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Prediction of local relapse and distant metastasis in patients with definitive chemoradiotherapy-treated cervical cancer by deep learning from [18F]-fluorodeoxyglucose positron emission tomography/computed tomography

  • Molecular Imaging
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Background

We designed a deep learning model for assessing 18F-FDG PET/CT for early prediction of local and distant failures for patients with locally advanced cervical cancer.

Methods

All 142 patients with cervical cancer underwent 18F-FDG PET/CT for pretreatment staging and received allocated treatment. To augment the amount of image data, each tumor was represented as 11 slice sets each of which contains 3 2D orthogonal slices to acquire a total of 1562 slice sets. In each round of k-fold cross-validation, a well-trained proposed model and a slice-based optimal threshold were derived from a training set and used to classify each slice set in the test set into the categories of with or without local or distant failure. The classification results of each tumor were aggregated to summarize a tumor-based prediction result.

Results

In total, 21 and 26 patients experienced local and distant failures, respectively. Regarding local recurrence, the tumor-based prediction result summarized from all test sets demonstrated that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 71%, 93%, 63%, 95%, and 89%, respectively. The corresponding values for distant metastasis were 77%, 90%, 63%, 95%, and 87%, respectively.

Conclusion

This is the first study to use deep learning model for assessing 18F-FDG PET/CT images which is capable of predicting treatment outcomes in cervical cancer patients.

Key Points

• This is the first study to use deep learning model for assessing 18 F-FDG PET/CT images which is capable of predicting treatment outcomes in cervical cancer patients.

• All 142 patients with cervical cancer underwent 18 F-FDG PET/CT for pretreatment staging and received allocated treatment. To augment the amount of image data, each tumor was represented as 11 slice sets each of which contains 3 2D orthogonal slices to acquire a total of 1562 slice sets.

• For local recurrence, all test sets demonstrated that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 71%, 93%, 63%, 95%, and 89%, respectively. The corresponding values for distant metastasis were 77%, 90%, 63%, 95%, and 87%, respectively.

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Abbreviations

18F-FDG PET/CT:

18F-fluorodeoxyglucose positron emission tomography-computed tomography

CRT:

Chemoradiotherapy

CTV:

Clinical target volume

HGRE:

High gray-level run emphasis

MTV:

Metabolic tumor volume

PLNs:

Pelvic lymph nodes

SUV:

Standardized uptake value

VOI:

Volume of interest

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Funding

This work was supported by grants from the Ministry of Health and Welfare, Taiwan (MOHW107-TDU-B-212-123004); China Medical University Hospital (DMR-107-192, CRS-106-036, CRS106-039, CRS106-040, CRS106-041); Asia University (DMR-106-150); Academia Sinica Stroke Biosignature Project (BM10701010021); MOST Clinical Trial Consortium for Stroke (MOST 107-2321-B-039-004-); Tseng-Lien Lin Foundation, Taichung, Taiwan; and Katsuzo and Kiyo Aoshima Memorial Funds, Japan. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.

Author information

Author notes

  1. Wei-Chih Shen and Shang-Wen Chen contributed equally to this work.

Authors and Affiliations

  1. Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan

    Wei-Chih Shen & Kuo-Chen Wu

  2. Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan

    Shang-Wen Chen & Ji-An Liang

  3. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Shang-Wen Chen, Yao-Ching Hung, Lian-Shung Yeh, Wei-Chun Chang & Wu-Chou Lin

  4. Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Shang-Wen Chen

  5. Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan

    Te-Chun Hsieh, Kuo-Yang Yen & Chia-Hung Kao

  6. Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan

    Te-Chun Hsieh & Kuo-Yang Yen

  7. Graduate Institute of Biomedical Sciences, School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 404, Taiwan

    Ji-An Liang & Chia-Hung Kao

  8. Department of Obstetrics and Gynecology, China Medical University Hospital, Taichung, Taiwan

    Yao-Ching Hung, Lian-Shung Yeh, Wei-Chun Chang & Wu-Chou Lin

  9. Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan

    Chia-Hung Kao

Authors
  1. Wei-Chih Shen
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Corresponding author

Correspondence to Chia-Hung Kao.

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Guarantor

The scientific guarantor of this publication is Chia-Hung Kao, MD, Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung 404, Taiwan. E-mail: d10040@mail.cmuh.org.tw; dr.kaochiahung@gmail.com

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Prof. Shang-Wen Chen) has significant statistical expertise.

Informed consent

This is a retrospective study for images’ analyses. The IRB also specifically waived the consent requirement.

Ethical approval

This study was approved by the local institutional review board (certificate numbers CMUH102-REC2-74 and DMR99-IRB-010-1).

Study subjects or cohorts overlap

This work was partially presented at NVIDIA GTC Taiwan 2018 Poster Contest.

Methodology

• Retrospective

• Diagnostic or prognostic study

• Performed at one institution

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Shen, WC., Chen, SW., Wu, KC. et al. Prediction of local relapse and distant metastasis in patients with definitive chemoradiotherapy-treated cervical cancer by deep learning from [18F]-fluorodeoxyglucose positron emission tomography/computed tomography. Eur Radiol 29, 6741–6749 (2019). https://doi.org/10.1007/s00330-019-06265-x

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  • DOI: https://doi.org/10.1007/s00330-019-06265-x

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