, AI was applied to digitalized whole slide imaging (WSI) annotation. Integrating with more information, like demographics and clinical data, the AI systems could play a role in decision-making by classifying EGFR mutations and PD-L1 expression. AI systems also help clinicians to estimate the patient’s prognosis by predicting drug response, the tumor recurrence rate after surgery, radiotherapy response, and side effects. Though there are still some obstacles, deploying AI systems in the clinical workflow is vital for the foreseeable future.
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Affiliation(s)
- Hwa-Yen Chiu
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-Y.C.); (Y.-M.C.)
- Institute of Biophotonics, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Division of Internal Medicine, Hsinchu Branch, Taipei Veterans General Hospital, Hsinchu 310, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Heng-Sheng Chao
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-Y.C.); (Y.-M.C.)
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-2-28712121
| | - Yuh-Min Chen
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-Y.C.); (Y.-M.C.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
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Qiu ZB, Zhang C, Chu XP, Cai FY, Yang XN, Wu YL, Zhong WZ. Quantifying invasiveness of clinical stage IA lung adenocarcinoma with computed tomography texture features. J Thorac Cardiovasc Surg 2022; 163:805-815.e3. [PMID: 33541730 DOI: 10.1016/j.jtcvs.2020.12.092] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 11/21/2020] [Accepted: 12/11/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The study objectives were to establish and validate a nomogram for pathological invasiveness prediction in clinical stage IA lung adenocarcinoma and to help identify those potentially unsuitable for sublobar resection-based computed tomography texture features. METHOD Patients with clinical stage IA lung adenocarcinoma who underwent surgery at Guangdong Provincial People's Hospital between January 2015 and October 2018 were retrospectively reviewed. All surgically resected nodules were pathologically classified into less-invasive and invasive cohorts. Each nodule was manually segmented, and its computerized texture features were extracted. Clinicopathological and computed tomographic texture features were compared between 2 cohorts. A nomogram for distinguishing the pathological invasiveness was established and validated. RESULTS Among 428 enrolled patients, 249 were diagnosed with invasive pathological subtypes. Smoking status (odds ratio, 2.906; 95% confidence interval, 1.285-6.579; P = .011), mean computed tomography attenuation value (odds ratio, 1.005, 95% confidence interval, 1.002-1.007; P < .001), and entropy (odds ratio, 8.536, 95% confidence interval, 3.478-20.951; P < .001) were identified as independent predictors for pathological invasiveness by multivariate logistics regression analysis. The nomogram showed good calibration (P = .182) with an area under the curve of 0.849 when validated with testing set data. Decision curve analysis indicated the potentially clinical usefulness of the model with respect to treat-all or treat-none scenario. Compared with intraoperative frozen-section, the nomogram performed better in pathological invasiveness diagnosis (area under the curve, 0.815 vs 0.670; P = .00095). CONCLUSIONS We established and validated a nomogram to compute the probability of invasiveness of clinical stage IA lung adenocarcinoma with great calibration, which may contribute to decisions related to resection extent.
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Affiliation(s)
- Zhen-Bin Qiu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; Shantou University Medical College, Shantou, China
| | - Chao Zhang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Xiang-Peng Chu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China; School of Medicine, South China University of Technology, Guangzhou, China
| | - Fei-Yue Cai
- Perception Vision Medical Technologies Co Ltd, Guangzhou, China
| | - Xue-Ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-Zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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Li XF, Shi YM, Niu R, Shao XN, Wang JF, Shao XL, Zhang FF, Wang YT. Risk analysis in peripheral clinical T1 non-small cell lung cancer correlations between tumor-to-blood standardized uptake ratio on 18F-FDG PET-CT and primary tumor pathological invasiveness: a real-world observational study. Quant Imaging Med Surg 2022; 12:159-171. [PMID: 34993068 DOI: 10.21037/qims-21-394] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/09/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Sublobar resection is not suitable for patients with pathological invasiveness [including lymph node metastasis (LNM), visceral pleural invasion (VPI), and lymphovascular invasion (LVI)] of peripheral clinical T1 (cT1) non-small cell lung cancer (NSCLC), while primary tumor maximum standardized uptake value (SUVmax) on 18F-FDG PET-CT is related to pathological invasiveness, the significance differed among different institutions is still challenging. This study explored the relationship between the tumor-to-blood standardized uptake ratio (SUR) of 18F-FDG PET-CT and primary tumor pathological invasiveness in peripheral cT1 NSCLC patients. METHODS This retrospective study included 174 patients with suspected lung neoplasms who underwent preoperative 18F-FDG PET-CT. We compared the differences of the clinicopathological variables, metabolic and morphological parameters in the pathological invasiveness and less-invasiveness group. We performed a trend test for these parameters based on the tertiles of SUR. The relationship between SUR and pathological invasiveness was evaluated by univariate and multivariate logistics regression models (included unadjusted, simple adjusted, and fully adjusted models), odds ratios (ORs), and 95% confidence intervals (95% CIs) were calculated. A smooth fitting curve between SUR and pathological invasiveness was produced by the generalized additive model (GAM). RESULTS Thirty-eight point five percent of patients had pathological invasiveness and tended to have a higher SUR value than the less-invasiveness group [6.50 (4.82-11.16) vs. 4.12 (2.04-6.61), P<0.001]. The trend of SUVmax, mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), mean CT value (CTmean), size of the primary tumor, neuron-specific enolase (NSE), the incidence of LNM, adenocarcinoma (AC), and poor differentiation in the tertiles of SUR value were statistically significant (P were <0.001, <0.001, 0.010, <0.001, <0.001, 0.002, 0.033, <0.001, 0.002, and <0.001, respectively). Univariate analysis showed that the risk of pathological invasiveness increased significantly with increasing SUR [OR: 1.13 (95% CI: 1.06-1.21), P<0.001], and multivariate analysis demonstrated SUR, as a continuous variable, was still significantly related to pathological invasiveness [OR: 1.09 (95% CI: 1.01-1.18), P=0.032] after adjusting for confounding covariates. GAM revealed that SUR tended to be linearly and positively associated with pathological invasiveness and E-value analysis suggested robustness to unmeasured confounding. CONCLUSIONS SUR is linearly and positively associated with primary tumor pathological invasiveness independent of confounding covariates in peripheral cT1 NSCLC patients and could be used as a supplementary risk maker to assess the risk of pathological invasiveness.
