Abstract
ObjectiveTo identify imaging markers that reflect the epidermal growth factor receptor (EGFR) mutation status by comparing computed tomography (CT) imaging-based histogram features between bone metastases with and without EGFR mutation in patients with primary lung adenocarcinoma.Materials and methodsThis retrospective study included 57 patients, with pathologically confirmed bone metastasis of primary lung adenocarcinoma. EGFR mutation status of bone metastases was confirmed by gene detection. The CT imaging of the metastatic bone lesions which were obtained between June 2014 and December 2017 were collected and analyzed. A total of 42 CT imaging-based histogram features were automatically extracted. Feature selection was conducted using Student’s t-test, Mann-Whitney U test, single-factor logistic regression analysis and Spearman correlation analysis. A receiver operating characteristic (ROC) curve was plotted to compare the effectiveness of features in distinguishing between EGFR(+) and EGFR(−) groups. DeLong’s test was used to analyze the differences between the area under the curve (AUC) values.ResultsThree histogram features, namely range, skewness, and quantile 0.975 were significantly associated with EGFR mutation status. After combining these three features and combining range and skewness, we obtained the same AUC values, sensitivity and specificity. Meanwhile, the highest AUC value was achieved (AUC 0.783), which also had a higher sensitivity (0.708) and specificity (0.788). The differences between AUC values of the three features and their various combinations were statistically insignificant.ConclusionCT imaging-based histogram features of bone metastases with and without EGFR mutation in patients with primary lung adenocarcinoma were identified, and they may contribute to diagnosis and prediction of EGFR mutation status.
Highlights
In recent years, molecular targeted therapy has been widely accepted for lung adenocarcinoma, and the epidermal growth factor receptor (EGFR) gene is a vital target of lung adenocarcinoma
computed tomography (CT) imaging-based histogram features of bone metastases with and without EGFR mutation in patients with primary lung adenocarcinoma were identified, and they may contribute to diagnosis and prediction of EGFR mutation status
Our results indicated that histogram features may be helpful to diagnose and predict EGFR mutation status of metastatic bone lesions in patients with primary lung adenocarcinoma
Summary
Molecular targeted therapy has been widely accepted for lung adenocarcinoma, and the epidermal growth factor receptor (EGFR) gene is a vital target of lung adenocarcinoma. In the progression of lung adenocarcinoma, synchronous and metachronous bone metastases are a more common phenomenon, with a prevalence of 30–40% [3]. When the specimens of primary lesions are not available in patients with advanced lung adenocarcinoma, the EGFR mutation status of metastatic lesions can be analyzed to represent the primary lesions for guiding the treatment. When EGFR mutation is positive, synchronous metastatic lesions may be enlarged in size or may even increase in number in the patients receiving EGFRTKIs treatment [5]. This is a minor phenomenon, it indicates that there may be heterogeneity between the primary tumors and metastases. There are frequent changes in the gene mutation status of tumors in metachronous metastases, such as breast cancer [7, 8]
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