Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

Win, Thida; Miles, Kenneth A.; Janes, Sam M.; Ganeshan, Balaji; Shastry, Manu; Endozo, Raymondo; Meagher, Marie; Shortman, Robert I.; Wan, Simon; Kayani, Irfan; Ell, Peter J.; Groves, Ashley M.

doi:10.1158/1078-0432.ccr-12-1307

Cited by 190 publications

(159 citation statements)

References 32 publications

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“…Intratumor heterogeneity has been suggested to correlate with worse patient outcome (27)(28)(29)(30)(31)(32)(33) and to manifest on multiple spatial scales (eg, at molecular or genetic, cellular, and tissue levels). In this study, the extraction of advanced PET imaging features allowed us to assess intratumor heterogeneity quantitatively on a macroscopic tissue scale.…”

Section: Thoracic Imaging: Predicting Distant Metastasis In Lung Cancmentioning

confidence: 99%

Early-Stage Non–Small Cell Lung Cancer: Quantitative Imaging Characteristics of¹⁸F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis

Wu¹,

Aguilera²,

Shultz³

et al. 2016

Radiology

158

123

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Purpose:To identify quantitative imaging biomarkers at fluorine 18 ( 18 F) positron emission tomography (PET) for predicting distant metastasis in patients with early-stage non-small cell lung cancer (NSCLC). Materials andMethods:In this institutional review board-approved HIPAA-compliant retrospective study, the pretreatment 18 F fluorodeoxyglucose PET images in 101 patients treated with stereotactic ablative radiation therapy from 2005 to 2013 were analyzed. Data for 70 patients who were treated before 2011 were used for discovery purposes, while data from the remaining 31 patients were used for independent validation. Quantitative PET imaging characteristics including statistical, histogram-related, morphologic, and texture features were analyzed, from which 35 nonredundant and robust features were further evaluated. Cox proportional hazards regression model coupled with the least absolute shrinkage and selection operator was used to predict distant metastasis. Whether histologic type provided complementary value to imaging by combining both in a single prognostic model was also assessed. Results:The optimal prognostic model included two image features that allowed quantification of intratumor heterogeneity and peak standardized uptake value. In the independent validation cohort, this model showed a concordance index of 0.71, which was higher than those of the maximum standardized uptake value and tumor volume, with concordance indexes of 0.67 and 0.64, respectively. The prognostic model also allowed separation of groups with low and high risk for developing distant metastasis (hazard ratio, 4.8; P = .0498, log-rank test), which compared favorably with maximum standardized uptake value and tumor volume (hazard ratio, 1.5 and 2.0, respectively; P = .73 and 0.54, log-rank test, respectively). When combined with histologic types, the prognostic power was further improved (hazard ratio, 6.9; P = .0289, log-rank test; and concordance index, 0.80). Conclusion:PET imaging characteristics associated with distant metastasis that could potentially help practitioners to tailor appropriate therapy for individual patients with earlystage NSCLC were identified.q RSNA, 2016

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Section: Thoracic Imaging: Predicting Distant Metastasis In Lung Cancmentioning

confidence: 99%

Early-Stage Non–Small Cell Lung Cancer: Quantitative Imaging Characteristics of¹⁸F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis

Wu¹,

Aguilera²,

Shultz³

et al. 2016

Radiology

158

123

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“…Features were selected to cover the diverse range of features that have been used in previous texture feature studies using CT images of NSCLC. [6][7][8]10,11,[13][14][15]17,31,32 The features were all calculated using the open-source Imaging Biomarker EXplorer () software, which is available for download at http://bit.ly/ IBEX_MDAnderson. 33 Selected features included first-order descriptors from the intensity histogram (Hist); secondorder features to describe spatial relationships in gray level intensities from the co-occurrence matrix (COM), 17,34 runlength matrix (RLM), 35 and neighborhood gray-tone difference matrix (NGTDM); 36 and Laplacian of Gaussian (LoG) filtered features, which can highlight tumor characteristics not visible in the original image.…”

Section: C Texture Features and Preprocessingmentioning

confidence: 99%

Can radiomics features be reproducibly measured from CBCT images for patients with non‐small cell lung cancer?

