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Abstract
BackgroundLymph node metastasis (LNM) in gastric cancer is a very important prognostic factor affecting long-term survival. Currently, several common imaging techniques are used to evaluate the lymph node status. However, they are incapable of achieving both high sensitivity and specificity simultaneously. In order to deal with this complex issue, a new evidential reasoning (ER) based model is proposed to support diagnosis of LNM in gastric cancer.MethodsThere are 175 consecutive patients who went through multidetector computed tomography (MDCT) consecutively before the surgery. Eight indicators, which are serosal invasion, tumor classification, tumor enhancement pattern, tumor thickness, number of lymph nodes, maximum lymph node size, lymph node station and lymph node enhancement are utilized to evaluate the tumor and lymph node through CT images. All of the above indicators reflect the biological behavior of gastric cancer. An ER based model is constructed by taking the above indicators as input index. The output index determines whether LNM occurs for the patients, which is decided by the surgery and histopathology. A technique called k-fold cross-validation is used for training and testing the new model. The diagnostic capability of LNM is evaluated by receiver operating characteristic (ROC) curves. A Radiologist classifies LNM by adopting lymph node size for comparison.Results134 out of 175 cases are cases of LNM, and the remains are not. Eight indicators have statistically significant difference between the positive and negative groups. The sensitivity, specificity and AUC of the ER based model are 88.41%, 77.57% and 0.813, respectively. However, for the radiologist evaluating LNM by maximum lymph node size, the corresponding values are only 63.4%, 75.6% and 0.757. Therefore, the proposed model can obtain better performance than the radiologist. Besides, the proposed model also outperforms other machine learning methods.ConclusionsAccording to the biological behavior information of gastric cancer, the ER based model can diagnose LNM effectively and preoperatively.
Highlights
Lymph node metastasis (LNM) in gastric cancer is a very important prognostic factor affecting longterm survival
Doctors diagnose LNM empirically based on the size of lymph nodes which relies on various imaging methods, such as endoscopic ultrasound (EUS), abdominal ultrasound, multi-slice spiral computerized tomography (CT), Magnetic Resonance Imaging (MRI) and Positron Emission computed Tomography (PET)
By univariate statistical analysis, it shows that all the indicators including serosal invasion, tumor classification, tumor enhancement pattern, tumor thickness, number of lymph nodes, maximum lymph node size, lymph nodes station and Lymph node enhancement are significant different between LNM positive and negative group
Summary
Lymph node metastasis (LNM) in gastric cancer is a very important prognostic factor affecting longterm survival. Several common imaging techniques are used to evaluate the lymph node status. Lymph node metastasis (LNM) is a very important prognostic factor regarding long-term survival [2]. A few researches [9,10,11] have discussed the diagnostic capabilities of morphological characteristics in rectum cancer According to these studies, the morphological characteristics including border contour and signal intensity of lymph nodes may partly improve the diagnostic ability of metastasis. The morphological characteristics including border contour and signal intensity of lymph nodes may partly improve the diagnostic ability of metastasis These studies mainly focus on the MRI imaging in rectum cancer. We consider building a model to diagnose LNM with multiple indicators
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