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Colon cancer microsatellite instability influences computed tomography assessment of regional lymph node morphology and diagnostic performance. Eur J Radiol 2022; 154:110396. [PMID: 35709643 DOI: 10.1016/j.ejrad.2022.110396] [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: 04/08/2022] [Revised: 05/24/2022] [Accepted: 06/03/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE To elucidate whether a high level of microsatellite instability (MSI-high) in colon cancer influences the CT assessment of regional lymph node (rLN) morphology and diagnostic performance on predicting pathological node-negative (pN0) patients. METHOD We retrospectively reviewed 507 patients with cecal/proximal ascending colon cancer (age, 63.0 ± 11.6 years; MSI-stable, n = 398; MSI-high, n = 109) who underwent right hemicolectomy between July 1, 2009, and December 31, 2018. Preoperative CT images were assessed for number of rLNs, long/short diameter of the largest rLN, and CT LN grade (CTN0, low probability of metastasis; CTN1, borderline; CTN2, high probability). Sensitivity, specificity, positive predictive value and negative predictive value for predicting pN0 was calculated. Multivariable logistic regression analysis was performed. Statistical significance was defined as P < 0.05. RESULTS A study population of 507 patients (mean age ± standard deviation, 63.0 ± 11.6; 264 women) were evaluated. In patients with rLN metastasis, the rLN long axis (pN1: P = 0.013, pN2: P = 0.039) and short axis (pN1: P = 0.001, pN2: P = 0.009) were both longer in MSI-high tumors compared with MSI-stable tumors. High specificity for predicting pN0 was only achieved in MSI-high tumors [sensitivityMSI-stable = 58.3% (n = 137/235), specificityMSI-stable = 71.2% (n = 116/163); sensitivityMSI-high = 38.4% (n = 33/86), specificityMSI-high = 91.3% (n = 21/23)]. Multivariable logistic regression indicated MSI-high (P < 0.001, odds ratio = 3.701), smaller LN long axis (P = 0.023, odds ratio = 0.905), and lower CT LN grade (CTN0: P = 0.009, odds ratio = 2.987; CTN1: P = 0.014, odds ratio = 2.195) as significant parameters in predicting pN0. CONCLUSION MSI-high colon cancer is associated with larger rLNs and high specificity for predicting pN0 on CT assessment.
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Ying M, Pan J, Lu G, Zhou S, Fu J, Wang Q, Wang L, Hu B, Wei Y, Shen J. Development and validation of a radiomics-based nomogram for the preoperative prediction of microsatellite instability in colorectal cancer. BMC Cancer 2022; 22:524. [PMID: 35534797 PMCID: PMC9087961 DOI: 10.1186/s12885-022-09584-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/21/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Preoperative prediction of microsatellite instability (MSI) status in colorectal cancer (CRC) patients is of great significance for clinicians to perform further treatment strategies and prognostic evaluation. Our aims were to develop and validate a non-invasive, cost-effective reproducible and individualized clinic-radiomics nomogram method for preoperative MSI status prediction based on contrast-enhanced CT (CECT)images. METHODS A total of 76 MSI CRC patients and 200 microsatellite stability (MSS) CRC patients with pathologically confirmed (194 in the training set and 82 in the validation set) were identified and enrolled in our retrospective study. We included six significant clinical risk factors and four qualitative imaging data extracted from CECT images to build the clinics model. We applied the intra-and inter-class correlation coefficient (ICC), minimal-redundancy-maximal-relevance (mRMR) and the least absolute shrinkage and selection operator (LASSO) for feature reduction and selection. The selected independent prediction clinical risk factors, qualitative imaging data and radiomics features were performed to develop a predictive nomogram model for MSI status on the basis of multivariable logistic regression by tenfold cross-validation. The area under the receiver operating characteristic (ROC) curve (AUC), calibration plots and Hosmer-Lemeshow test were performed to assess the nomogram model. Finally, decision curve analysis (DCA) was performed to determine the clinical utility of the nomogram model by quantifying the net benefits of threshold probabilities. RESULTS Twelve top-ranked radiomics features, three clinical risk factors (location, WBC and histological grade) and CT-reported IFS were finally selected to construct the radiomics, clinics and combined clinic-radiomics nomogram model. The clinic-radiomics nomogram model with the highest AUC value of 0.87 (95% CI, 0.81-0.93) and 0.90 (95% CI, 0.83-0.96), as well as good calibration and clinical utility observed using the calibration plots and DCA in the training and validation sets respectively, was regarded as the candidate model for identification of MSI status in CRC patients. CONCLUSION The proposed clinic-radiomics nomogram model with a combination of clinical risk factors, qualitative imaging data and radiomics features can potentially be effective in the individualized preoperative prediction of MSI status in CRC patients and may help performing further treatment strategies.
