1
|
Li TZ, Still JM, Xu K, Lee HH, Cai LY, Krishnan AR, Gao R, Khan MS, Antic S, Kammer M, Sandler KL, Maldonado F, Landman BA, Lasko TA. Longitudinal Multimodal Transformer Integrating Imaging and Latent Clinical Signatures From Routine EHRs for Pulmonary Nodule Classification. MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION : MICCAI ... INTERNATIONAL CONFERENCE ON MEDICAL IMAGE COMPUTING AND COMPUTER-ASSISTED INTERVENTION 2023; 14221:649-659. [PMID: 38779102 PMCID: PMC11110542 DOI: 10.1007/978-3-031-43895-0_61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
The accuracy of predictive models for solitary pulmonary nodule (SPN) diagnosis can be greatly increased by incorporating repeat imaging and medical context, such as electronic health records (EHRs). However, clinically routine modalities such as imaging and diagnostic codes can be asynchronous and irregularly sampled over different time scales which are obstacles to longitudinal multimodal learning. In this work, we propose a transformer-based multimodal strategy to integrate repeat imaging with longitudinal clinical signatures from routinely collected EHRs for SPN classification. We perform unsupervised disentanglement of latent clinical signatures and leverage time-distance scaled self-attention to jointly learn from clinical signatures expressions and chest computed tomography (CT) scans. Our classifier is pretrained on 2,668 scans from a public dataset and 1,149 subjects with longitudinal chest CTs, billing codes, medications, and laboratory tests from EHRs of our home institution. Evaluation on 227 subjects with challenging SPNs revealed a significant AUC improvement over a longitudinal multimodal baseline (0.824 vs 0.752 AUC), as well as improvements over a single cross-section multimodal scenario (0.809 AUC) and a longitudinal imaging-only scenario (0.741 AUC). This work demonstrates significant advantages with a novel approach for co-learning longitudinal imaging and non-imaging phenotypes with transformers. Code available at https://github.com/MASILab/lmsignatures.
Collapse
Affiliation(s)
- Thomas Z Li
- Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - John M Still
- Biomedical Informatics, Vanderbilt University, Nashville, TN 37212, USA
| | - Kaiwen Xu
- Computer Science, Vanderbilt University, Nashville, TN 37212, USA
| | - Ho Hin Lee
- Computer Science, Vanderbilt University, Nashville, TN 37212, USA
| | - Leon Y Cai
- Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Aravind R Krishnan
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37212, USA
| | - Riqiang Gao
- Digital Technology and Innovation, Siemens Healthineers, Princeton NJ 08540, USA
| | - Mirza S Khan
- Saint Luke's Mid America Heart Institute, Kansas City, MO 64111, USA
| | - Sanja Antic
- Medicine, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Michael Kammer
- Medicine, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Kim L Sandler
- Radiology, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Fabien Maldonado
- Medicine, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Bennett A Landman
- Biomedical Engineering, Vanderbilt University, Nashville, TN 37212, USA
- Computer Science, Vanderbilt University, Nashville, TN 37212, USA
- Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37212, USA
- Radiology, Vanderbilt University Medical Center, Nashville, TN 37235, USA
| | - Thomas A Lasko
- Biomedical Informatics, Vanderbilt University, Nashville, TN 37212, USA
- Computer Science, Vanderbilt University, Nashville, TN 37212, USA
| |
Collapse
|
2
|
Kammer MN, Deppen SA, Antic S, Jamshedur Rahman S, Eisenberg R, Maldonado F, Aldrich MC, Sandler KL, Landman B, Massion PP, Grogan EL. The impact of the lung EDRN-CVC on Phase 1, 2, & 3 biomarker validation studies. Cancer Biomark 2022; 33:449-465. [DOI: 10.3233/cbm-210382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Early Detection Research Network’s (EDRN) purpose is to discover, develop and validate biomarkers and imaging methods to detect early-stage cancers or at-risk individuals. The EDRN is composed of sites that fall into four categories: Biomarker Developmental Laboratories (BDL), Biomarker Reference Laboratories (BRL), Clinical Validation Centers (CVC) and Data Management and Coordinating Centers. Each component has a crucial role to play within the mission of the EDRN. The primary role of the CVCs is to support biomarker developers through validation trials on promising biomarkers discovered by both EDRN and non-EDRN investigators. The second round of funding for the EDRN Lung CVC at Vanderbilt University Medical Center (VUMC) was funded in October 2016 and we intended to accomplish the three missions of the CVCs: To conduct innovative research on the validation of candidate biomarkers for early cancer detection and risk assessment of lung cancer in an observational study; to compare biomarker performance; and to serve as a resource center for collaborative research within the Network and partner with established EDRN BDLs and BRLs, new laboratories and industry partners. This report outlines the impact of the VUMC EDRN Lung CVC and describes the role in promoting and validating biological and imaging biomarkers.
