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Tian M, Qin F, Sun X, Pang H, Yu T, Dong Y. A Hybrid Model-Based Clinicopathological Features and Radiomics Based on Conventional MRI for Predicting Lymph Node Metastasis and DFS in Cervical Cancer. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2025:10.1007/s10278-024-01371-9. [PMID: 40251433 DOI: 10.1007/s10278-024-01371-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 11/25/2024] [Accepted: 12/03/2024] [Indexed: 04/20/2025]
Abstract
This study aimed to improve the accuracy of the diagnosis of lymph node metastasis (LNM) and prediction of patient prognosis in cervical cancer patients using a hybrid model based on MRI and clinical aspects. We retrospectively analyzed routine MR data from 485 patients with pathologically confirmed cervical cancer from January 2014 to June 2021. The data were divided into a training cohort (N = 261), internal cohort (N = 113), and external validation cohort (n = 111). A total of 2194 features were extracted from each ROI from T2WI and CE-T1WI. The clinical model (M1) was built with clinicopathological features including squamous cell carcinoma antigen, MRI-reported LNM, maximal tumor diameter (MTD). The radiomics model (M2) was built with four radiomics features. The hybrid model (M3) was constructed with squamous cell carcinoma antigen, MRI-reported LNM, MTD which consists of M1 and four radiomics features which consist of M2. GBDT algorithms were used to create the scores of M1 (clinical-score, C-score), M2 (radiomic score, R-score), and M3 (hybrid-score, H-score). M3 showed good performance in the training cohort (AUCs, M3 vs. M1 vs. M2, 0.917 vs. 0.830 vs. 0.788), internal validation cohorts (AUCs, M3 vs. M1 vs. M2, 0.872 vs. 0.750 vs. 0.739), and external validation cohort (AUCs, M3 vs. M1 vs. M2, 0.907 vs. 0.811 vs. 0.785). In addition, higher scores were significantly associated with worse disease-free survival (DFS) in the training cohort and the internal validation cohort (C-score, P = 0.001; R-score, P = 0.002; H-score, P = 0.006). Radiomics models can accurately predict LNM status in patients with cervical cancer. The hybrid model, which incorporates clinical and radiomics features, is a novel way to enhance diagnostic performance and predict the prognosis of cervical cancer.
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Affiliation(s)
- Mingke Tian
- Department of Radiology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital & Institute, Shenyang, 110042, Liaoning, China
- Graduate School of Dalian Medical University, Dalian, China
| | - Fengying Qin
- Department of Radiology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital & Institute, Shenyang, 110042, Liaoning, China
| | - Xinyan Sun
- Department of Radiology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital & Institute, Shenyang, 110042, Liaoning, China
| | - Huiting Pang
- Department of Radiology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital & Institute, Shenyang, 110042, Liaoning, China
| | - Tao Yu
- Department of Radiology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital & Institute, Shenyang, 110042, Liaoning, China
| | - Yue Dong
- Department of Radiology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, LiaoNing Cancer Hospital & Institute, Shenyang, 110042, Liaoning, China.
- School of Biomedical Engineering, Faculty of Medicine, Dalian University of Technology, Dalian, China.
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Kirsch-Mangu AT, Pop DC, Tipcu A, Andries AI, Pasca GI, Fekete Z, Roman A, Irimie A, Ordeanu C. CT Angiography-Guided Needle Insertion for Interstitial Brachytherapy in Locally Advanced Cervical Cancer. Diagnostics (Basel) 2024; 14:1267. [PMID: 38928682 PMCID: PMC11202455 DOI: 10.3390/diagnostics14121267] [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: 05/02/2024] [Revised: 06/01/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
CT angiography might be a suitable procedure to avoid arterial puncture in combined intracavitary and interstitial brachytherapy for cervical cancer curatively treated with combined chemoradiation and brachytherapy boost. Data in the literature about this technique are scarce. We introduced this method and collected brachytherapy data from patients treated in our department between May 2021 and April 2024. We analyzed the applicator subtype, needle insertion (planned versus implanted), implanted depth and the role of CT angiography in selecting needle trajectories and insertion depths. None of the patients managed through this protocol experienced atrial puncture and consequent hemorrhage. Needle positions were accurately selected with the aid of CT angiography with proper coverage of brachytherapy targets and avoidance of organs at risk. CT angiography is a promising method for guiding needle insertion during interstitial brachytherapy.