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Affiliation(s)
- Mingliang Ying
- Department of Radiology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China.,Department of Radiology, Jinhua Hospital of Zhejiang University: Jinhua Municipal Central Hospital, No. 351 Mingyue Road, Jinhua, Zhejiang, China
| | - Jiangfeng Pan
- Department of Radiology, Jinhua Hospital of Zhejiang University: Jinhua Municipal Central Hospital, No. 351 Mingyue Road, Jinhua, Zhejiang, China
| | - Guanghong Lu
- Department of Radiology, Jinhua Hospital of Zhejiang University: Jinhua Municipal Central Hospital, No. 351 Mingyue Road, Jinhua, Zhejiang, China
| | - Shaobin Zhou
- Department of Radiology, Jinhua Hospital of Zhejiang University: Jinhua Municipal Central Hospital, No. 351 Mingyue Road, Jinhua, Zhejiang, China
| | - Jianfei Fu
- Department of Oncology, Jinhua Hospital of Zhejiang University: Jinhua Municipal Central Hospital, No. 351 Mingyue Road, Jinhua, Zhejiang, China
| | - Qinghua Wang
- Department of Oncology, Jinhua Hospital of Zhejiang University: Jinhua Municipal Central Hospital, No. 351 Mingyue Road, Jinhua, Zhejiang, China
| | - Lixia Wang
- Department of Pathology, Jinhua Hospital of Zhejiang University: Jinhua Municipal Central Hospital, No. 351 Mingyue Road, Jinhua, Zhejiang, China
| | - Bin Hu
- Department of Pathology, Jinhua Hospital of Zhejiang University: Jinhua Municipal Central Hospital, No. 351 Mingyue Road, Jinhua, Zhejiang, China
| | - Yuguo Wei
- Precision Health Institution, GE Healthcare, Xihu District, Hangzhou, China
| | - Junkang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, No.1055 Sanxiang Road, Gusu District, Suzhou, 215004, Jiangsu, China. .,Institute of Radiation Oncology Therapeutics of Soochow University, Suzhou, 215004, China.
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Golia Pernicka JS, Gagniere J, Chakraborty J, Yamashita R, Nardo L, Creasy JM, Petkovska I, Do RRK, Bates DDB, Paroder V, Gonen M, Weiser MR, Simpson AL, Gollub MJ. Radiomics-based prediction of microsatellite instability in colorectal cancer at initial computed tomography evaluation. Abdom Radiol (NY) 2019; 44:3755-3763. [PMID: 31250180 PMCID: PMC6824954 DOI: 10.1007/s00261-019-02117-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To predict microsatellite instability (MSI) status of colon cancer on preoperative CT imaging using radiomic analysis. METHODS This retrospective study involved radiomic analysis of preoperative CT imaging of patients who underwent resection of stage II-III colon cancer from 2004 to 2012. A radiologist blinded to MSI status manually segmented the tumor region on CT images. 254 Intensity-based radiomic features were extracted from the tumor region. Three prediction models were developed with (1) only clinical features, (2) only radiomic features, and (3) "combined" clinical and radiomic features. Patients were randomly separated into training (n = 139) and test (n = 59) sets. The model was constructed from training data only; the test set was reserved for validation only. Model performance was evaluated using AUC, sensitivity, specificity, PPV, and NPV. RESULTS Of the total 198 patients, 134 (68%) patients had microsatellite stable tumors and 64 (32%) patients had MSI tumors. The combined model performed slightly better than the other models, predicting MSI with an AUC of 0.80 for the training set and 0.79 for the test set (specificity = 96.8% and 92.5%, respectively), whereas the model with only clinical features achieved an AUC of 0.74 and the model with only radiomic features achieved an AUC of 0.76. The model with clinical features alone had the lowest specificity (70%) compared with the model with radiomic features alone (95%) and the combined model (92.5%). CONCLUSIONS Preoperative prediction of MSI status via radiomic analysis of preoperative CT adds specificity to clinical assessment and could contribute to personalized treatment selection.
