Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Multiphase computed tomography radiomics of pancreatic intraductal papillary mucinous neoplasms to predict malignancy
Stuart L Polk, Jung W Choi, Melissa J McGettigan, Trevor Rose, Abraham Ahmed, Jongphil Kim, Kun Jiang, Yoganand Balagurunathan, Jin Qi, Paola T Farah, Alisha Rathi, Jennifer B Permuth, Daniel Jeong
Stuart L Polk, University of South Florida College of Medicine, Tampa, FL 33612, United States
Jung W Choi, Melissa J McGettigan, Trevor Rose, Abraham Ahmed, Daniel Jeong, Department of Diagnostic and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Jongphil Kim, Yoganand Balagurunathan, Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Kun Jiang, Department of Anatomic Pathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Jin Qi, Department of Cancer Physiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Paola T Farah, Department of Clinical Science, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Alisha Rathi, Department of Radiology, University of Florida, Gainesville, FL 32610, United States
Jennifer B Permuth, Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States
Author contributions: Choi JW, Rose T, Ahmed A, McGettigan M, Balagurunathan Y, Qi J, Farah P, Rathi A and Permuth JB contributed to research design and manuscript editing; Rathi A and Jeong D evaluated radiological imaging; Polk SL and Jeong D wrote the paper; all authors contributed to the manuscript content and revisions prior to submission.
Supported by National Cancer Institute of the National Institutes of Health, No. R37CA229810; and Biostatistics Core Facility at the H. Lee Moffitt Cancer Center and Research Institute, an NCI designated Comprehensive Cancer Center, No. P30-CA076292.
Institutional review board statement: The study was reviewed and approved by University of South Florida Institutional Review Board.
Informed consent statement: Based on the institutional review board approved protocol, patients were not required to give informed consent to this retrospective study because analysis used anonymized data obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to STROBE guidelines.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Daniel Jeong, MD, Associate Professor, Department of Diagnostic and Interventional Radiology, H. Lee Moffitt Cancer Center and Research Institute, 12902 USF Magnolia Dr., Tampa, FL 33612, United States. daniel.jeong@moffitt.org
Received: December 30, 2019
Peer-review started: January 8, 2020
First decision: February 28, 2020
Revised: May 9, 2020
Accepted: June 13, 2020
Article in press: June 13, 2020
Published online: June 28, 2020
Processing time: 171 Days and 21.2 Hours
ARTICLE HIGHLIGHTS
Research background
Intraductal papillary mucinous neoplasms (IPMNs) are non-invasive pancreatic precursor lesions which can potentially develop into invasive pancreatic adenocarcinoma. IPMNs are detected on up to 2.6% of all computed tomography (CT) exams, however accurate risk stratification of these lesions remains a challenge.
Research motivation
International Consensus Guidelines (ICG) provides the basis for which pancreatic IPMNs are often evaluated and risk stratified. However, previous studies show limited diagnostic accuracy of ICG criteria in predicting the presence of high grade or invasive disease within an IPMN.
Research objectives
This study aimed to evaluate the diagnostic accuracy of multiphase CT radiomics in predicting malignant vs benign IPMN histology.
Research methods
This retrospective cohort study evaluated presurgical whole lesion CT radiomics features on three contrast phases (precontrast, arterial, and venous phases) in patients who underwent surgical resection for IPMN.
Research results
Radiomic analysis showed that 18/39 precontrast, 19/39 arterial phase, and 21/39 venous phase features differentiated malignant from benign IPMNs (P < 0.05). Multivariate analysis of ICG criteria alone achieved an AUC (95%CI) of 0.817 (0.709-0.926). A combined multivariable model including conventional variables and arterial phase radiomics features achieved an AUC (95%CI) of 0.93 (0.85-1.0) with a 5-fold cross validation AUC of 0.90.
Research conclusions
Combining multiphase radiomic CT evaluation with conventional ICG criteria analysis may improve predictive capability in diagnosing malignancy in IPMNs.
Research perspectives
This study demonstrates the potential utility of whole lesion radiomics on multiphase CT as a supplementary method for predicting malignancy in IPMN. A larger prospective multi-center trial will be beneficial to further define clinical utility and to improve risk stratification in IPMN.