et al. 2015

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Purpose: Increasing evidence suggests radiomics features extracted from computed tomography (CT) images may be useful in prognostic models for patients with nonsmall cell lung cancer (NSCLC). This study was designed to determine whether such features can be reproducibly obtained from cone-beam CT (CBCT) images taken using medical Linac onboard-imaging systems in order to track them through treatment. Methods: Test-retest CBCT images of ten patients previously enrolled in a clinical trial were retrospectively obtained and used to determine the concordance correlation coefficient (CCC) for 68 different texture features. The volume dependence of each feature was also measured using the Spearman rank correlation coefficient. Features with a high reproducibility (CCC > 0.9) that were not due to volume dependence in the patient test-retest set were further examined for their sensitivity to differences in imaging protocol, level of scatter, and amount of motion by using two phantoms. The first phantom was a texture phantom composed of rectangular cartridges to represent different textures. Features were measured from two cartridges, shredded rubber and dense cork, in this study. The texture phantom was scanned with 19 different CBCT imagers to establish the features' interscanner variability. The effect of scatter on these features was studied by surrounding the same texture phantom with scattering material (rice and solid water). The effect of respiratory motion on these features was studied using a dynamic-motion thoracic phantom and a specially designed tumor texture insert of the shredded rubber material. The differences between scans acquired with different Linacs and protocols, varying amounts of scatter, and with different levels of motion were compared to the mean intrapatient difference from the test-retest image set. Results: Of the original 68 features, 37 had a CCC >0.9 that was not due to volume dependence. When the Linac manufacturer and imaging protocol were kept consistent, 4-13 of these 37 features passed our criteria for reproducibility more than 50% of the time, depending on the manufacturerprotocol combination. Almost all of the features changed substantially when scatter material was added around the phantom. For the dense cork, 23 features passed in the thoracic scans and 11 features passed in the head scans when the differences between one and two layers of scatter were compared. Using the same test for the shredded rubber, five features passed the thoracic scans and eight features passed the head scans. Motion substantially impacted the reproducibility of the features. With 4 mm of motion, 12 features from the entire volume and 14 features from the center slice measurements were reproducible. With 6-8 mm of motion, three features (Laplacian of Gaussian filtered kurtosis, gray-level nonuniformity, and entropy), from the entire volume and seven features (coarseness, high gray-level run emphasis, gray-level nonuniformity, sum-average, information measure correlation, scaled mean, and entropy) from ...

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“…Consequently this can be of use in guiding further treatment and predicting survival in cancer patients (6,7,9).…”

Section: Discussionmentioning

confidence: 99%

“…Treatment response is evaluated in order to determine the therapeutic effect and to modify the treatment regimen when progressive disease is observed in a variety of cancers. Heterogeneous radiological response (HRR) among tumor lesions, where certain lesions decrease in size or disappear and other lesions increase in size, is usually observed following chemotherapy or radiation treatment in cancer patients and is estimated to occur in 15-36% of cancer cases (6,7). With advances in high-throughput technologies, such as next-generation sequencing, intra-or inter-tumoral genomic heterogeneity has been highlighted in the area of molecular oncology and can improve our understanding of this response (8).…”

Section: Introductionmentioning

confidence: 99%

Interpretation of a heterogeneous radiological response as tumor heterogeneity or a non-tumor diagnosis: A case report

Ryu

Kim

et al. 2015

Oncology Letters

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Abstract. Heterogeneous radiological responses (HRRs) among tumor lesions are usually observed following chemotherapy or radiation treatment in cancer patients. When HRR is observed after chemotherapy or radiation treatment, a change in anticancer treatment is recommended due to the clinically high suspicion of resistance in the majority of cases. The present study reports the case report of a patient with limited-stage small cell lung cancer, diagnosed by bronchoscopy, who received concurrent chemoradiation therapy. Upon response evaluation, the majority of lesions irradiated had nearly completely disappeared following treatment, but one lesion had apparently increased in size. For histological confirmation, a percutaneous needle biopsy for the lesion was performed, however, non-specific necrosis was found and the results were inconclusive for the differentiation of other causes from tumor necrosis. Several acid-fast bacilli were identified on Ziehl-Neelsen staining for the differential diagnosis. This case suggests that a non-tumor diagnosis should be considered when HRR presents after treatment that is expected to result in a higher response rate, particularly in tuberculosis endemic areas.

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Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

Cited by 190 publications

References 32 publications

Early-Stage Non–Small Cell Lung Cancer: Quantitative Imaging Characteristics of¹⁸F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis

Early-Stage Non–Small Cell Lung Cancer: Quantitative Imaging Characteristics of¹⁸F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis

Can radiomics features be reproducibly measured from CBCT images for patients with non‐small cell lung cancer?

Interpretation of a heterogeneous radiological response as tumor heterogeneity or a non-tumor diagnosis: A case report

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Tumor Heterogeneity and Permeability as Measured on the CT Component of PET/CT Predict Survival in Patients with Non–Small Cell Lung Cancer

Cited by 190 publications

References 32 publications

Early-Stage Non–Small Cell Lung Cancer: Quantitative Imaging Characteristics of18F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis

Early-Stage Non–Small Cell Lung Cancer: Quantitative Imaging Characteristics of18F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis

Can radiomics features be reproducibly measured from CBCT images for patients with non‐small cell lung cancer?

Interpretation of a heterogeneous radiological response as tumor heterogeneity or a non-tumor diagnosis: A case report

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Early-Stage Non–Small Cell Lung Cancer: Quantitative Imaging Characteristics of¹⁸F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis

Early-Stage Non–Small Cell Lung Cancer: Quantitative Imaging Characteristics of¹⁸F Fluorodeoxyglucose PET/CT Allow Prediction of Distant Metastasis