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Affiliation(s)
- Jennifer S Golia Pernicka
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA.
| | - Johan Gagniere
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Digestive and Hepatobiliary Surgery, U1071 INSERM / Clermont-Auvergne University, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jayasree Chakraborty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rikiya Yamashita
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Lorenzo Nardo
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - John M Creasy
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iva Petkovska
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Richard R K Do
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - David D B Bates
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Viktoriya Paroder
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Mithat Gonen
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amber L Simpson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J Gollub
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
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Zauber P, Marotta S, Sabbath-Solitare M. Copy number of the Adenomatous Polyposis Coli gene is not always neutral in sporadic colorectal cancers with loss of heterozygosity for the gene. BMC Cancer 2016; 16:213. [PMID: 26970738 PMCID: PMC4788828 DOI: 10.1186/s12885-016-2243-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 03/01/2016] [Indexed: 02/05/2023] Open
Abstract
Background Changes in the number of alleles of a chromosome may have an impact upon gene expression. Loss of heterozygosity (LOH) indicates that one allele of a gene has been lost, and knowing the exact copy number of the gene would indicate whether duplication of the remaining allele has occurred. We were interested to determine the copy number of the Adenomatous Polyposis Coli (APC) gene in sporadic colorectal cancers with LOH. Methods We selected 38 carcinomas with LOH for the APC gene region of chromosome 5, as determined by amplification of the CA repeat region within the D5S346 loci. The copy number status of APC was ascertained using the SALSA® MLPA® P043-B1 APC Kit. LOH for the DCC gene, KRAS gene mutation, and microsatellite instability were also evaluated for each tumor, utilizing standard polymerase chain reaction methods. Results No tumor demonstrated microsatellite instability. LOH of the DCC gene was also present in 33 of 36 (91.7 %) informative tumors. A KRAS gene mutation was present in 16 of the 38 (42.1 %) tumors. Twenty-four (63.2 %) of the tumors were copy number neutral, 10 (26.3 %) tumors demonstrated major loss, while two (5.3 %) showed partial loss. Two tumors (5.3 %) had copy number gain. Conclusions Results of APC and DCC LOH, KRAS and microsatellite instability indicate our colorectal cancer cases were typical of sporadic cancers following the ‘chromosomal instability’ pathway. The majority of our colorectal carcinomas with LOH for APC gene are copy number neutral. However, one-third of our cases showed copy number loss, suggesting that duplication of the remaining allele is not required for the development of a colorectal carcinoma.
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Affiliation(s)
- Peter Zauber
- Department of Medicine, Saint Barnabas Medical Center, 22 Old Short Hills Road, Livingston, NJ, 07039, USA.
| | - Stephen Marotta
- Department of Pathology, Saint Barnabas Medical Center, 100 Old Short Hills Road, Livingston, NJ, 07039, USA
| | - Marlene Sabbath-Solitare
- Department of Pathology, Saint Barnabas Medical Center, 100 Old Short Hills Road, Livingston, NJ, 07039, USA
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Zauber P, Marotta S, Sabbath-Solitare M. Colorectal Cancers with the Uncommon Findings of KRAS Mutation and Microsatellite Instability. Cytogenet Genome Res 2015; 146:261-7. [PMID: 26523369 DOI: 10.1159/000441086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Indexed: 11/19/2022] Open
Abstract
Sporadic colorectal cancers with microsatellite instability (MSI) frequently contain a mutation of the BRAF gene. Additionally, it has been shown that BRAF mutations in colorectal cancers are mutually exclusive of KRAS mutation. We evaluated 14 cases of colorectal cancer with MSI that were BRAF wild type but demonstrated a KRAS mutation. The codon 12/13 region in exon 2 of the KRAS oncogene and the codon 600 region in exon 15 of the BRAF gene were analyzed with standard PCR methods. MSI was evaluated by using the Bethesda panel of markers. The methylation status of the mismatch repair system was ascertained using the SALSA(®) MS-MLPA(®) methylation-specific DNA detection. The mismatch repair proteins MLH1, MSH2, MSH6, and PMS2 were evaluated by immunohistochemical staining. A total of 530 colorectal cancers were studied for MSI and KRAS gene mutation. Fourteen (2.6%) cancers with both MSI and a KRAS mutation were identified, and all cancers were BRAF wild type. Methylation was present in 7 (50%), 5 demonstrated methylation of MLH1, 1 showed methylation of MGMT, and 1 showed methylation of MSH2. Four patients had simultaneous cancers, some of which showed different genetic changes. Immunohistochemical staining suggested a germ line mutation for 4 of 10 cases with complete staining information. KRAS mutation may occur with MSI in colorectal cancers with wild-type BRAF. If a mutation in KRAS co-exists with MSI, then strong methylation of the MLH1 gene is unlikely. These tumors demonstrate that a small number of colorectal cancers will develop with atypical patterns of molecular genetic changes, suggesting that a specific pattern of genetic changes may not be as crucial as the overall accumulation of changes, consistent with the 'unique tumor principle'.
