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Park TY, Kwon LM, Hyeon J, Cho BJ, Kim BJ. Deep Learning Prediction of Axillary Lymph Node Metastasis in Breast Cancer Patients Using Clinical Implication-Applied Preprocessed CT Images. Curr Oncol 2024; 31:2278-2288. [PMID: 38668072 PMCID: PMC11049657 DOI: 10.3390/curroncol31040169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Accurate detection of axillary lymph node (ALN) metastases in breast cancer is crucial for clinical staging and treatment planning. This study aims to develop a deep learning model using clinical implication-applied preprocessed computed tomography (CT) images to enhance the prediction of ALN metastasis in breast cancer patients. Methods: A total of 1128 axial CT images of ALN (538 malignant and 590 benign lymph nodes) were collected from 523 breast cancer patients who underwent preoperative CT scans between January 2012 and July 2022 at Hallym University Medical Center. To develop an optimal deep learning model for distinguishing metastatic ALN from benign ALN, a CT image preprocessing protocol with clinical implications and two different cropping methods (fixed size crop [FSC] method and adjustable square crop [ASC] method) were employed. The images were analyzed using three different convolutional neural network (CNN) architectures (ResNet, DenseNet, and EfficientNet). Ensemble methods involving and combining the selection of the two best-performing CNN architectures from each cropping method were applied to generate the final result. Results: For the two different cropping methods, DenseNet consistently outperformed ResNet and EfficientNet. The area under the receiver operating characteristic curve (AUROC) for DenseNet, using the FSC and ASC methods, was 0.934 and 0.939, respectively. The ensemble model, which combines the performance of the DenseNet121 architecture for both cropping methods, delivered outstanding results with an AUROC of 0.968, an accuracy of 0.938, a sensitivity of 0.980, and a specificity of 0.903. Furthermore, distinct trends observed in gradient-weighted class activation mapping images with the two cropping methods suggest that our deep learning model not only evaluates the lymph node itself, but also distinguishes subtler changes in lymph node margin and adjacent soft tissue, which often elude human interpretation. Conclusions: This research demonstrates the promising performance of a deep learning model in accurately detecting malignant ALNs in breast cancer patients using CT images. The integration of clinical considerations into image processing and the utilization of ensemble methods further improved diagnostic precision.
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Affiliation(s)
- Tae Yong Park
- Medical Artificial Intelligence Center, Doheon Institute for Digital Innovation in Medicine, Hallym Univesity Medical Center, Anyang-si 14068, Republic of Korea;
| | - Lyo Min Kwon
- Department of Radiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si 14068, Republic of Korea;
| | - Jini Hyeon
- School of Medicine, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea;
| | - Bum-Joo Cho
- Medical Artificial Intelligence Center, Doheon Institute for Digital Innovation in Medicine, Hallym Univesity Medical Center, Anyang-si 14068, Republic of Korea;
- Department of Ophthalmology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si 14068, Republic of Korea
| | - Bum Jun Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si 14068, Republic of Korea
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Guo Y, Zhang H, Yuan L, Chen W, Zhao H, Yu QQ, Shi W. Machine learning and new insights for breast cancer diagnosis. J Int Med Res 2024; 52:3000605241237867. [PMID: 38663911 PMCID: PMC11047257 DOI: 10.1177/03000605241237867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/21/2024] [Indexed: 04/28/2024] Open
Abstract
Breast cancer (BC) is the most prominent form of cancer among females all over the world. The current methods of BC detection include X-ray mammography, ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography and breast thermographic techniques. More recently, machine learning (ML) tools have been increasingly employed in diagnostic medicine for its high efficiency in detection and intervention. The subsequent imaging features and mathematical analyses can then be used to generate ML models, which stratify, differentiate and detect benign and malignant breast lesions. Given its marked advantages, radiomics is a frequently used tool in recent research and clinics. Artificial neural networks and deep learning (DL) are novel forms of ML that evaluate data using computer simulation of the human brain. DL directly processes unstructured information, such as images, sounds and language, and performs precise clinical image stratification, medical record analyses and tumour diagnosis. Herein, this review thoroughly summarizes prior investigations on the application of medical images for the detection and intervention of BC using radiomics, namely DL and ML. The aim was to provide guidance to scientists regarding the use of artificial intelligence and ML in research and the clinic.
