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Predicting T790M mutation status in non-small cell lung cancer based on radiomics: A systematic review and
Hongyang Chen1,2, Bingjie Fan1,2, Mengqi Yuan3,4
1Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Background:
Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have revolutionized the prognosis for patients with EGFR-mutant lung cancer. The emergence of the T790M resistance mutation compromises the efficacy of EGFR-TKI therapy. Therefore, assessing EGFR T790M mutation status during non-small cell lung cancer (NSCLC) treatment is crucial for improving NSCLC prognosis.
Method:
PubMed, Embase, Web of Science databases, China National Knowledge Infrastructure, and Wanfang as primary sources were systematically searched up to January 1, 2026. To assess the risk of bias and study quality, we employed the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool and the Radiomics Quality Score version 2.0 (RQS). The diagnostic accuracy of radiomics for detecting T790M in NSCLC patients was evaluated by calculating the area under the curve (AUC), sensitivity, specificity, and accuracy for each study.
Results:
This meta-analysis analyzed 13 studies with 2,654 patients. The pooled AUC, sensitivity, and specificity of internal validation models were 0.91, 0.73, and 0.95, respectively. The pooled AUC, sensitivity, and specificity of external validation models were 0.81, 0.73, and 0.87, respectively. Subgroup analysis revealed that imaging examinations derived from lung and mediastinal metastases achieved the highest sensitivity (0.76; 95% CI, 0.73-0.79), whereas those based on brain metastases exhibited the highest specificity (0.95; 95% CI, 0.95-0.96). The high specificity of the lung/mediastinal models was further confirmed in external validation (0.96; 95% CI, 0.95-0.98). Compared with CT, MRI-based models demonstrated a trade-off in internal validation: lower sensitivity (0.72 vs. 0.75) but significantly higher specificity (0.96 vs. 0.80). Notably, in external validation, CT achieved superior sensitivity (0.96, 95% CI 0.94-0.99). ITK-SNAP demonstrated higher sensitivity (internal: 0.76 [95% CI, 0.73-0.79]; external: 0.76 [95% CI, 0.67-0.84]) and lower specificity (internal: 0.80 [95% CI, 0.76-0.85]; external: 0.83 [95% CI, 0.70-0.95]). When stratified by a median RQS exceeding 20, higher-scoring studies were associated with higher pooled sensitivity (0.76 [95% CI, 0.70-0.82]) but a lower specificity (0.85 [95% CI, 0.79-0.90]). While in external validation, RQS ≤ 20 demonstrated higher sensitivity (0.75 [95% CI, 0.68-0.82], P < 0.001). Integrating clinical factors with radiomics improved sensitivity but reduced specificity compared with radiomics-only models (0.79 vs. 0.72 and 0.81 vs. 0.95, respectively). A similar sensitivity-specificity trade-off was observed with standardized data processing (sensitivity: 0.76 vs. 0.72; specificity: 0.80 vs 0.95).
Conclusion:
Radiomics, as a non-invasive detection method, has demonstrated significant potential in predicting the T790M mutation status in NSCLC, showing promising clinical application prospects based on retrospective evidence. However, further standardization and validation are required in future studies.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420251130164 (CRD420251130164).
Insights
Radiomics shows promise for non-invasively detecting the T790M mutation in non-small cell lung cancer (NSCLC). Further standardization is needed, but this method could improve NSCLC treatment and prognosis.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) have transformed EGFR-mutant lung cancer treatment.
- The T790M resistance mutation limits EGFR-TKI efficacy.
- Assessing T790M status is vital for non-small cell lung cancer (NSCLC) patient outcomes.
Purpose of the Study:
- To evaluate the diagnostic accuracy of radiomics for detecting the T790M mutation in NSCLC.
- To assess the clinical utility of radiomics as a non-invasive method for T790M detection.
Main Methods:
- Systematic literature search of PubMed, Embase, Web of Science, CNKI, and Wanfang up to January 1, 2026.
- Quality assessment using QUADAS and Radiomics Quality Score (RQS) version 2.0.
- Meta-analysis of diagnostic accuracy, including AUC, sensitivity, and specificity.
Main Results:
- 13 studies with 2,654 patients were analyzed.
- Pooled AUC, sensitivity, and specificity for internal validation were 0.91, 0.73, and 0.95, respectively.
- Lung/mediastinal metastases imaging showed highest sensitivity (0.76), while brain metastases showed highest specificity (0.95). MRI demonstrated higher specificity than CT in internal validation, but CT showed superior sensitivity in external validation.
Conclusions:
- Radiomics is a promising non-invasive method for predicting T790M mutation status in NSCLC.
- The findings suggest potential clinical applications for radiomics in NSCLC management.
- Further standardization and validation are necessary for widespread adoption.
