Radiomics analysis of F-FDG PET/CT for visceral pleural invasion in non-small cell lung cancer with pleural attachment.

AIM

This study aimed to establish and validate a preoperative model that integrates clinical factors and radiomic features from 2-[F]-fluoro-2-deoxy-D-glucose (F-FDG) positron emission tomography (PET)/computed tomography (CT) for predicting visceral pleural invasion (VPI) in non-small cell lung cancer (NSCLC) with radiological pleural attachment.

MATERIALS AND METHODS

A total of 974 NSCLC patients (408 with VPI-present and 566 with VPI-absent) were retrospectively included from two medical centres. Clinical data and PET/CT radiomic features were collected. The optimal predictors from these radiomic features were selected to create the radiomics score (Rad-score) for the PET/CT radiomics model. Significant clinical factors and Rad-scores were incorporated into a combined PET/CT radiomics-clinical model. The predictive performance of the models was assessed using receiver operating characteristic (ROC) analysis.

RESULTS

The combined PET/CT radiomics-clinical model predicted VPI status with areas under the ROC curve (AUCs) of 0.869, 0.858, and 0.863 in the training set (n=569), internal validation set (n=245), and external validation set (n=160), respectively. These were significantly higher than the AUCs of the PET/CT radiomics model, which were 0.828, 0.782, and 0.704 (all P<0.001). In patients with a maximum tumour diameter (Dmax) ≤ 3 cm (n=537) and in patients with adenocarcinoma (n=659), the AUCs of the combined model were 0.876 and 0.877, respectively. A nomogram based on the combined model was developed, with well-fitted calibration curves.

CONCLUSION

The combined PET/CT radiomics-clinical model provides an advantage in predicting VPI status in NSCLC with pleural attachment.