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Affiliation(s)
- Ya Guo
- Department of Oncology, Jining No.1 People’s Hospital, Shandong First Medical University, Jining, Shandong Province, China
| | - Heng Zhang
- Department of Laboratory Medicine, Shandong Daizhuang Hospital, Jining, Shandong Province, China
| | - Leilei Yuan
- Department of Oncology, Jining No.1 People’s Hospital, Shandong First Medical University, Jining, Shandong Province, China
| | - Weidong Chen
- Department of Oncology, Jining No.1 People’s Hospital, Shandong First Medical University, Jining, Shandong Province, China
| | - Haibo Zhao
- Department of Oncology, Jining No.1 People’s Hospital, Shandong First Medical University, Jining, Shandong Province, China
| | - Qing-Qing Yu
- Phase I Clinical Research Centre, Jining No.1 People’s Hospital, Shandong First Medical University, Jining, Shandong Province, China
| | - Wenjie Shi
- Molecular and Experimental Surgery, University Clinic for General-, Visceral-, Vascular- and Trans-Plantation Surgery, Medical Faculty University Hospital Magdeburg, Otto-von Guericke University, Magdeburg, Germany
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Chen Z, Wang Y, Ying MTC, Su Z. Interpretable machine learning model integrating clinical and elastosonographic features to detect renal fibrosis in Asian patients with chronic kidney disease. J Nephrol 2024:10.1007/s40620-023-01878-4. [PMID: 38315278 DOI: 10.1007/s40620-023-01878-4] [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: 06/09/2023] [Accepted: 12/26/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Non-invasive renal fibrosis assessment is critical for tailoring personalized decision-making and managing follow-up in patients with chronic kidney disease (CKD). We aimed to exploit machine learning algorithms using clinical and elastosonographic features to distinguish moderate-severe fibrosis from mild fibrosis among CKD patients. METHODS A total of 162 patients with CKD who underwent shear wave elastography examinations and renal biopsies at our institution were prospectively enrolled. Four classifiers using machine learning algorithms, including eXtreme Gradient Boosting (XGBoost), Support Vector Machine (SVM), Light Gradient Boosting Machine (LightGBM), and K-Nearest Neighbor (KNN), which integrated elastosonographic features and clinical characteristics, were established to differentiate moderate-severe renal fibrosis from mild forms. The area under the receiver operating characteristic curve (AUC) and average precision were employed to compare the performance of constructed models, and the SHapley Additive exPlanations (SHAP) strategy was used to visualize and interpret the model output. RESULTS The XGBoost model outperformed the other developed machine learning models, demonstrating optimal diagnostic performance in both the primary (AUC = 0.97, 95% confidence level (CI) 0.94-0.99; average precision = 0.97, 95% CI 0.97-0.98) and five-fold cross-validation (AUC = 0.85, 95% CI 0.73-0.98; average precision = 0.90, 95% CI 0.86-0.93) datasets. The SHAP approach provided visual interpretation for XGBoost, highlighting the features' impact on the diagnostic process, wherein the estimated glomerular filtration rate provided the largest contribution to the model output, followed by the elastic modulus, then renal length, renal resistive index, and hypertension. CONCLUSION This study proposed an XGBoost model for distinguishing moderate-severe renal fibrosis from mild forms in CKD patients, which could be used to assist clinicians in decision-making and follow-up strategies. Moreover, the SHAP algorithm makes it feasible to visualize and interpret the feature processing and diagnostic processes of the model output.
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Affiliation(s)
- Ziman Chen
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Yingli Wang
- Ultrasound Department, EDAN Instruments, Inc., Shenzhen, China
| | - Michael Tin Cheung Ying
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Kowloon, Hong Kong.
