Panli Li1,2,3, Xiuying Wang3,4, Chongrui Xu4, Cheng Liu5, Chaojie Zheng4, Michael J Fulham3,6, Dagan Feng3,4, Lisheng Wang3,7, Shaoli Song8,9,10, Gang Huang11,12,13. 1. Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China. 2. Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 3. SJTU-USYD Joint Research Alliance for Translational Medicine, Shanghai Jiao Tong University, Shanghai, China. 4. Biomedical and Multimedia Information Technology Research Group, School of Computer Science, The University of Sydney, Sydney, NSW, 2006, Australia. 5. Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. 6. Department of Molecular Imaging, Royal Prince Alfred Hospital, Australia and Sydney Medical School, University of Sydney, Sydney, Australia. 7. Department of Automation, Shanghai Jiao Tong University, Shanghai, China. 8. Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China. shaoli-song@163.com. 9. SJTU-USYD Joint Research Alliance for Translational Medicine, Shanghai Jiao Tong University, Shanghai, China. shaoli-song@163.com. 10. Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China. shaoli-song@163.com. 11. Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine and Health Sciences, Shanghai, China. huangg@sumhs.edu.cn. 12. Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. huangg@sumhs.edu.cn. 13. SJTU-USYD Joint Research Alliance for Translational Medicine, Shanghai Jiao Tong University, Shanghai, China. huangg@sumhs.edu.cn.
Abstract
PURPOSE: Pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) is commonly accepted as the gold standard to assess outcome after NAC in breast cancer patients. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has unique value in tumor staging, predicting prognosis, and evaluating treatment response. Our aim was to determine if we could identify radiomic predictors from PET/CT in breast cancer patient therapeutic efficacy prior to NAC. METHODS: This retrospective study included 100 breast cancer patients who received NAC; there were 2210 PET/CT radiomic features extracted. Unsupervised and supervised machine learning models were used to identify the prognostic radiomic predictors through the following: (1) selection of the significant (p < 0.05) imaging features from consensus clustering and the Wilcoxon signed-rank test; (2) selection of the most discriminative features via univariate random forest (Uni-RF) and the Pearson correlation matrix (PCM); and (3) determination of the most predictive features from a traversal feature selection (TFS) based on a multivariate random forest (RF). The prediction model was constructed with RF and then validated with 10-fold cross-validation for 30 times and then independently validated. The performance of the radiomic predictors was measured in terms of area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: The PET/CT radiomic predictors achieved a prediction accuracy of 0.857 (AUC = 0.844) on the training split set and 0.767 (AUC = 0.722) on the independent validation set. When age was incorporated, the accuracy for the split set increased to 0.857 (AUC = 0.958) and 0.8 (AUC = 0.73) for the independent validation set and both outperformed the clinical prediction model. We also found a close association between the radiomic features, receptor expression, and tumor T stage. CONCLUSION: Radiomic predictors from pre-treatment PET/CT scans when combined with patient age were able to predict pCR after NAC. We suggest that these data will be valuable for patient management.
PURPOSE: Pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) is commonly accepted as the gold standard to assess outcome after NAC in breast cancerpatients. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) has unique value in tumor staging, predicting prognosis, and evaluating treatment response. Our aim was to determine if we could identify radiomic predictors from PET/CT in breast cancerpatient therapeutic efficacy prior to NAC. METHODS: This retrospective study included 100 breast cancerpatients who received NAC; there were 2210 PET/CT radiomic features extracted. Unsupervised and supervised machine learning models were used to identify the prognostic radiomic predictors through the following: (1) selection of the significant (p < 0.05) imaging features from consensus clustering and the Wilcoxon signed-rank test; (2) selection of the most discriminative features via univariate random forest (Uni-RF) and the Pearson correlation matrix (PCM); and (3) determination of the most predictive features from a traversal feature selection (TFS) based on a multivariate random forest (RF). The prediction model was constructed with RF and then validated with 10-fold cross-validation for 30 times and then independently validated. The performance of the radiomic predictors was measured in terms of area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: The PET/CT radiomic predictors achieved a prediction accuracy of 0.857 (AUC = 0.844) on the training split set and 0.767 (AUC = 0.722) on the independent validation set. When age was incorporated, the accuracy for the split set increased to 0.857 (AUC = 0.958) and 0.8 (AUC = 0.73) for the independent validation set and both outperformed the clinical prediction model. We also found a close association between the radiomic features, receptor expression, and tumor T stage. CONCLUSION: Radiomic predictors from pre-treatment PET/CT scans when combined with patient age were able to predict pCR after NAC. We suggest that these data will be valuable for patient management.
Entities:
Keywords:
Breast cancer; NAC; PET/CT; Radiomics; pCR
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