Abstract
BackgroundThe purpose of this study was to investigate the role of CT radiomics features combined with a support vector machine (SVM) model in potentially differentiating pelvic rhabdomyosarcoma (RMS) from yolk sac tumors (YSTs) in children.MethodsA total of 94 patients with RMS (n = 49) and YSTs (n = 45) were enrolled. Non-enhanced phase (NP), arterial phase (AP), and venous phase (VP) images were retrieved for analysis. The volumes of interest (VOIs) were constructed by segmenting tumor regions on CT images to extract radiomics features. Datasets were randomly divided into two sets including a training set and a test set. In the training set, the least absolute shrinkage and selection operator (LASSO) algorithm was used to screen out the optimal radiomics features that could distinguish RMS from YSTs, and the features were combined with the SVM algorithm to build the classifier model. In the testing set, the areas under the receiver operating characteristic (ROC) curves (AUCs), accuracy, specificity, and sensitivity of the model were calculated to evaluate its diagnostic performance. The clinical factors (including age, sex, tumor site, tumor volume, AFP level) were collected.ResultsIn total, 1,321 features were extracted from the NP, AP, and VP images. The LASSO regression algorithm was used to screen out 23, 26, and 17 related features, respectively. Subsequently, to prevent model overfitting, the 10 features with optimal correlation coefficients were retained. The SVM classifier achieved good diagnostic performance. The AUCs of the NP, AP, and VP radiomics models were 0.937 (95% CI: 0.862, 0.978), 0.973 (95% CI: 0.913, 0.996), and 0.855 (95% CI: 0.762, 0.922) in the training set, respectively, which were confirmed in the test set by AUCs of 0.700 (95% CI: 0.328, 0.940), 0.800 (95% CI: 0.422, 0.979), and 0.750 (95% CI: 0.373, 0.962), respectively. The difference in sex, tumor volume, and AFP level were statistically significant (P < 0.05).ConclusionsThe CT-based radiomics model can be used to effectively distinguish RMS and YST, and combined with clinical features, which can improve diagnostic accuracy and increase the confidence of radiologists in the diagnosis of pelvic solid tumors in children.
Highlights
The purpose of this study was to investigate the role of CT radiomics features combined with a support vector machine (SVM) model in potentially differentiating pelvic rhabdomyosarcoma (RMS) from yolk sac tumors (YSTs) in children
YSTs are more sensitive to preoperative neoadjuvant chemotherapy than RMS, which are mainly treated by neoadjuvant chemotherapy combined with the surgery
The area under the ROC curve (AUC) of the non-enhanced phase (NP), arterial phase (AP), and venous phase (VP) radiomics models were 0.937, 0.973, and 0.855 in the training set, respectively, which were confirmed in the test set by AUCs of 0.700, 0.800, and 0.750, respectively (Figure 3)
Summary
The purpose of this study was to investigate the role of CT radiomics features combined with a support vector machine (SVM) model in potentially differentiating pelvic rhabdomyosarcoma (RMS) from yolk sac tumors (YSTs) in children. RMS has the general radiological appearance of soft tissue tumors, making it difficult to distinguish from other soft tissue malignancies [4]. During the course of routine radiology diagnosis, 54% (20/37) of RMS cases in this study were misdiagnosed as yolk sac tumor (YST) or were difficult to distinguish from YST. RMS in the pelvis of children can be misdiagnosed as YST, which is the most common tumor among pelvic germ cell tumors [5]. If a pelvic mass is present, RMS should be considered only when a laboratory examination of alpha fetoprotein (AFP) is used to exclude the mass as a germ cell tumor. Studies on new radiological methods to effectively identify the two tumors are essential for accurate treatment and assessments of patient prognosis
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