| | - Zhongzhen Su
- Department of Ultrasound, Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
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Wang M, Liu Z, Ma L. Application of artificial intelligence in ultrasound imaging for predicting lymph node metastasis in breast cancer: A meta-analysis. Clin Imaging 2024; 106:110048. [PMID: 38065024 DOI: 10.1016/j.clinimag.2023.110048] [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: 08/01/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND This study aims to comprehensively evaluate the accuracy and effectiveness of ultrasound imaging based on artificial intelligence algorithms in predicting lymph node metastasis in breast cancer patients through a meta-analysis. METHODS We systematically searched PubMed, Embase, and Cochrane Library for literature published up to May 2023. The search terms included artificial intelligence, ultrasound, breast cancer, and lymph node. Studies meeting the inclusion criteria were selected, and data were extracted for analysis. The main evaluation indicators included sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and area under the curve (AUC). The heterogeneity was assessed using the Cochrane Q test combined with the I^2 statistic expressing the percentage of total effect variation that can be attributed to the effect variation between studies, as recommended by the Cochrane Handbook for heterogeneity quantification. A threshold p-value of 0.10 was considered to compensate for the low power of the Q test. Sensitivity analysis was performed to assess the stability of individual studies, and publication bias was determined with funnel plots. Additionally, fagan plots were used to assess clinical utility. RESULTS Ten studies involving 4726 breast cancer patients were included in the meta-analysis. The results showed that ultrasound imaging based on artificial intelligence algorithms had high accuracy and effectiveness in predicting lymph node metastasis in breast cancer patients. The pooled sensitivity was 0.88 (95% CI: 0.81-0.93; P < 0.001; I2 = 84.68), specificity was 0.75 (95% CI: 0.66-0.83; P < 0.001; I2 = 91.11), and AUC was 0.89 (95% CI: 0.86-0.91). The positive likelihood ratio was 3.5 (95% CI: 2.6-4.8), negative likelihood ratio was 0.16 (95% CI: 0.10-0.26), and diagnostic odds ratio was 23 (95% CI: 13-40). However, the combined sensitivity of ultrasound imaging based on non-AI algorithms for predicting lymph node metastasis in breast cancer patients was 0.78 (95%CI: 0.63-0.88), the specificity was 0.76 (95%CI: 0.63-0.86), and the AUC was 0.84 (95%CI: 0.80-0.87). The positive likelihood ratio was 3.3 (95% CI: 1.9-5.6), the negative likelihood ratio was 0.29 (95% CI: 0.15-0.54), and the diagnostic odds ratio was 11 (95% CI: 4-33). Due to limited sample size (n = 2), meta-analysis was not conducted for the outcome of predicting lymph node metastasis burden. CONCLUSION Ultrasound imaging based on artificial intelligence algorithms holds promise in predicting lymph node metastasis in breast cancer patients, demonstrating high accuracy and effectiveness. The application of this technology helps in the diagnosis and treatment decisions for breast cancer patients and is expected to become an important tool in future clinical practice.
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Affiliation(s)
- Minghui Wang
- Department of Breast Surgery, Affiliate Hospital of Chengde Medical University, Hebei 067000, China
| | - Zihui Liu
- Department of Pathology, Affiliate Hospital of Chengde Medical University, Hebei 067000, China
| | - Lihui Ma
- Department of Breast Surgery, Affiliate Hospital of Chengde Medical University, Hebei 067000, China.
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Pang W, Wang Y, Zhu Y, Jia Y, Nie F. Predictive value for axillary lymph node metastases in early breast cancer: Based on contrast-enhanced ultrasound characteristics of the primary lesion and sentinel lymph node. Clin Hemorheol Microcirc 2024; 86:357-367. [PMID: 37955082 DOI: 10.3233/ch-231973] [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] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To evaluate the value of contrast-enhanced ultrasound (CEUS) characteristics based on primary lesion combined with lymphatic contrast-enhanced ultrasound (LCEUS) patterns of SLN in predicting axillary lymph node metastasis (ALNM) with T1-2N0 breast cancer. METHODS A retrospective study was conducted in 118 patients with clinically confirmed T1-2N0 breast cancer. Conventional ultrasound (CUS) and CEUS characteristics of the primary lesion and enhancement patterns of SLN were recorded. The risk factors associated with ALNM were selected by univariate and binary logistic regression analysis, and the receiver operating characteristic (ROC) curve was drawn for the evaluation of predictive ALNM metastasis performance. RESULTS Univariate analysis showed that age, HER-2 status, tumor size, nutrient vessels, extended range of enhancement lesion, and the enhancement patterns of SLN were significant predictive features of ALNM. Further binary logistic regression analysis indicated that the extended range of enhancement lesion (p < 0.001) and the enhancement patterns of SLN (p < 0.001) were independent risk factors for ALNM. ROC analysis showed that the AUC of the combination of these two indicators for predicting ALNM was 0.931 (95% CI: 0.887-0.976, sensitivity: 75.0%, specificity: 99.8%). CONCLUSION The CEUS characteristics of primary lesion combined with enhancement patterns of SLN are highly valuable in predicting ALNM and can guide clinical axillary surgery decision-making in early breast cancer.