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Affiliation(s)
- Xiao-Feng Li
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Radiology, Xuzhou Cancer Hospital, Xuzhou, China
| | - Yun-Mei Shi
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Rong Niu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiao-Nan Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jian-Feng Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiao-Liang Shao
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fei-Fei Zhang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yue-Tao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Changzhou Key Laboratory of Molecular Imaging, Changzhou, China
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Xiong Z, Jiang Y, Che S, Zhao W, Guo Y, Li G, Liu A, Li Z. Use of CT radiomics to differentiate minimally invasive adenocarcinomas and invasive adenocarcinomas presenting as pure ground-glass nodules larger than 10 mm. Eur J Radiol 2021; 141:109772. [PMID: 34022476 DOI: 10.1016/j.ejrad.2021.109772] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE This study aimed to develop a model based on radiomics features extracted from computed tomography (CT) images to effectively differentiate between minimally invasive adenocarcinomas (MIAs) and invasive adenocarcinomas (IAs) manifesting as pure ground-glass nodules (pGGNs) larger than 10 mm. METHOD This retrospective study included patients who underwent surgical resection for persistent pGGN between November 2012 and June 2018 and diagnosed with MIAs or IAs. The patients were randomly assigned to the training and test cohorts. The correlation coefficient method and the least absolute shrinkage and selection operator (LASSO) method were applied to select radiomics features useful for constructing a model whose performance was assessed by the area under the receiver operating characteristic curve (AUC-ROC). The radiomics model was compared to a standard CT model (shape, volume and mean CT value of the largest cross-section) and the combined radiomics-standard CT model using univariate and multivariate logistic regression analysis. RESULTS The radiomics model showed better discriminative ability (training AUC, 0.879; test AUC, 0.877) than the standard CT model (training AUC, 0.820; test AUC, 0.828). The combined model (training AUC, 0.879; test AUC, 0.870) did not demonstrate improved performance compared with the radiomics model. Radiomics_score was an independent predictor of invasiveness following multivariate logistic analysis. CONCLUSIONS For pGGNs larger than 10 mm, the radiomics model demonstrated superior diagnostic performance in differentiating between IAs and MIAs, which may be useful to clinicians for diagnosis and treatment selection.
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Affiliation(s)
- Ziqi Xiong
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Yining Jiang
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Siyu Che
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Wenjing Zhao
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Yan Guo
- GE Healthcare, Shenyang, China
| | - Guosheng Li
- Department of Pathology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Ailian Liu
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
| | - Zhiyong Li
- Department of Radiology, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
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Commentary: Reading the voxels: A fortune teller's nomogram to invasiveness in stage IA lung adenocarcinoma. J Thorac Cardiovasc Surg 2021; 163:816-817. [PMID: 33593609 DOI: 10.1016/j.jtcvs.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 11/21/2022]
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Reznik SI. Commentary: Fear not the rise of the machines. J Thorac Cardiovasc Surg 2020; 162:487-488. [PMID: 32711970 DOI: 10.1016/j.jtcvs.2020.05.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Scott I Reznik
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Tex.
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Commentary: Through the looking glass-radiomics and evaluation of early lung cancer. J Thorac Cardiovasc Surg 2020; 162:486-487. [PMID: 32713642 DOI: 10.1016/j.jtcvs.2020.06.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 11/23/2022]
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Sesti J, Paul S. Commentary: More science, less fortunetelling: Using radiomics to predict the invasiveness of lung cancer. J Thorac Cardiovasc Surg 2020; 162:488-489. [PMID: 32624305 DOI: 10.1016/j.jtcvs.2020.05.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/17/2020] [Accepted: 05/18/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Joanna Sesti
- Thoracic Surgical Services, RWJBarnabas Health, West Orange, NJ
| | - Subroto Paul
- Thoracic Surgical Services, RWJBarnabas Health, West Orange, NJ.
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