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Affiliation(s)
- Alexandra Timea Kirsch-Mangu
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (A.T.K.-M.); (A.T.); (A.I.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (D.C.P.); (A.I.A.); (G.I.P.); (C.O.)
| | - Diana Cristina Pop
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (D.C.P.); (A.I.A.); (G.I.P.); (C.O.)
| | - Alexandru Tipcu
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (A.T.K.-M.); (A.T.); (A.I.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (D.C.P.); (A.I.A.); (G.I.P.); (C.O.)
| | - Alexandra Ioana Andries
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (D.C.P.); (A.I.A.); (G.I.P.); (C.O.)
| | - Gina Iulia Pasca
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (D.C.P.); (A.I.A.); (G.I.P.); (C.O.)
| | - Zsolt Fekete
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (A.T.K.-M.); (A.T.); (A.I.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (D.C.P.); (A.I.A.); (G.I.P.); (C.O.)
| | - Andrei Roman
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (A.T.K.-M.); (A.T.); (A.I.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (D.C.P.); (A.I.A.); (G.I.P.); (C.O.)
| | - Alexandru Irimie
- Department of Oncology, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania; (A.T.K.-M.); (A.T.); (A.I.)
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (D.C.P.); (A.I.A.); (G.I.P.); (C.O.)
| | - Claudia Ordeanu
- “Prof. Dr. I. Chiricuță” Oncology Institute, 400015 Cluj-Napoca, Romania; (D.C.P.); (A.I.A.); (G.I.P.); (C.O.)
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Guo Q, Gao Y, Lin Y, Li W, Zhang Z, Mao Y, Xu X. A nomogram of preoperative indicators predicting lymph vascular space invasion in cervical cancer. Arch Gynecol Obstet 2024; 309:2079-2087. [PMID: 38358484 DOI: 10.1007/s00404-024-07385-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE To develop predictive nomograms of lymph vascular space invasion (LVSI) in patients with early-stage cervical cancer. METHODS We identified 403 patients with cervical cancer from the Affiliated Hospital of Jiangnan University from January 2015 to December 2019. Patients were divided into the training set (n = 242) and the validation set (n = 161), with patients in the training set subdivided into LVSI (+) and LVSI (-) groups according to postoperative pathology. Preoperative hematologic indexes were compared between the two subgroups. Univariate and multivariate logistic regression analyses were used to analyze the independent risk factors for LVSI, from which a nomogram was constructed using the R package. RESULTS LVSI (+) was present in 94 out of 242 patients in the training set, accompanied by a significant increase in the preoperative squamous cell carcinoma antigen (SCC), white blood cells (WBC), neutrophil (NE), platelet (PLT), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation index (SII), and tumor size (P < 0.05). Univariate analysis showed that SCC, WBC, NE, NLR, PLR, SII, and tumor size were correlated with LVSI (P < 0.05), and multivariate analysis showed that tumor size, SCC, WBC, and NLR were independent risk factors for LVSI (P < 0.05). A nomogram was correspondingly established with good performance in predicting LVSI [training: ROC-AUC = 0.845 (95% CI: 0.731-0.843) and external validation: ROC-AUC = 0.704 (95% CI: 0.683-0.835)] and high accuracy (training: C-index = 0.787; external validation: C-index = 0.759). CONCLUSION The nomogram based on preoperative tumor size, SCC, WBC, and NLR had excellent accuracy and discriminative capability to assess the risk of LVSI in early-stage cervical cancer patients.
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Affiliation(s)
- Qu Guo
- Department of Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yufeng Gao
- Department of Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, China
- Wuxi Medical College, Jiangnan University, Wuxi, China
| | - Yaying Lin
- Department of Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, China
- Wuxi Medical College, Jiangnan University, Wuxi, China
| | - Weimin Li
- Ultrasonography Department, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Zhenyu Zhang
- Department of Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Yurong Mao
- Department of Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Xizhong Xu
- Department of Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, China.