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Affiliation(s)
- Wenjing Pang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Yao Wang
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Yangyang Zhu
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Yingying Jia
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
| | - Fang Nie
- Ultrasound Medical Center, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Ultrasonography, Lanzhou, China
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Su F, Chao J, Liu P, Zhang B, Zhang N, Luo Z, Han J. Prognostic models for breast cancer: based on logistics regression and Hybrid Bayesian Network. BMC Med Inform Decis Mak 2023; 23:120. [PMID: 37443001 PMCID: PMC10347801 DOI: 10.1186/s12911-023-02224-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND To construct two prognostic models to predict survival in breast cancer patients; to compare the efficacy of the two models in the whole group and the advanced human epidermal growth factor receptor-2-positive (HER2+) subgroup of patients; to conclude whether the Hybrid Bayesian Network (HBN) model outperformed the logistics regression (LR) model. METHODS In this paper, breast cancer patient data were collected from the SEER database. Data processing and analysis were performed using Rstudio 4.2.0, including data preprocessing, model construction and validation. The L_DVBN algorithm in Julia0.4.7 and bnlearn package in R was used to build and evaluate the HBN model. Data with a diagnosis time of 2018(n = 23,384) were distributed randomly as training and testing sets in the ratio of 7:3 using the leave-out method for model construction and internal validation. External validation of the model was done using the dataset of 2019(n = 8128). Finally, the late HER2 + patients(n = 395) was selected for subgroup analysis. Accuracy, calibration and net benefit of clinical decision making were evaluated for both models. RESULTS The HBN model showed that seventeen variables were associated with survival outcome, including age, tumor size, site, histologic type, radiotherapy, surgery, chemotherapy, distant metastasis, subtype, clinical stage, ER receptor, PR receptor, clinical grade, race, marital status, tumor laterality, and lymph node. The AUCs for the internal validation of the LR and HBN models were 0.831 and 0.900; The AUCs for the external validation of the LR and HBN models on the whole population were 0.786 and 0.871; the AUCs for the external validation of the two models on the subgroup population were 0.601 and 0.813. CONCLUSION The accuracy, net clinical benefit, and calibration of the HBN model were better than LR model. The predictive efficacy of both models decreased and the difference was greater in advanced HER2 + patients, which means the HBN model had higher robustness and more stable predictive performance in the subgroup.
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Affiliation(s)
- Fan Su
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No. 87 Ding Jia Qiao, Central Gate Street, Gulou District, Nanjing, Jiangsu China
| | - Jianqian Chao
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No. 87 Ding Jia Qiao, Central Gate Street, Gulou District, Nanjing, Jiangsu China
- Department of Medical Insurance, School of Public Health, Southeast University, No. 87 Ding Jia Qiao, Central Gate Street, Gulou District, Nanjing, Jiangsu China
| | - Pei Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No. 87 Ding Jia Qiao, Central Gate Street, Gulou District, Nanjing, Jiangsu China
| | - Bowen Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No. 87 Ding Jia Qiao, Central Gate Street, Gulou District, Nanjing, Jiangsu China
| | - Na Zhang
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No. 87 Ding Jia Qiao, Central Gate Street, Gulou District, Nanjing, Jiangsu China
| | - Zongyu Luo
- Department of Medical Insurance, School of Public Health, Southeast University, No. 87 Ding Jia Qiao, Central Gate Street, Gulou District, Nanjing, Jiangsu China
| | - Jiaying Han
- Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No. 87 Ding Jia Qiao, Central Gate Street, Gulou District, Nanjing, Jiangsu China
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Nose D, Matsui T, Otsuka T, Matsuda Y, Arimura T, Yasumoto K, Sugimoto M, Miura SI. Development of Machine Learning-Based Web System for Estimating Pleural Effusion Using Multi-Frequency Bioelectrical Impedance Analyses. J Cardiovasc Dev Dis 2023; 10:291. [PMID: 37504547 PMCID: PMC10380905 DOI: 10.3390/jcdd10070291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Transthoracic impedance values have not been widely used to measure extravascular pulmonary water content due to accuracy and complexity concerns. Our aim was to develop a foundational model for a novel system aiming to non-invasively estimate the intrathoracic condition of heart failure patients. METHODS We employed multi-frequency bioelectrical impedance analysis to simultaneously measure multiple frequencies, collecting electrical, physical, and hematological data from 63 hospitalized heart failure patients and 82 healthy volunteers. Measurements were taken upon admission and after treatment, and longitudinal analysis was conducted. RESULTS Using a light gradient boosting machine, and a decision tree-based machine learning method, we developed an intrathoracic estimation model based on electrical measurements and clinical findings. Out of the 286 features collected, the model utilized 16 features. Notably, the developed model demonstrated high accuracy in discriminating patients with pleural effusion, achieving an area under the receiver characteristic curves (AUC) of 0.905 (95% CI: 0.870-0.940, p < 0.0001) in the cross-validation test. The accuracy significantly outperformed the conventional frequency-based method with an AUC of 0.740 (95% CI: 0.688-0.792, and p < 0.0001). CONCLUSIONS Our findings indicate the potential of machine learning and transthoracic impedance measurements for estimating pleural effusion. By incorporating noninvasive and easily obtainable clinical and laboratory findings, this approach offers an effective means of assessing intrathoracic conditions.
