Damiano Caruso1, Marta Zerunian2, Julia Daffina3, Michela Polici4, Tiziano Polidori5, Marcello Andrea Tipaldi6, Edoardo Ronconi7, Francesco Pucciarelli8, Elena Lucertini9, Michele Rossi10, Andrea Laghi11. 1. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: damiano.caruso@uniroma1.it. 2. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: marta.zerunian@uniroma1.it. 3. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: daffinajulia@gmail.com. 4. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: michela.polici@uniroma1.it. 5. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: tiziano.polidori@uniroma1.it. 6. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: tipaldi.andrea@gmail.com. 7. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: edoardo.roncon1@gmail.com. 8. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: francesco.pucciarelli@uniroma1.it. 9. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: elena.lucertini@uniroma1.it. 10. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: michele.rossi@uniroma1.it. 11. Department of Surgical Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital Via di Grottarossa 1035-1039 00189 Rome, Italy. Electronic address: andrea.laghi@uniroma1.it.
Abstract
PURPOSE: [18F]-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET/CT) has a central role in the lung nodules' characterization even if, with SUV < 2.5, percutaneous CT-guided Lung Biopsy (CTLB) is needed to assess nodule nature. In that scenario, CT Texture Analysis (CTTA) could be a non-invasive imaging biomarker. Our purpose is to test CTTA ability in differentiating malignant from benign nodules. METHOD: Patients that underwent FDG PET/CT followed by CTLB between January 2013 and December 2018 were retrospectively enrolled. Were included patients with lung nodule SUV < 2.5 and histological diagnosis. EXCLUSION CRITERIA: nodules SUV > 2.5, patients who refused CTLB or received oncological treatment before CTLB, indeterminate pathology report, CT motion artifacts. Two radiologists in consensus performed CTTA, drawing a volumetric Region of Interest of nodule with a dedicated first order TA software with and without spatial scaling filters, on preliminary CT performed for CTLB. Statistics included a comparison between malignant and benign neoplasms distribution (2-tailed T-test or Mann-Whitney test according to normal/non-normal data distribution), P-values < 0.05 were considered statistically significant. CTTA accuracy was tested with Receiver Operating Characteristics (ROC) curve. RESULTS: Form an initial population of 1178, 46 patients encountered inclusion criteria. Pathologist reported 27/46 (59%) malignant and 19/46 (41%) benign nodules. In malignant lesions CTTA showed lower Kurtosis' and higher Skewness' values (all P ≤ 0.0013 and all filtered TA P < 0.024, respectively). ROC curve showed significant Area Under the Curve for Kurtosis and Skewness (0.654 and 0.642, P < 0.001) at medium filtration. CONCLUSIONS: CTTA is a promising radiological tool to characterize benign and malignant lung nodules, even in those cases without an altered glucose metabolism.
PURPOSE:[18F]-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography (FDG PET/CT) has a central role in the lung nodules' characterization even if, with SUV < 2.5, percutaneous CT-guided Lung Biopsy (CTLB) is needed to assess nodule nature. In that scenario, CT Texture Analysis (CTTA) could be a non-invasive imaging biomarker. Our purpose is to test CTTA ability in differentiating malignant from benign nodules. METHOD:Patients that underwent FDG PET/CT followed by CTLB between January 2013 and December 2018 were retrospectively enrolled. Were included patients with lung nodule SUV < 2.5 and histological diagnosis. EXCLUSION CRITERIA: nodules SUV > 2.5, patients who refused CTLB or received oncological treatment before CTLB, indeterminate pathology report, CT motion artifacts. Two radiologists in consensus performed CTTA, drawing a volumetric Region of Interest of nodule with a dedicated first order TA software with and without spatial scaling filters, on preliminary CT performed for CTLB. Statistics included a comparison between malignant and benign neoplasms distribution (2-tailed T-test or Mann-Whitney test according to normal/non-normal data distribution), P-values < 0.05 were considered statistically significant. CTTA accuracy was tested with Receiver Operating Characteristics (ROC) curve. RESULTS: Form an initial population of 1178, 46 patients encountered inclusion criteria. Pathologist reported 27/46 (59%) malignant and 19/46 (41%) benign nodules. In malignant lesions CTTA showed lower Kurtosis' and higher Skewness' values (all P ≤ 0.0013 and all filtered TA P < 0.024, respectively). ROC curve showed significant Area Under the Curve for Kurtosis and Skewness (0.654 and 0.642, P < 0.001) at medium filtration. CONCLUSIONS:CTTA is a promising radiological tool to characterize benign and malignant lung nodules, even in those cases without an altered glucose metabolism.
Authors: Athanasios K Anagnostopoulos; Anastasios Gaitanis; Ioannis Gkiozos; Emmanouil I Athanasiadis; Sofia N Chatziioannou; Konstantinos N Syrigos; Dimitris Thanos; Achilles N Chatziioannou; Nikolaos Papanikolaou Journal: Cancers (Basel) Date: 2022-03-25 Impact factor: 6.639