Development and Validation of a 18F-FDG PET-Based Radiomic Model for Evaluating Hypermetabolic Mediastinal-Hilar Lymph Nodes in Non-Small-Cell Lung Cancer

Ming-Li Ouyang; Yi-Ran Wang; Qing-Shan Deng; Ye-Fei Zhu; Zhen-Hua Zhao; Ling Wang; Liang-Xing Wang; Kun Tang

doi:10.3389/fonc.2021.710909

Development and Validation of a ¹⁸F-FDG PET-Based Radiomic Model for Evaluating Hypermetabolic Mediastinal-Hilar Lymph Nodes in Non-Small-Cell Lung Cancer

Front Oncol. 2021 Sep 8:11:710909. doi: 10.3389/fonc.2021.710909. eCollection 2021.

Authors

Ming-Li Ouyang¹, Yi-Ran Wang², Qing-Shan Deng³, Ye-Fei Zhu⁴, Zhen-Hua Zhao⁵, Ling Wang⁶, Liang-Xing Wang¹, Kun Tang⁶

Affiliations

¹ Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
² Department of Medical Engineering, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
³ Department of Radiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
⁴ Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China.
⁵ Department of Radiology, Shaoxing People's Hospital, Shaoxing Hospital of Zhejiang University, Shaoxing, China.
⁶ Department of Nuclear Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.

Abstract

Background: Accurate evaluation of lymph node (LN) status is critical for determining the treatment options in patients with non-small cell lung cancer (NSCLC). This study aimed to develop and validate a ¹⁸F-FDG PET-based radiomic model for the identification of metastatic LNs from the hypermetabolic mediastinal-hilar LNs in NSCLC.

Methods: We retrospectively reviewed 259 patients with hypermetabolic LNs who underwent pretreatment ¹⁸F-FDG PET/CT and were pathologically confirmed as NSCLC from two centers. Two hundred twenty-eight LNs were allocated to a training cohort (LN = 159) and an internal validation cohort (LN = 69) from one center (7:3 ratio), and 60 LNs were enrolled to an external validation cohort from the other. Radiomic features were extracted from LNs of PET images. A PET radiomics signature was constructed by multivariable logistic regression after using the least absolute shrinkage and selection operator (LASSO) method with 10-fold cross-validation. The PET radiomics signature (model 1) and independent predictors from CT image features and clinical data (model 2) were incorporated into a combined model (model 3). A nomogram was plotted for the complex model, and the performance of the nomogram was assessed by its discrimination, calibration, and clinical usefulness.

Results: The area under the curve (AUC) values of model 1 were 0.820, 0.785, and 0.808 in the training, internal, and external validation cohorts, respectively, showing good diagnostic efficacy for lymph node metastasis (LNM). Furthermore, model 2 was able to discriminate metastatic LNs in the training (AUC 0.780), internal (AUC 0.794), and external validation cohorts (AUC 0.802), respectively. Model 3 showed optimal diagnostic performance among the three cohorts, with an AUC of 0.874, 0.845, and 0.841, respectively. The nomogram based on the model 3 showed good discrimination and calibration.

Conclusions: Our study revealed that PET radiomics signature, especially when integrated with CT imaging features, showed the ability to identify true and false positives of mediastinal-hilar LNM detected by PET/CT in patients with NSCLC, which would help clinicians to make individual treatment decisions.

Keywords: hypermetabolic lymph node; metastasis; non-small cell lung cancer (NSCLC); positron emission tomography/computed tomography (PET/CT); radiomics.