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Affiliation(s)
- Daisuke Nose
- Department of Cardiology, Fukuoka University Faculty of Medicine, Fukuoka 814-0180, Japan
- Department of Cardiology, Fukuoka Heartnet Hospital, Fukuoka 819-0002, Japan
- Research Institute for Advanced Medical Development for Heart Failure, Fukuoka University, Fukuoka 814-0180, Japan
| | - Tomokazu Matsui
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Nara 690-0101, Japan
| | - Takuya Otsuka
- Technical Sales Department, Dialysis Division, Toray Medical Company Limited, Tokyo 103-0023, Japan
| | - Yuki Matsuda
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Nara 690-0101, Japan
| | - Tadaaki Arimura
- Department of Cardiology, Fukuoka University Faculty of Medicine, Fukuoka 814-0180, Japan
| | - Keiichi Yasumoto
- Graduate School of Science and Technology, Nara Institute of Science and Technology, Nara 690-0101, Japan
| | - Masahiro Sugimoto
- Institute for Advanced Biosciences, Keio University, Tsuruoka 997-0035, Japan
- Institute of Medical Science, Tokyo Medical University, Tokyo 160-0023, Japan
| | - Shin-Ichiro Miura
- Department of Cardiology, Fukuoka University Faculty of Medicine, Fukuoka 814-0180, Japan
- Research Institute for Advanced Medical Development for Heart Failure, Fukuoka University, Fukuoka 814-0180, Japan
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Yang Y, Hu P, Chen SR, Wu WW, Chen P, Wang SW, Ma JZ, Hu JY. Predicting the Activity of Oral Lichen Planus with Glycolysis-related Molecules: A Scikit-learn-based Function. Curr Med Sci 2023:10.1007/s11596-023-2716-7. [PMID: 37115394 PMCID: PMC10141813 DOI: 10.1007/s11596-023-2716-7] [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: 11/03/2022] [Accepted: 02/09/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Oral lichen planus (OLP) is one of the most common oral mucosa diseases, and is mainly mediated by T lymphocytes. The metabolic reprogramming of activated T cells has been shown to transform from oxidative phosphorylation to aerobic glycolysis. The present study investigated the serum levels of glycolysis-related molecules (lactate dehydrogenase, LDH; pyruvic acid, PA; lactic acid, LAC) in OLP, and the correlation with OLP activity was assessed using the reticular, atrophic and erosive lesion (RAE) scoring system. METHODS Univariate and multivariate linear regression functions based on scikit-learn were designed to predict the RAE scores in OLP patients, and the performance of these two machine learning functions was compared. RESULTS The results revealed that the serum levels of PA and LAC were upregulated in erosive OLP (EOLP) patients, when compared to healthy volunteers. Furthermore, the LDH and LAC levels were significantly higher in the EOLP group than in the nonerosive OLP (NEOLP) group. All glycolysis-related molecules were positively correlated to the RAE scores. Among these, LAC had a strong correlation. The univariate function that involved the LAC level and the multivariate function that involved all glycolysis-related molecules presented comparable prediction accuracy and stability, but the latter was more time-consuming. CONCLUSION It can be concluded that the serum LAC level can be a user-friendly biomarker to monitor the OLP activity, based on the univariate function developed in the present study. The intervention of the glycolytic pathway may provide a potential therapeutic strategy.
