立体定向消融放疗治疗肺癌后局部癌症复发的检测：医生表现与放射组学评估。
Detection of Local Cancer Recurrence After Stereotactic Ablative Radiation Therapy for Lung Cancer: Physician Performance Versus Radiomic Assessment.
机构信息
Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada; Baines Imaging Research Laboratory, London Regional Cancer Program, London, Ontario, Canada.
Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada; Baines Imaging Research Laboratory, London Regional Cancer Program, London, Ontario, Canada; Department of Oncology, The University of Western Ontario, London, Ontario, Canada.
出版信息
Int J Radiat Oncol Biol Phys. 2016 Apr 1;94(5):1121-8. doi: 10.1016/j.ijrobp.2015.12.369. Epub 2015 Dec 29.
PURPOSE
Stereotactic ablative radiation therapy (SABR) is a guideline-specified treatment option for early-stage lung cancer. However, significant posttreatment fibrosis can occur and obfuscate the detection of local recurrence. The goal of this study was to assess physician ability to detect timely local recurrence and to compare physician performance with a radiomics tool.
METHODS AND MATERIALS
Posttreatment computed tomography (CT) scans (n=182) from 45 patients treated with SABR (15 with local recurrence matched to 30 with no local recurrence) were used to measure physician and radiomic performance in assessing response. Scans were individually scored by 3 thoracic radiation oncologists and 3 thoracic radiologists, all of whom were blinded to clinical outcomes. Radiomic features were extracted from the same images. Performances of the physician assessors and the radiomics signature were compared.
RESULTS
When taking into account all CT scans during the whole follow-up period, median sensitivity for physician assessment of local recurrence was 83% (range, 67%-100%), and specificity was 75% (range, 67%-87%), with only moderate interobserver agreement (κ = 0.54) and a median time to detection of recurrence of 15.5 months. When determining the early prediction of recurrence within <6 months after SABR, physicians assessed the majority of images as benign injury/no recurrence, with a mean error of 35%, false positive rate (FPR) of 1%, and false negative rate (FNR) of 99%. At the same time point, a radiomic signature consisting of 5 image-appearance features demonstrated excellent discrimination, with an area under the receiver operating characteristic curve of 0.85, classification error of 24%, FPR of 24%, and FNR of 23%.
CONCLUSIONS
These results suggest that radiomics can detect early changes associated with local recurrence that are not typically considered by physicians. This decision support system could potentially allow for early salvage therapy of patients with local recurrence after SABR.
目的
立体定向消融放疗（SABR）是早期肺癌的指南规定的治疗选择。然而，大量的治疗后纤维化可能发生，并使局部复发的检测变得模糊不清。本研究的目的是评估医生及时检测局部复发的能力，并比较医生的表现与放射组学工具。
方法和材料
45 名接受 SABR 治疗的患者（15 例局部复发与 30 例无局部复发相匹配）的治疗后 CT 扫描（n=182）被用于评估治疗反应中医生和放射组学的表现。扫描由 3 名胸部放射肿瘤学家和 3 名胸部放射科医生分别进行评分，所有医生均对临床结果不知情。从相同的图像中提取放射组学特征。比较了医生评估者和放射组学特征的表现。
结果
在考虑整个随访期间的所有 CT 扫描时，医生评估局部复发的中位敏感性为 83%（范围，67%-100%），特异性为 75%（范围，67%-87%），只有中度的观察者间一致性（κ=0.54），且复发的中位检测时间为 15.5 个月。当确定 SABR 后<6 个月内的复发早期预测时，医生将大多数图像评估为良性损伤/无复发，平均误差为 35%，假阳性率（FPR）为 1%，假阴性率（FNR）为 99%。与此同时，一个由 5 个图像外观特征组成的放射组学特征表现出出色的区分能力，ROC 曲线下面积为 0.85，分类误差为 24%，FPR 为 24%，FNR 为 23%。
结论
这些结果表明，放射组学可以检测到通常不为医生所考虑的与局部复发相关的早期变化。这种决策支持系统有可能允许在 SABR 后对局部复发的患者进行早期挽救治疗。
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