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Radiological Investigation III: Pulmonary Angiogram and PET Scan01:13

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Radiological investigations are paramount in the diagnosis and management of various pulmonary diseases. Two essential investigations are the Pulmonary Angiogram and the Positron Emission Tomography (PET) Scan.
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A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
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From Passive Sampling to Precision Intervention: A Standardized Radiomics-Driven Workflow for Molecularly Adequate

Luca Marinelli1, Vittorio Patanè2, Riccardo Monti2

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Standardizing CT-guided lung biopsy procedures and incorporating radiomics significantly improves molecular adequacy for genetic testing. This predictive framework enhances diagnostic yield and supports interventional radiology decision-making.

Keywords:
Artificial intelligenceInterventional radiologyLung cancerPrecision oncologyRadiomics

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Area of Science:

  • Interventional Radiology
  • Oncology
  • Medical Imaging

Background:

  • Molecular adequacy is crucial for lung cancer diagnosis and treatment planning.
  • Computed tomography (CT)-guided transthoracic needle biopsy (TTNB) is a key diagnostic tool.
  • Optimizing TTNB for molecular testing requires robust predictive frameworks.

Purpose of the Study:

  • To develop and validate a predictive framework for molecular adequacy in CT-guided TTNB.
  • To integrate procedural variables and radiomic features for enhanced prediction.
  • To assess the framework's performance in a temporal validation cohort.

Main Methods:

  • Observational derivation-validation study with retrospective and prospective cohorts (670 procedures).
  • Development of a multivariable procedural model and an exploratory radiomics model.
  • Evaluation of molecular adequacy for next-generation sequencing and PD-L1 testing.
  • Performance assessment using AUC, calibration, and transportability analyses.

Main Results:

  • Overall molecular adequacy was 83.9%, with higher rates in the prospective cohort (91.2%).
  • The procedural model achieved AUCs of 0.86 (derivation) and 0.84 (validation).
  • Radiomics integration improved discrimination (AUC 0.88), especially for subsolid lesions, without increasing complications.

Conclusions:

  • Procedural standardization and radiomics integration significantly improve molecular adequacy in CT-guided lung biopsies.
  • The developed framework serves as a basis for future decision-support strategies in interventional radiology.
  • This approach enhances diagnostic yield for precision oncology.