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Lakhman Y, Aherne EA, Jayaprakasam VS, Nougaret S, Reinhold C. Staging of Cervical Cancer: A Practical Approach Using MRI and FDG PET. AJR Am J Roentgenol 2023; 221:633-648. [PMID: 37459457 PMCID: PMC467038 DOI: 10.2214/ajr.23.29003] [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] [Indexed: 09/15/2023]
Abstract
This review provides a practical approach to the imaging evaluation of patients with cervical cancer (CC), from initial diagnosis to restaging of recurrence, focusing on MRI and FDG PET. The primary updates to the International Federation of Gynecology and Obstetrics (FIGO) CC staging system, as well as these updates' relevance to clinical management, are discussed. The recent literature investigating the role of MRI and FDG PET in CC staging and image-guided brachytherapy is summarized. The utility of MRI and FDG PET in response assessment and posttreatment surveillance is described. Important findings on MRI and FDG PET that interpreting radiologists should recognize and report are illustrated. The essential elements of structured reports during various phases of CC management are outlined. Special considerations, including the role of imaging in patients desiring fertility-sparing management, differentiation of CC and endometrial cancer, and unusual CC histologies, are also described. Finally, future research directions including PET/MRI, novel PET tracers, and artificial intelligence applications are highlighted.
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Affiliation(s)
- Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Emily A Aherne
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, Montpellier, France
- Pinkcc Lab, IRCM, Montpellier, France
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
- Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, QC, Canada
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Jacobsen MC, Beriwal S, Dyer BA, Klopp AH, Lee SI, McGinnis GJ, Robbins JB, Rauch GM, Sadowski EA, Simiele SJ, Stafford RJ, Taunk NK, Yashar CM, Venkatesan AM. Contemporary image-guided cervical cancer brachytherapy: Consensus imaging recommendations from the Society of Abdominal Radiology and the American Brachytherapy Society. Brachytherapy 2022; 21:369-388. [PMID: 35725550 DOI: 10.1016/j.brachy.2022.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 04/15/2022] [Accepted: 04/24/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To present recommendations for the use of imaging for evaluation and procedural guidance of brachytherapy for cervical cancer patients. METHODS An expert panel comprised of members of the Society of Abdominal Radiology Uterine and Ovarian Cancer Disease Focused Panel and the American Brachytherapy Society jointly assessed the existing literature and provide data-driven guidance on imaging protocol development, interpretation, and reporting. RESULTS Image-guidance during applicator implantation reduces rates of uterine perforation by the tandem. Postimplant images may be acquired with radiography, computed tomography (CT), or magnetic resonance imaging (MRI), and CT or MRI are preferred due to a decrease in severe complications. Pre-brachytherapy T2-weighted MRI may be used as a reference for contouring the high-risk clinical target volume (HR-CTV) when CT is used for treatment planning. Reference CT and MRI protocols are provided for reference. CONCLUSIONS Image-guided brachytherapy in locally advanced cervical cancer is essential for optimal patient management. Various imaging modalities, including orthogonal radiographs, ultrasound, computed tomography, and magnetic resonance imaging, remain integral to the successful execution of image-guided brachytherapy.
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Affiliation(s)
- Megan C Jacobsen
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Sushil Beriwal
- Allegheny Health Network, Department of Radiation Oncology, Pittsburgh, PA; Varian Medical Systems, Palo Alto, CA
| | - Brandon A Dyer
- Legacy Health, Department of Radiation Oncology, Portland, OR
| | - Ann H Klopp
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | - Susanna I Lee
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | - Gwendolyn J McGinnis
- The University of Texas MD Anderson Cancer Center, Department of Radiation Oncology, Houston, TX
| | | | - Gaiane M Rauch
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX
| | | | - Samantha J Simiele
- The University of Texas MD Anderson Cancer Center, Department of Radiation Physics, Houston, TX
| | - R Jason Stafford
- The University of Texas MD Anderson Cancer Center, Department of Imaging Physics, Houston, TX
| | - Neil K Taunk
- University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA
| | - Catheryn M Yashar
- University of California San Diego, Department of Radiation Oncology, San Diego, CA
| | - Aradhana M Venkatesan
- The University of Texas MD Anderson Cancer Center, Department of Abdominal Imaging, Houston, TX.
