Computed tomography-based radiomics diagnostic approach for differential diagnosis between early- and late-stage pancreatic ductal adenocarcinoma

Abstract

BACKGROUND

One of the primary reasons for the dismal survival rates in pancreatic ductal adenocarcinoma (PDAC) is that most patients are usually diagnosed at late stages. There is an urgent unmet clinical need to identify and develop diagnostic methods that could precisely detect PDAC at its earliest stages.

AIM

To evaluate the potential value of radiomics analysis in the differentiation of early-stage PDAC from late-stage PDAC.

METHODS

A total of 71 patients with pathologically proved PDAC based on surgical resection who underwent contrast-enhanced computed tomography (CT) within 30 d prior to surgery were included in the study. Tumor staging was performed in accordance with the 8^th edition of the American Joint Committee on Cancer staging system. Radiomics features were extracted from the region of interest (ROI) for each patient using Analysis Kit software. The most important and predictive radiomics features were selected using Mann-Whitney U test, univariate logistic regression analysis, and minimum redundancy maximum relevance (MRMR) method. Random forest (RF) method was used to construct the radiomics model, and 10-times leave group out cross-validation (LGOCV) method was used to validate the robustness and reproducibility of the model.

RESULTS

A total of 792 radiomics features (396 from late arterial phase and 396 from portal venous phase) were extracted from the ROI for each patient using Analysis Kit software. Nine most important and predictive features were selected using Mann-Whitney U test, univariate logistic regression analysis, and MRMR method. RF method was used to construct the radiomics model with the nine most predictive radiomics features, which showed a high discriminative ability with 97.7% accuracy, 97.6% sensitivity, 97.8% specificity, 98.4% positive predictive value, and 96.8% negative predictive value. The radiomics model was proved to be robust and reproducible using 10-times LGOCV method with an average area under the curve of 0.75 by the average performance of the 10 newly built models.

CONCLUSION

The radiomics model based on CT could serve as a promising non-invasive method in differential diagnosis between early and late stage PDAC.

Keywords: Pancreatic ductal adenocarcinoma, Radiomics, Computed tomography, American Joint Committee on Cancer staging

Core Tip: Pancreatic ductal adenocarcinoma (PDAC) remains the deadliest of the common cancers, with little change in patient survival in the past several decades. One of the biggest challenges of the management of PDAC that physicians often encounter is that the early detection in high-risk individuals and the early diagnosis of patients with suspected symptoms. Precise staging of PDAC is vital not only in making treatment decisions, but also in evaluating prognosis. Radiomics, the generation of minable high throughput data through conversion of digital computed tomography (CT) or magnetic resonance imaging, allows obtaining additional insight into pancreatic tissue heterogeneity. The aim of our study was to investigate a radiomics approach for potential differentiation of early- from late-stage PDAC. In conclusion, our study demonstrated that the radiomics model based on CT could serve as a promising non-invasive method in differential diagnosis between early and late stage PDAC. Large-scale prospective cohort studies, preferably multi-center, to validate the potential value of the radiomics diagnostic approach in differentiating early from late stage PDAC are in order.