Collapse
Affiliation(s)
- Michael N. Kammer
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen A. Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Healthcare System, Veterans Affairs, Nashville, TN, USA
| | - Sanja Antic
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - S.M. Jamshedur Rahman
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rosana Eisenberg
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Melinda C. Aldrich
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kim L. Sandler
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bennett Landman
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Pierre P. Massion
- Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Healthcare System, Veterans Affairs, Nashville, TN, USA
- Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eric L. Grogan
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Tennessee Valley Healthcare System, Veterans Affairs, Nashville, TN, USA
| |
Collapse
|
3
|
Gao R, Tang Y, Khan MS, Xu K, Paulson AB, Sullivan S, Huo Y, Deppen S, Massion PP, Sandler KL, Landman BA. Cancer Risk Estimation Combining Lung Screening CT with Clinical Data Elements. Radiol Artif Intell 2021; 3:e210032. [PMID: 34870220 DOI: 10.1148/ryai.2021210032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 12/26/2022]
Abstract
Purpose To develop a model to estimate lung cancer risk using lung cancer screening CT and clinical data elements (CDEs) without manual reading efforts. Materials and Methods Two screening cohorts were retrospectively studied: the National Lung Screening Trial (NLST; participants enrolled between August 2002 and April 2004) and the Vanderbilt Lung Screening Program (VLSP; participants enrolled between 2015 and 2018). Fivefold cross-validation using the NLST dataset was used for initial development and assessment of the co-learning model using whole CT scans and CDEs. The VLSP dataset was used for external testing of the developed model. Area under the receiver operating characteristic curve (AUC) and area under the precision-recall curve were used to measure the performance of the model. The developed model was compared with published risk-prediction models that used only CDEs or imaging data alone. The Brock model was also included for comparison by imputing missing values for patients without a dominant pulmonary nodule. Results A total of 23 505 patients from the NLST (mean age, 62 years ± 5 [standard deviation]; 13 838 men, 9667 women) and 147 patients from the VLSP (mean age, 65 years ± 5; 82 men, 65 women) were included. Using cross-validation on the NLST dataset, the AUC of the proposed co-learning model (AUC, 0.88) was higher than the published models predicted with CDEs only (AUC, 0.69; P < .05) and with images only (AUC, 0.86; P < .05). Additionally, using the external VLSP test dataset, the co-learning model had a higher performance than each of the published individual models (AUC, 0.91 [co-learning] vs 0.59 [CDE-only] and 0.88 [image-only]; P < .05 for both comparisons). Conclusion The proposed co-learning predictive model combining chest CT images and CDEs had a higher performance for lung cancer risk prediction than models that contained only CDE or only image data; the proposed model also had a higher performance than the Brock model.Keywords: Computer-aided Diagnosis (CAD), CT, Lung, Thorax Supplemental material is available for this article. © RSNA, 2021.
Collapse
Affiliation(s)
- Riqiang Gao
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Yucheng Tang
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Mirza S Khan
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Kaiwen Xu
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Alexis B Paulson
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Shelbi Sullivan
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Yuankai Huo
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Stephen Deppen
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Pierre P Massion
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Kim L Sandler
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| | - Bennett A Landman
- Departments of Computer Science (R.G., K.X., Y.H., B.A.L.) and Electrical and Computer Engineering (Y.T., Y.H., B.A.L.), Vanderbilt University, 400 24th Ave S, Featheringill Hall, Room 371, Nashville, TN 37235; and Departments of Radiology and Radiological Sciences (A.B.P., K.L.S.), Thoracic Surgery (S.S., S.D.), General Internal Medicine and Public Health (M.S.K.), Biomedical Informatics (M.S.K.), and Medicine, Division of Allergy, Pulmonary and Critical Care Medicine (P.P.M.), Vanderbilt University Medical Center, Nashville, Tenn
| |
Collapse
|