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Hou M, Song K, Ren J, Wang K, Guo J, Niu Y, Li Z, Han D. Comparative analysis of the value of amide proton transfer-weighted imaging and diffusion kurtosis imaging in evaluating the histological grade of cervical squamous carcinoma. BMC Cancer 2022; 22:87. [PMID: 35057777 PMCID: PMC8780242 DOI: 10.1186/s12885-022-09205-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/14/2022] [Indexed: 01/21/2023] Open
Abstract
Background Uterine cervical cancer (UCC) was the fourth leading cause of cancer death among women worldwide. The conventional MRI hardly revealing the microstructure information. This study aimed to compare the value of amide proton transfer-weighted imaging (APTWI) and diffusion kurtosis imaging (DKI) in evaluating the histological grade of cervical squamous carcinoma (CSC) in addition to routine diffusion-weighted imaging (DWI). Methods Forty-six patients with CSC underwent pelvic DKI and APTWI. The magnetization transfer ratio asymmetry (MTRasym), apparent diffusion coefficient (ADC), mean diffusivity (MD) and mean kurtosis (MK) were calculated and compared based on the histological grade. Correlation coefficients between each parameter and histological grade were calculated. Results The MTRasym and MK values of grade 1 (G1) were significantly lower than those of grade 2 (G2), and those parameters of G2 were significantly lower than those of grade 3 (G3). The MD and ADC values of G1 were significantly higher than those of G2, and those of G2 were significantly higher than those of G3. MTRasym and MK were both positively correlated with histological grade (r = 0.789 and 0.743, P < 0.001), while MD and ADC were both negatively correlated with histological grade (r = − 0.732 and - 0.644, P < 0.001). For the diagnosis of G1 and G2 CSCs, AUC (APTWI+DKI + DWI) > AUC (DKI + DWI) > AUC (APTWI+DKI) > AUC (APTWI+DWI) > AUC (MTRasym) > AUC (MK) > AUC (MD) > AUC (ADC), where the differences between AUC (APTWI+DKI + DWI), AUC (DKI + DWI) and AUC (ADC) were significant. For the diagnosis of G2 and G3 CSCs, AUC (APTWI+DKI + DWI) > AUC (APTWI+DWI) > AUC (APTWI+DKI) > AUC (DKI + DWI) > AUC (MTRasym) > AUC (MK) > AUC (MD > AUC (ADC), where the differences between AUC (APTWI+DKI + DWI), AUC (APTWI+DWI) and AUC (ADC) were significant. Conclusion Compared with DWI and DKI, APTWI is more effective in identifying the histological grades of CSC. APTWI is recommended as a supplementary scan to routine DWI in CSCs.
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Towithelertkul C, Chugh A, Hattori M, Yoshimura R, Sumita YI. A custom-made brachytherapy applicator for recurrent endometrial and vaginal cancer: A dental technique for prosthesis fabrication. J Prosthet Dent 2020; 126:711-714. [PMID: 33162114 DOI: 10.1016/j.prosdent.2020.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/25/2022]
Abstract
The role of the prosthodontist in radiation therapy includes fabrication of radiation therapy prosthetic applicators. Brachytherapy is a form of cancer treatment that involves direct insertion of radioactive implants into the tissue. In the case of vaginal cancer, brachytherapy requires the radiation oncologist to use a device called an applicator. Conventional applicators have limitations in terms of the number of radiation tubes that can be inserted, positioning of the tubes, applicator misfit, and pain when inserted. A well-fitted applicator is needed to improve the orientation of the radiation source toward the target area and to reduce the amount of scatter radiation and tissue irritation. Using an appropriate dental material to make an impression can serve to achieve these aims. This article describes a technique for fabricating an acrylic resin custom-made applicator by using techniques used in dentistry.
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Affiliation(s)
- Cheewin Towithelertkul
- Doctoral student, Department of Maxillofacial Prosthetics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Anshul Chugh
- Doctoral student, Department of Maxillofacial Prosthetics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan; Associate Professor, Department of Prosthodontics Crown and Bridge, Postgraduate Institute of Dental Sciences, University of Health Sciences, Rohtak, Haryana, India
| | - Mariko Hattori
- Assistant Professor, Department of Maxillofacial Prosthetics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ryoichi Yoshimura
- Professor, Department of Radiation Therapeutics and Oncology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yuka I Sumita
- Junior Associate Professor, Department of Maxillofacial Prosthetics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.
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