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Affiliation(s)
- Yan Yang
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Pei Hu
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Su-Rong Chen
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei-Wei Wu
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Pan Chen
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shi-Wen Wang
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jing-Zhi Ma
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jing-Yu Hu
- Department of Stomatology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- School of Stomatology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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Silva-Aravena F, Núñez Delafuente H, Gutiérrez-Bahamondes JH, Morales J. A Hybrid Algorithm of ML and XAI to Prevent Breast Cancer: A Strategy to Support Decision Making. Cancers (Basel) 2023; 15:cancers15092443. [PMID: 37173910 PMCID: PMC10177162 DOI: 10.3390/cancers15092443] [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: 03/02/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023] Open
Abstract
Worldwide, the coronavirus has intensified the management problems of health services, significantly harming patients. Some of the most affected processes have been cancer patients' prevention, diagnosis, and treatment. Breast cancer is the most affected, with more than 20 million cases and at least 10 million deaths by 2020. Various studies have been carried out to support the management of this disease globally. This paper presents a decision support strategy for health teams based on machine learning (ML) tools and explainability algorithms (XAI). The main methodological contributions are: first, the evaluation of different ML algorithms that allow classifying patients with and without cancer from the available dataset; and second, an ML methodology mixed with an XAI algorithm, which makes it possible to predict the disease and interpret the variables and how they affect the health of patients. The results show that first, the XGBoost Algorithm has a better predictive capacity, with an accuracy of 0.813 for the train data and 0.81 for the test data; and second, with the SHAP algorithm, it is possible to know the relevant variables and their level of significance in the prediction, and to quantify the impact on the clinical condition of the patients, which will allow health teams to offer early and personalized alerts for each patient.
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Affiliation(s)
- Fabián Silva-Aravena
- Facultad de Ciencias Sociales y Económicas, Universidad Católica del Maule, Avenida San Miguel 3605, Talca 3460000, Chile
| | - Hugo Núñez Delafuente
- Doctorado en Sistemas de Ingeniería, Facultad de Ingeniería, Universidad de Talca, Camino Los Niches Km 1, Curicó 3340000, Chile
| | - Jimmy H Gutiérrez-Bahamondes
- Doctorado en Sistemas de Ingeniería, Facultad de Ingeniería, Universidad de Talca, Camino Los Niches Km 1, Curicó 3340000, Chile
| | - Jenny Morales
- Facultad de Ciencias Sociales y Económicas, Universidad Católica del Maule, Avenida San Miguel 3605, Talca 3460000, Chile
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Zhao X, Jiang C. The prediction of distant metastasis risk for male breast cancer patients based on an interpretable machine learning model. BMC Med Inform Decis Mak 2023; 23:74. [PMID: 37085843 PMCID: PMC10120176 DOI: 10.1186/s12911-023-02166-8] [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: 01/11/2023] [Accepted: 04/04/2023] [Indexed: 04/23/2023] Open
Abstract
OBJECTIVES This research was designed to compare the ability of different machine learning (ML) models and nomogram to predict distant metastasis in male breast cancer (MBC) patients and to interpret the optimal ML model by SHapley Additive exPlanations (SHAP) framework. METHODS Four powerful ML models were developed using data from male breast cancer (MBC) patients in the SEER database between 2010 and 2015 and MBC patients from our hospital between 2010 and 2020. The area under curve (AUC) and Brier score were used to assess the capacity of different models. The Delong test was applied to compare the performance of the models. Univariable and multivariable analysis were conducted using logistic regression. RESULTS Of 2351 patients were analyzed; 168 (7.1%) had distant metastasis (M1); 117 (5.0%) had bone metastasis, and 71 (3.0%) had lung metastasis. The median age at diagnosis is 68.0 years old. Most patients did not receive radiotherapy (1723, 73.3%) or chemotherapy (1447, 61.5%). The XGB model was the best ML model for predicting M1 in MBC patients. It showed the largest AUC value in the tenfold cross validation (AUC:0.884; SD:0.02), training (AUC:0.907; 95% CI: 0.899-0.917), testing (AUC:0.827; 95% CI: 0.802-0.857) and external validation (AUC:0.754; 95% CI: 0.739-0.771) sets. It also showed powerful ability in the prediction of bone metastasis (AUC: 0.880, 95% CI: 0.856-0.903 in the training set; AUC: 0.823, 95% CI:0.790-0.848 in the test set; AUC: 0.747, 95% CI: 0.727-0.764 in the external validation set) and lung metastasis (AUC: 0.906, 95% CI: 0.877-0.928 in training set; AUC: 0.859, 95% CI: 0.816-0.891 in the test set; AUC: 0.756, 95% CI: 0.732-0.777 in the external validation set). The AUC value of the XGB model was larger than that of nomogram in the training (0.907 vs 0.802) and external validation (0.754 vs 0.706) sets. CONCLUSIONS The XGB model is a better predictor of distant metastasis among MBC patients than other ML models and nomogram; furthermore, the XGB model is a powerful model for predicting bone and lung metastasis. Combining with SHAP values, it could help doctors intuitively understand the impact of each variable on outcome.
