Rationale and objectives: This study aimed to non-invasively predict epidermal growth factor receptor (EGFR) mutation status in patients with lung adenocarcinoma using multi-phase computed tomography (CT) radiomics features.
Materials and methods: A total of 424 patients with lung adenocarcinoma were recruited from two hospitals who underwent preoperative non-enhanced CT (NE-CT) and enhanced CT (including arterial phase CT [AP-CT], and venous phase CT [VP-CT]). Patients were divided into training (n = 297) and external validation (n = 127) cohorts according to hospital. Radiomics features were extracted from the NE-CT, AP-CT, and VP-CT images, respectively. The Wilcoxon test, correlation analysis, and simulated annealing were used for feature screening. A clinical model and eight radiomics models were established. Furthermore, a clinical-radiomics model was constructed by incorporating multi-phase CT features and clinical risk factors. Receiver operating characteristic curves were used to evaluate the predictive performance of the models.
Results: The predictive performance of multi-phase CT radiomics model (AUC of 0.925 [95% CI, 0.879-0.971] in the validation cohort) was higher than that of NE-CT, AP-CT, VP-CT, and clinical models (AUCs of 0.860 [95% CI,0.794-0.927], 0.792 [95% CI, 0.713-0.871], 0.753 [95% CI, 0.669-0.838], and 0.706 [95% CI, 0.620-0.791] in the validation cohort, respectively) (all P < 0.05). The predictive performance of the clinical-radiomics model (AUC of 0.927 [95% CI, 0.882-0.971] in the validation cohort) was comparable to that of multi-phase CT radiomics model (P > 0.05).
Conclusion: Our multi-phase CT radiomics model showed good performance in identifying the EGFR mutation status in patients with lung adenocarcinoma, which may assist personalized treatment decisions.
Keywords: Computed tomography; EGFR mutation; Lung adenocarcinoma; Non-small cell lung cancer; Radiomics.
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