Skip to main content
Top
Published in: European Radiology 6/2020

01-06-2020 | Magnetic Resonance Imaging | Imaging Informatics and Artificial Intelligence

Preoperative prediction of parametrial invasion in early-stage cervical cancer with MRI-based radiomics nomogram

Authors: Tao Wang, Tingting Gao, Hua Guo, Yubo Wang, Xiaobo Zhou, Jie Tian, Liyu Huang, Ming Zhang

Published in: European Radiology | Issue 6/2020

Login to get access

Abstract

Purpose

To develop and identify a MRI-based radiomics nomogram for the preoperative prediction of parametrial invasion (PMI) in patients with early-stage cervical cancer (ECC).

Materials and methods

All 137 patients with ECC (FIGO stages IB–IIA) underwent T2WI and DWI scans before radical hysterectomy surgery. The radiomics signatures were calculated with the radiomics features which were extracted from T2WI and DWI and selected by the least absolute shrinkage and selection operation regression. The support vector machine (SVM) models were built using radiomics signatures derived from T2WI and joint T2WI and DWI respectively to evaluate the performance of radiomics signatures for distinguishing patients with PMI. A radiomics nomogram was drawn based on the radiomics signatures with a better performance, patient’s age, and pathological grade; its discrimination and calibration performances were estimated.

Results

For T2WI and joint T2WI and DWI, the radiomics signatures yielded an AUC of 0.797 (95% CI, 0.682–0.911) vs 0.946 (95% CI, 0.899–0.994), and 0.780 (95% CI, 0.641–0.920) vs 0.921 (95% CI, 0.832–1) respectively in the primary and validation cohorts. The radiomics nomogram, integrating the radiomics signatures from joint T2WI and DWI, patient’s age, and pathological grade, showed excellent discrimination, with C-index values of 0.969 (95% CI, 0.933–1) and 0.941 (95% CI, 0.868–1) in the primary and validation cohorts, respectively. The calibration curve showed a good agreement.

Conclusions

The radiomics nomogram performed well for the preoperative prediction of PMI in patients with ECC and may be used as a supplementary tool to provide individualized treatment plans for patients with ECC.

