Abstract
Purpose
To investigate the value of radiomics features from diffusion-weighted imaging (DWI) in differentiating muscle-invasive bladder cancer (MIBC) from non-muscle-invasive bladder cancer (NMIBC).
Methods
This retrospective study included 218 pathologically confirmed bladder cancer patients (training set: 131 patients, 86 MIBC; validation set: 87 patients, 55 MIBC) who underwent DWI before biopsy through transurethral resection (TUR) between July 2014 and December 2018. Radiomics models based on DWI for discriminating state of muscle-invasive were built using random forest (RF) and all-relevant (AR) methods on the training set and were tested on validation set. Combination models based on TUR data were also built. Discrimination performances were evaluated with the area under the receiver operating characteristic (ROC) curve (AUC), accuracy, sensitivity, specificity, and F1 and F2 scores. Qualitative MRI evaluation based on morphology was performed for comparison.
Results
No significant difference was found between RF and AR models. RF model was more sensitive than TUR (0.873 vs 0.655, p = 0.019) for discriminating muscle-invasive bladder cancer. When combining RF with TUR, the sensitivity increased to 0.964, significantly higher than TUR (0.655, p < 0.001), MRI evaluation (0.764, p = 0.006), and the combination of TUR and MRI (0.836, p = 0.046). Combining RF and TUR achieved the highest accuracy of 0.897 and F2 score of 0.946.
Conclusion
Combining DWI radiomics features with TUR could improve the sensitivity and accuracy in discriminating the presence of muscle invasion in bladder cancer for clinical practice. Multicenter, prospective studies are needed to confirm our results.
Key Points
• Twenty-seven to 51% of superficial bladder cancers diagnosed by transurethral resection are upstaged to muscle-invasive at radical cystectomy, suggesting its poor sensitivity for discriminating muscle-invasive bladder cancer.
• A small subset of selected all-relevant radiomics features exhibited an equivalent performance compared to that of all the extracted features, confirming that radiomics data contained redundant or irrelevant features and that feature selection should be performed in building radiomics models.
• Combining DWI radiomics features with transurethral resection could improve in clinical practice the sensitivity and accuracy for the detection of muscle invasion in bladder cancer.
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Abbreviations
- ACC:
-
Accuracy
- AR:
-
All-relevant
- AUC:
-
Area under the receiver operating characteristic curve
- BC:
-
Bladder cancer
- CIS:
-
Carcinoma in situ
- DKI:
-
Diffusion kurtosis imaging
- DTI:
-
Diffusion tensor imaging
- DWI:
-
Diffusion-weighted imaging
- GLCM:
-
Gray-level co-occurrence matrix
- GLRLM:
-
Gray-level run length matrix
- GLSZM:
-
Gray-level size zone matrix
- ICC:
-
Intraclass correlation coefficient
- MDGini:
-
Mean Decrease in Gini index
- MIBC:
-
Muscle-invasive bladder cancer
- NGTDM:
-
Neighborhood gray-tone difference matrix
- NMIBC:
-
Non-muscle-invasive bladder cancer
- PPV:
-
Positive predictive value
- RC:
-
Radical cystectomy
- RF:
-
Random forest
- ROC:
-
Receiver operating characteristic
- SEN:
-
Sensitivity
- SPE:
-
Specificity
- TUR:
-
Transurethral resection
- VOI:
-
Volume of interest
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Acknowledgements
The authors thank their colleagues of the department of radiology of their institute.
Funding
This study has received funding by the National Natural Science Foundation of China; contract grant numbers are the following: Youth Program Nos. 81601487 and 81672514.
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The scientific guarantor of this publication is Guangyu Wu.
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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.
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Written informed consent was waived by the Institutional Review Board.
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• Retrospective
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Xu, S., Yao, Q., Liu, G. et al. Combining DWI radiomics features with transurethral resection promotes the differentiation between muscle-invasive bladder cancer and non-muscle-invasive bladder cancer. Eur Radiol 30, 1804–1812 (2020). https://doi.org/10.1007/s00330-019-06484-2
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DOI: https://doi.org/10.1007/s00330-019-06484-2