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Affiliation(s)
- Xuhai Zhao
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Cong Jiang
- Department of Breast Surgery, Harbin Medical University Cancer Hospital, Harbin, China.
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Vrdoljak J, Krešo A, Kumrić M, Martinović D, Cvitković I, Grahovac M, Vickov J, Bukić J, Božic J. The Role of AI in Breast Cancer Lymph Node Classification: A Comprehensive Review. Cancers (Basel) 2023; 15:cancers15082400. [PMID: 37190328 DOI: 10.3390/cancers15082400] [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: 03/28/2023] [Revised: 04/19/2023] [Accepted: 04/19/2023] [Indexed: 05/17/2023] Open
Abstract
Breast cancer is a significant health issue affecting women worldwide, and accurately detecting lymph node metastasis is critical in determining treatment and prognosis. While traditional diagnostic methods have limitations and complications, artificial intelligence (AI) techniques such as machine learning (ML) and deep learning (DL) offer promising solutions for improving and supplementing diagnostic procedures. Current research has explored state-of-the-art DL models for breast cancer lymph node classification from radiological images, achieving high performances (AUC: 0.71-0.99). AI models trained on clinicopathological features also show promise in predicting metastasis status (AUC: 0.74-0.77), whereas multimodal (radiomics + clinicopathological features) models combine the best from both approaches and also achieve good results (AUC: 0.82-0.94). Once properly validated, such models could greatly improve cancer care, especially in areas with limited medical resources. This comprehensive review aims to compile knowledge about state-of-the-art AI models used for breast cancer lymph node metastasis detection, discusses proper validation techniques and potential pitfalls and limitations, and presents future directions and best practices to achieve high usability in real-world clinical settings.
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Affiliation(s)
- Josip Vrdoljak
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Ante Krešo
- Department of Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumrić
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Dinko Martinović
- Department of Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Ivan Cvitković
- Department of Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marko Grahovac
- Department of Pharmacology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josip Vickov
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josipa Bukić
- Department of Pharmacy, University of Split School of Medicine, 21000 Split, Croatia
| | - Joško Božic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
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Haraguchi T, Kobayashi Y, Hirahara D, Kobayashi T, Takaya E, Nagai MT, Tomita H, Okamoto J, Kanemaki Y, Tsugawa K. Radiomics model of diffusion-weighted whole-body imaging with background signal suppression (DWIBS) for predicting axillary lymph node status in breast cancer. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2023; 31:627-640. [PMID: 37038802 DOI: 10.3233/xst-230009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND In breast cancer diagnosis and treatment, non-invasive prediction of axillary lymph node (ALN) metastasis can help avoid complications related to sentinel lymph node biopsy. OBJECTIVE This study aims to develop and evaluate machine learning models using radiomics features extracted from diffusion-weighted whole-body imaging with background signal suppression (DWIBS) examination for predicting the ALN status. METHODS A total of 100 patients with histologically proven, invasive, clinically N0 breast cancer who underwent DWIBS examination consisting of short tau inversion recovery (STIR) and DWIBS sequences before surgery were enrolled. Radiomic features were calculated using segmented primary lesions in DWIBS and STIR sequences and were divided into training (n = 75) and test (n = 25) datasets based on the examination date. Using the training dataset, optimal feature selection was performed using the least absolute shrinkage and selection operator algorithm, and the logistic regression model and support vector machine (SVM) classifier model were constructed with DWIBS, STIR, or a combination of DWIBS and STIR sequences to predict ALN status. Receiver operating characteristic curves were used to assess the prediction performance of radiomics models. RESULTS For the test dataset, the logistic regression model using DWIBS, STIR, and a combination of both sequences yielded an area under the curve (AUC) of 0.765 (95% confidence interval: 0.548-0.982), 0.801 (0.597-1.000), and 0.779 (0.567-0.992), respectively, whereas the SVM classifier model using DWIBS, STIR, and a combination of both sequences yielded an AUC of 0.765 (0.548-0.982), 0.757 (0.538-0.977), and 0.779 (0.567-0.992), respectively. CONCLUSIONS Use of machine learning models incorporating with the quantitative radiomic features derived from the DWIBS and STIR sequences can potentially predict ALN status.