Key Points

• No previously reported study that has utilized radiomics nomogram to preoperatively predict PMI for patients with ECC.
• Radiomics model involves radiomics features extracted from joint T2WI and DWI which characterize the heterogeneity between tumors in patients with ECC.
• Radiomics nomogram can assist clinicians with individualized treatment decision-making for patients with ECC.
Appendix
Available only for authorised users
Literature
1.
go back to reference Cohen PA, Jhingran A, Oaknin A, Denny L (2019) Cervical cancer. Lancet 393:169–182CrossRef Cohen PA, Jhingran A, Oaknin A, Denny L (2019) Cervical cancer. Lancet 393:169–182CrossRef
2.
go back to reference Vanichtantikul A, Tantbirojn P, Manchana T (2017) Parametrial involvement in women with low-risk, early-stage cervical cancer. Eur J Cancer Care (Engl) 26:1–5CrossRef Vanichtantikul A, Tantbirojn P, Manchana T (2017) Parametrial involvement in women with low-risk, early-stage cervical cancer. Eur J Cancer Care (Engl) 26:1–5CrossRef
3.
go back to reference Woo S, Kim SY, Cho JY, Kim SH (2018) Apparent diffusion coefficient for prediction of parametrial invasion in cervical cancer: a critical evaluation based on stratification to a Likert scale using T2-weighted imaging. Radiol Med 123:209–216CrossRef Woo S, Kim SY, Cho JY, Kim SH (2018) Apparent diffusion coefficient for prediction of parametrial invasion in cervical cancer: a critical evaluation based on stratification to a Likert scale using T2-weighted imaging. Radiol Med 123:209–216CrossRef
4.
go back to reference Ma C, Zhang Y, Li R, Mao HL, Liu PS (2018) Risk of parametrial invasion in women with early stage cervical cancer: a meta-analysis. Arch Gynecol Obstet 297:573–580CrossRef Ma C, Zhang Y, Li R, Mao HL, Liu PS (2018) Risk of parametrial invasion in women with early stage cervical cancer: a meta-analysis. Arch Gynecol Obstet 297:573–580CrossRef
5.
go back to reference Baiocchi G, de Brot L, Faloppa CC et al (2017) Is parametrectomy always necessary in early-stage cervical cancer? Gynecol Oncol 146:16–19CrossRef Baiocchi G, de Brot L, Faloppa CC et al (2017) Is parametrectomy always necessary in early-stage cervical cancer? Gynecol Oncol 146:16–19CrossRef
6.
go back to reference Dabi Y, Willecocq C, Ballester M et al (2018) Identification of a low risk population for parametrial invasion in patients with early-stage cervical cancer. J Transl Med 16:1–9 Dabi Y, Willecocq C, Ballester M et al (2018) Identification of a low risk population for parametrial invasion in patients with early-stage cervical cancer. J Transl Med 16:1–9
7.
go back to reference Qu JR, Qin L, Li X et al (2018) Predicting parametrial invasion in cervical carcinoma (stages IB1, IB2, and IIA): diagnostic accuracy of T2-weighted imaging combined with DWI at 3 T. AJR Am J Roentgenol 210(3):677–684CrossRef Qu JR, Qin L, Li X et al (2018) Predicting parametrial invasion in cervical carcinoma (stages IB1, IB2, and IIA): diagnostic accuracy of T2-weighted imaging combined with DWI at 3 T. AJR Am J Roentgenol 210(3):677–684CrossRef
8.
go back to reference Woo S, Suh CH, Kim SY, Cho JY, Kim SH (2018) Magnetic resonance imaging for detection of parametrial invasion in cervical cancer: an updated systematic review and meta-analysis of the literature between 2012 and 2016. Eur Radiol 28:530–541CrossRef Woo S, Suh CH, Kim SY, Cho JY, Kim SH (2018) Magnetic resonance imaging for detection of parametrial invasion in cervical cancer: an updated systematic review and meta-analysis of the literature between 2012 and 2016. Eur Radiol 28:530–541CrossRef
9.
go back to reference Liu Z, Wang S, Dong D et al (2019) The applications of radiomics in precision diagnosis and treatment of oncology: opportunities and challenges. Theranostics 9:1303–1322CrossRef Liu Z, Wang S, Dong D et al (2019) The applications of radiomics in precision diagnosis and treatment of oncology: opportunities and challenges. Theranostics 9:1303–1322CrossRef
10.
go back to reference Lambin P, Rios-Velazquez E, Leijenaar R et al (2012) Radiomics: extracting more information from medical images using advanced feature analysis. Eur J Cancer 48:441–446CrossRef Lambin P, Rios-Velazquez E, Leijenaar R et al (2012) Radiomics: extracting more information from medical images using advanced feature analysis. Eur J Cancer 48:441–446CrossRef