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Affiliation(s)
- Peter Zauber
- Department of Medicine, Saint Barnabas Medical Center, Livingston, N.J., USA
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Hale MD, Gotoda T, Hayden JD, Grabsch HI. Endoscopic biopsies from gastrointestinal carcinomas and their suitability for molecular analysis: a review of the literature and recommendations for clinical practice and research. Histopathology 2015; 67:147-57. [DOI: 10.1111/his.12626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | - Takuji Gotoda
- Department of Gastroenterology and Hepatology; Tokyo Medical University; Tokyo Japan
| | - Jeremy David Hayden
- Department of Upper Gastrointestinal Surgery; St James's Institute of Oncology; Leeds Teaching Hospitals NHS Trust; Leeds UK
| | - Heike Irmgard Grabsch
- Leeds Institute of Cancer and Pathology; University of Leeds; Leeds UK
- Department of Pathology; Maastricht University Medical Center; Maastricht The Netherlands
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Boyle TA, Bridge JA, Sabatini LM, Nowak JA, Vasalos P, Jennings LJ, Halling KC. Summary of microsatellite instability test results from laboratories participating in proficiency surveys: proficiency survey results from 2005 to 2012. Arch Pathol Lab Med 2014; 138:363-70. [PMID: 24576032 DOI: 10.5858/arpa.2013-0159-cp] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The College of American Pathologists surveys are the largest laboratory peer comparison programs in the world. These programs allow laboratories to regularly evaluate their performance and improve the accuracy of the patient test results they provide. Proficiency testing is offered twice a year to laboratories performing microsatellite instability testing. These surveys are designed to emulate clinical practice, and some surveys have more challenging cases to encourage the refinement of laboratory practices. OBJECTIVE This report summarizes the results and trends in microsatellite instability proficiency testing from participating laboratories from the inception of the program in 2005 through 2012. DESIGN We compiled and analyzed data for 16 surveys of microsatellite instability proficiency testing during 2005 to 2012. RESULTS The number of laboratories participating in the microsatellite instability survey has more than doubled from 42 to 104 during the 8 years analyzed. An average of 95.4% of the laboratories correctly classified each of the survey test samples from the 2005A through 2012B proficiency challenges. In the 2011B survey, a lower percentage of laboratories (78.4%) correctly classified the specimen, possibly because of overlooking subtle changes of microsatellite instability and/or failing to enrich the tumor content of the specimen to meet the limit of detection of their assay. CONCLUSIONS In general, laboratories performed well in microsatellite instability testing. This testing will continue to be important in screening patients with colorectal and other cancers for Lynch syndrome and guiding the management of patients with sporadic colorectal cancer.
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Affiliation(s)
- Theresa A Boyle
- From the Department of Pathology and Division of Medical Oncology, University of Colorado, Aurora (Dr Boyle); the Department of Pathology & Microbiology, University of Nebraska Medical Center, Omaha (Dr Bridge); Roswell Park Cancer Institute, Buffalo, New York (Dr Sabatini); the Department of Pathology and Laboratory Medicine, North Shore University Health System, Evanston, Illinois (Dr Nowak); the College of American Pathologists, Northfield, Illinois (Ms Vasalos); Pathology and Laboratory Medicine, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois (Dr Jennings); and the Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Dr Halling). Dr Sabatini is now with Molecular Diagnostics, North Shore University Health System, Evanston, Illinois
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