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Testicular Radiomics To Predict Pathology At Time of Postchemotherapy Retroperitoneal Lymph Node Dissection for
Nikit Venishetty1, Jacob Taylor2, Yin Xi3
1Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX.
Introduction:
Testicular germ cell tumors are the most common malignancy in young adult males. Patients with metastatic disease receive standard of care chemotherapy followed by retroperitoneal lymph node dissection for residual masses >1cm. However, there is a need for better preoperative tools to discern which patients will have persistent disease after chemotherapy given low rates of metastatic germ cell tumor after chemotherapy. The purpose of this study was to use radiomics to predict which patients would have viable germ cell tumor or teratoma after chemotherapy at time of retroperitoneal lymph node dissection.
Patients And Methods:
Patients with nonseminomatous germ cell tumor undergoing postchemotherapy retroperitoneal lymph node dissection (PC-RPLND) between 2008 and 2019 were queried from our institutional database. Patients were included if prechemotherapy computed tomography (CT) scan and postchemotherapy imaging were available. Semiqualitative and quantitative features of residual masses and nodal regions of interest and radiomic feature extractions were performed by 2 board certified radiologists. Radiomic feature analysis was used to extract first order, shape, and second order statistics from each region of interest. Post-RPLND pathology was compared to the radiomic analysis using multiple t-tests.
Results:
45 patients underwent PC-RPLND at our institution, with the majority (28 patients) having stage III disease. 24 (53%) patients had teratoma on RPLND pathology, while 2 (4%) had viable germ cell tumor. After chemotherapy, 78%, 53%, and 33% of patients had cystic regions, fat stranding, and local infiltration present on imaging. After radiomic analysis, first order statistics mean, median, 90th percentile, and root mean squares were significant. Strong correlations were observed between these 4 features;a lower signal was associated with positive pathology at RPND.
Conclusions:
Testicular radiomics is an emerging tool that may help predict persistent disease after chemotherapy.
Insights
Radiomics analysis of testicular cancer imaging can predict residual disease after chemotherapy. This tool may help identify patients needing further treatment before retroperitoneal lymph node dissection.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Testicular germ cell tumors are common in young men.
- Current methods for assessing residual disease after chemotherapy can be imprecise.
- Predicting persistent disease preoperatively is crucial for treatment planning.
Purpose of the Study:
- To evaluate radiomics as a tool for predicting viable germ cell tumor or teratoma after chemotherapy.
- To identify imaging features that correlate with post-chemotherapy residual masses.
Main Methods:
- Retrospective analysis of 45 patients with nonseminomatous germ cell tumor undergoing post-chemotherapy retroperitoneal lymph node dissection.
- Extraction of radiomic features (first order, shape, second order statistics) from pre- and post-chemotherapy CT scans.
- Comparison of radiomic findings with post-RPLND pathology results.
Main Results:
- Radiomic analysis identified significant correlations between specific first-order statistics (mean, median, 90th percentile, root mean squares) and post-RPLND pathology.
- Lower signal intensity in radiomic features was associated with positive pathology (teratoma or viable germ cell tumor).
- Post-chemotherapy imaging showed cystic regions, fat stranding, and local infiltration in a majority of patients.
Conclusions:
- Testicular radiomics shows promise in predicting persistent disease after chemotherapy for germ cell tumors.
- This emerging tool may improve preoperative assessment and guide surgical decisions.
- Further research is warranted to validate radiomics in larger cohorts.
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