11.
go back to reference Gillies RJ, Kinahan PE, Hricak H (2016) Radiomics: images are more than pictures, they are data. Radiology 278:563–577CrossRef Gillies RJ, Kinahan PE, Hricak H (2016) Radiomics: images are more than pictures, they are data. Radiology 278:563–577CrossRef
12.
go back to reference Becker AS, Ghafoor S, Marcon M et al (2017) MRI texture features may predict differentiation and nodal stage of cervical cancer: a pilot study. Acta Radiol Open 6(10):2058460117729574PubMedPubMedCentral Becker AS, Ghafoor S, Marcon M et al (2017) MRI texture features may predict differentiation and nodal stage of cervical cancer: a pilot study. Acta Radiol Open 6(10):2058460117729574PubMedPubMedCentral
13.
go back to reference Wang T, Gao T, Yang J et al (2019) Preoperative prediction of pelvic lymph nodes metastasis in early-stage cervical cancer using radiomics nomogram developed based on T2-weighted MRI and diffusion-weighted imaging. Eur J Radiol 114:128–135CrossRef Wang T, Gao T, Yang J et al (2019) Preoperative prediction of pelvic lymph nodes metastasis in early-stage cervical cancer using radiomics nomogram developed based on T2-weighted MRI and diffusion-weighted imaging. Eur J Radiol 114:128–135CrossRef
14.
go back to reference Li Z, Li H, Wang S et al (2018) MR-based radiomics nomogram of cervical cancer in prediction of the lymph-vascular space invasion preoperatively. J Magn Reson Imaging 49:1420–1426CrossRef Li Z, Li H, Wang S et al (2018) MR-based radiomics nomogram of cervical cancer in prediction of the lymph-vascular space invasion preoperatively. J Magn Reson Imaging 49:1420–1426CrossRef
15.
go back to reference Park JJ, Kim CK, Park SY, Park BK, Kim B (2014) Value of diffusion-weighted imaging in predicting parametrial invasion in stage IA2-IIA cervical cancer. Eur Radiol 24(5):1081–1088CrossRef Park JJ, Kim CK, Park SY, Park BK, Kim B (2014) Value of diffusion-weighted imaging in predicting parametrial invasion in stage IA2-IIA cervical cancer. Eur Radiol 24(5):1081–1088CrossRef
16.
go back to reference Napel S, Mu W, Jardim-Perassi BV, Aerts HJWL, Gillies RJ (2018) Quantitative imaging of cancer in the postgenomic era: radio(geno)mics, deep learning, and habitats. Cancer 124:4633–4649CrossRef Napel S, Mu W, Jardim-Perassi BV, Aerts HJWL, Gillies RJ (2018) Quantitative imaging of cancer in the postgenomic era: radio(geno)mics, deep learning, and habitats. Cancer 124:4633–4649CrossRef
17.
go back to reference Hsu HC, Tai YJ, Chen YL, Chiang YC, Chen CA, Cheng WF (2018) Factors predicting parametrial invasion in patients with early-stage cervical carcinomas. PLoS One 13:1–11 Hsu HC, Tai YJ, Chen YL, Chiang YC, Chen CA, Cheng WF (2018) Factors predicting parametrial invasion in patients with early-stage cervical carcinomas. PLoS One 13:1–11
18.
go back to reference Jiamset I, Hanprasertpong J (2016) Risk factors for parametrial involvement in early-stage cervical cancer and identification of patients suitable for less radical surgery. Oncol Res Treat 39:432–438CrossRef Jiamset I, Hanprasertpong J (2016) Risk factors for parametrial involvement in early-stage cervical cancer and identification of patients suitable for less radical surgery. Oncol Res Treat 39:432–438CrossRef
19.
go back to reference Kodama J, Kusumoto T, Nakamura K, Seki N, Hongo A, Hiramatsu Y (2011) Factors associated with parametrial involvement in stage IB1 cervical cancer and identification of patients suitable for less radical surgery. Gynecol Oncol 122:491–494CrossRef Kodama J, Kusumoto T, Nakamura K, Seki N, Hongo A, Hiramatsu Y (2011) Factors associated with parametrial involvement in stage IB1 cervical cancer and identification of patients suitable for less radical surgery. Gynecol Oncol 122:491–494CrossRef
20.
go back to reference Covens A, Rosen B, Murphy J et al (2002) How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol 84:145–149CrossRef Covens A, Rosen B, Murphy J et al (2002) How important is removal of the parametrium at surgery for carcinoma of the cervix? Gynecol Oncol 84:145–149CrossRef
21.