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Affiliation(s)
- Takafumi Haraguchi
- Department of Advanced Biomedical Imaging and Informatics, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Yasuyuki Kobayashi
- Department of Medical Information and Communication Technology Research, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Daisuke Hirahara
- Department of Medical Information and Communication Technology Research, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
- Department of AI Research Lab, Harada Academy, Higashitaniyama, Kagoshima, Kagoshima, Japan
| | - Tatsuaki Kobayashi
- Department of Medical Information and Communication Technology Research, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Eichi Takaya
- Department of Medical Information and Communication Technology Research, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
- AI Lab, Tohoku University Hospital, Seiryomachi, Aoba-ku, Sendai, Miyagi, Japan
- School of Science for Open and Environmental Systems, Graduate School of Science and Technology, Keio University, Hiyoshi, Kohoku-ku, Yokohama, Kanagawa, Japan
| | - Mariko Takishita Nagai
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Hayato Tomita
- Department of Radiology, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Jun Okamoto
- Department of Radiology, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
| | - Yoshihide Kanemaki
- Department of Radiology, Breast and Imaging Center, St. Marianna University School of Medicine, Manpukuji, Asao-ku, Kawasaki, Kanagawa, Japan
| | - Koichiro Tsugawa
- Division of Breast and Endocrine Surgery, Department of Surgery, St. Marianna University School of Medicine, Sugao, Miyamae-ku, Kawasaki, Kanagawa, Japan
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Rodríguez-Tomàs E, Arenas M, Baiges-Gaya G, Acosta J, Araguas P, Malave B, Castañé H, Jiménez-Franco A, Benavides-Villarreal R, Sabater S, Solà-Alberich R, Camps J, Joven J. Gradient Boosting Machine Identified Predictive Variables for Breast Cancer Patients Pre- and Post-Radiotherapy: Preliminary Results of an 8-Year Follow-Up Study. Antioxidants (Basel) 2022; 11:antiox11122394. [PMID: 36552602 PMCID: PMC9774765 DOI: 10.3390/antiox11122394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 12/11/2022] Open
Abstract
Radiotherapy (RT) is part of the standard treatment of breast cancer (BC) because of its effects on relapse reduction and survival. However, response to treatment is highly variable, and some patients may develop disease progression (DP), a second primary cancer, or may succumb to the disease. Antioxidant systems and inflammatory processes are associated with the onset and development of BC and play a role in resistance to treatment. Here, we report our investigation into the clinical evolution of BC patients, and the impact of RT on the circulating levels of the antioxidant enzyme paraoxonase-1 (PON1), cytokines, and other standard biochemical and hematological variables. Gradient Boosting Machine (GBM) algorithm was used to identify predictive variables. This was a retrospective study in 237 patients with BC. Blood samples were obtained pre- and post-RT, with samples of healthy women used as control subjects. Results showed that 24 patients had DP eight years post-RT, and eight patients developed a second primary tumor. The algorithm identified interleukin-4 and total lymphocyte counts as the most relevant indices discriminating between BC patients and control subjects, while neutrophils, total leukocytes, eosinophils, very low-density lipoprotein cholesterol, and PON1 activity were potential predictors of fatal outcome.
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Affiliation(s)
- Elisabet Rodríguez-Tomàs
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43201 Reus, Spain
- Department of Radiation Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
- Correspondence: (M.A.); (J.C.); Tel.: +34-977-310-300 (ext. 54132) (M.A.); +34-977-310-300 (ext. 55409) (J.C.)
| | - Gerard Baiges-Gaya
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Johana Acosta
- Department of Radiation Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Pablo Araguas
- Department of Radiation Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Bárbara Malave
- Department of Radiation Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Helena Castañé
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Andrea Jiménez-Franco
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Rocío Benavides-Villarreal
- Department of Radiation Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Sebastià Sabater
- Department of Radiation Oncology, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43204 Reus, Spain
| | - Rosa Solà-Alberich
- Functional Nutrition, Oxidation and Cardiovascular Disease Group (NFOC-SALUT), Facultat de Medicina i Ciències de La Salut, Universitat Rovira i Virgili, 43201 Reus, Spain
| | - Jordi Camps
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43201 Reus, Spain
- Correspondence: (M.A.); (J.C.); Tel.: +34-977-310-300 (ext. 54132) (M.A.); +34-977-310-300 (ext. 55409) (J.C.)
| | - Jorge Joven
- Unitat de Recerca Biomèdica, Hospital Universitari de Sant Joan, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, 43201 Reus, Spain
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