An Intelligent Clinical Decision Support System for Preoperative Prediction of Lymph Node Metastasis in Gastric Cancer.
J Am Coll Radiol. 2019 Jul;16(7):952-960. doi: 10.1016/j.jacr.2018.12.017. Epub 2019 Feb 4.
Feng QX, Liu C, Qi L, Sun SW, Song Y, Yang G, Zhang YD, Liu XS.
PURPOSE: The aim of this study was to develop and validate a computational clinical decision support system (DSS) on the basis of CT radiomics features for the prediction of lymph node (LN) metastasis in gastric cancer (GC) using machine learning-based analysis.
METHODS: Clinicopathologic and CT imaging data were retrospectively collected from 490 patients who were diagnosed with GC between January 2002 and December 2016. Radiomics features were extracted from venous-phase CT images. Relevant features were selected, ranked, and modeled using a support vector machine classifier in 326 training and validation data sets. A model test was performed independently in a test set (n = 164). Finally, a head-to-head comparison of the diagnostic performance of the DSS and that of the conventional staging criterion was performed.
RESULTS: Two hundred ninety-seven of the 490 patients examined had histopathologic evidence of LN metastasis, yielding a 60.6% metastatic rate. The area under the curve for predicting LN+ was 0.824 (95% confidence interval, 0.804-0.847) for the DSS in the training and validation data and 0.764 (95% confidence interval, 0.699-0.833) in the test data. The calibration plots showed good concordance between the predicted and observed probability of LN+ using the DSS approach. The DSS was better able to predict LN metastasis than the conventional staging criterion in the training and validation data (accuracy 76.4% versus 63.5%) and in the test data (accuracy 71.3% versus 63.2%)
CONCLUSIONS: A DSS based on 13 "worrisome" radiomics features appears to be a promising tool for the preoperative prediction of LN status in patients with GC.
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