go back to reference Frumovitz M, Sun CC, Schmeler KM, et al (2009) Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer. Obstet Gynecol 114:93–99CrossRef Frumovitz M, Sun CC, Schmeler KM, et al (2009) Parametrial involvement in radical hysterectomy specimens for women with early-stage cervical cancer. Obstet Gynecol 114:93–99CrossRef
22.
go back to reference Kong TW, Kim J, Son JH et al (2016) Preoperative nomogram for prediction of microscopic parametrial infiltration in patients with FIGO stage IB cervical cancer treated with radical hysterectomy. Gynecol Oncol 142:109–114CrossRef Kong TW, Kim J, Son JH et al (2016) Preoperative nomogram for prediction of microscopic parametrial infiltration in patients with FIGO stage IB cervical cancer treated with radical hysterectomy. Gynecol Oncol 142:109–114CrossRef
23.
go back to reference Lee JY, Youm J, Kim TH et al (2014) Preoperative MRI criteria for trials on less radical surgery in stage IB1 cervical cancer. Gynecol Oncol 134:47–51CrossRef Lee JY, Youm J, Kim TH et al (2014) Preoperative MRI criteria for trials on less radical surgery in stage IB1 cervical cancer. Gynecol Oncol 134:47–51CrossRef
24.
go back to reference Woo S, Moon MH, Cho JY, Kim SH, Kim SY (2019) Diagnostic performance of MRI for assessing parametrial invasion in cervical cancer: a head-to-head comparison between oblique and true axial T2-weighted images. Korean J Radiol 20:378–384CrossRef Woo S, Moon MH, Cho JY, Kim SH, Kim SY (2019) Diagnostic performance of MRI for assessing parametrial invasion in cervical cancer: a head-to-head comparison between oblique and true axial T2-weighted images. Korean J Radiol 20:378–384CrossRef
25.
go back to reference Lee JY, Youm J, Kim JW et al (2015) Identifying a low-risk group for parametrial involvement in microscopic stage IB1 cervical cancer using criteria from ongoing studies and a new MRI criterion. BMC Cancer 15:1–7CrossRef Lee JY, Youm J, Kim JW et al (2015) Identifying a low-risk group for parametrial involvement in microscopic stage IB1 cervical cancer using criteria from ongoing studies and a new MRI criterion. BMC Cancer 15:1–7CrossRef
26.
go back to reference Reesink-Peters N, van der Velden J, Ten Hoor KA et al (2005) Preoperative serum squamous cell carcinoma antigen levels in clinical decision making for patients with early-stage cervical cancer. J Clin Oncol 23:1455–1462CrossRef Reesink-Peters N, van der Velden J, Ten Hoor KA et al (2005) Preoperative serum squamous cell carcinoma antigen levels in clinical decision making for patients with early-stage cervical cancer. J Clin Oncol 23:1455–1462CrossRef
27.
go back to reference Salvatici M, Achilarre MT, Sandri MT, Boveri S, Vanna Z, Landoni F (2016) Squamous cell carcinoma antigen (SCC-Ag) during follow-up of cervical cancer patients: role in the early diagnosis of recurrence. Gynecol Oncol 142:115–119CrossRef Salvatici M, Achilarre MT, Sandri MT, Boveri S, Vanna Z, Landoni F (2016) Squamous cell carcinoma antigen (SCC-Ag) during follow-up of cervical cancer patients: role in the early diagnosis of recurrence. Gynecol Oncol 142:115–119CrossRef
28.
go back to reference Xu F, Li Y, Fan L et al (2018) Preoperative SCC-Ag and thrombocytosis as predictive markers for pelvic lymphatic metastasis of squamous cervical cancer in early FIGO stage. J Cancer 9:1660–1666CrossRef Xu F, Li Y, Fan L et al (2018) Preoperative SCC-Ag and thrombocytosis as predictive markers for pelvic lymphatic metastasis of squamous cervical cancer in early FIGO stage. J Cancer 9:1660–1666CrossRef
29.
go back to reference Dappa E, Elger T, Hasenburg A, Düber C, Battista MJ, Hötker AM (2017) The value of advanced MRI techniques in the assessment of cervical cancer: a review. Insights Imaging 8:471–481CrossRef Dappa E, Elger T, Hasenburg A, Düber C, Battista MJ, Hötker AM (2017) The value of advanced MRI techniques in the assessment of cervical cancer: a review. Insights Imaging 8:471–481CrossRef
Metadata
Title
Preoperative prediction of parametrial invasion in early-stage cervical cancer with MRI-based radiomics nomogram
Authors
Tao Wang
Tingting Gao
Hua Guo
Yubo Wang
Xiaobo Zhou
Jie Tian
Liyu Huang
Ming Zhang
Publication date
01-06-2020
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 6/2020
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-019-06655-1

Other articles of this Issue 6/2020

European Radiology 6/2020 Go to the issue