Abstract
BackgroundOur study aims to develop and validate diagnostic models of the common parotid tumors based on whole-volume CT textural image biomarkers (IBMs) in combination with clinical parameters at a single institution.MethodsThe study cohort was composed of 51 pleomorphic adenoma (PA) patients and 42 Warthin tumor (WT) patients. Clinical parameters and conventional image features were scored retrospectively and textural IBMs were extracted from CT images of arterial phase. Independent-samples t test or Chi-square test was used for evaluating the significance of the difference among clinical parameters, conventional CT image features, and textural IBMs. The diagnostic performance of univariate model and multivariate model was evaluated via receiver operating characteristic (ROC) curve and area under ROC curve (AUC).ResultsSignificant differences were found in clinical parameters (age, gender, disease duration, smoking), conventional image features (site, maximum diameter, time-density curve, peripheral vessels sign) and textural IBMs (mean, uniformity, energy, entropy) between PA group and WT group (P<0.05). ROC analysis showed that clinical parameter (age) and quantitative textural IBMs (mean, energy, entropy) were able to categorize the patients into PA group and WT group, with the AUC of 0.784, 0.902, 0.910, 0.805, respectively. When IBMs were added in clinical model, the multivariate models including age-mean and age-energy performed significantly better than the univariate models with the improved AUC of 0.940, 0.944, respectively (P<0.001).ConclusionsBoth clinical parameter and CT textural IBMs can be used for the preoperative, noninvasive diagnosis of parotid PA and WT. The diagnostic performance of textural IBM model was obviously better than that of clinical model and conventional image model in this study. While the multivariate model consisted of clinical parameter and textural IBM had the optimal diagnostic performance, which would contribute to the better selection of individualized surgery program.
Highlights
Our study aims to develop and validate diagnostic models of the common parotid tumors based on whole-volume CT textural image biomarkers (IBMs) in combination with clinical parameters at a single institution
Step 1 clinical model Univariate analysis showed the age in the Warthin tumor (WT) group was significantly older than that in the Pleomorphic adenoma (PA) group (P < 0.001)
receiver operating characteristic (ROC) analysis showed that clinical parameter and textural parameters performed well in differentiating the WT group from the PA group, and yielded the area under ROC curve (AUC) of 0.784, 0.902, 0.910, 0.805, respectively (Figs. 3, 4, Table 4)
Summary
Our study aims to develop and validate diagnostic models of the common parotid tumors based on whole-volume CT textural image biomarkers (IBMs) in combination with clinical parameters at a single institution. Pleomorphic adenoma (PA) and Warthin tumor (WT) are the two most common types of the parotid gland tumors, and the incidence of WT has been gradually increasing nowadays [1, 2]. Both of them are benign tumors, the biological characteristics and surgery programme are completely different. PA may develop into malignant tumor as a result of a delayed surgery, and postoperative recurrence of PA is very common. ECD is not quite suitable to be applied to PA, for it will increase the postoperative recurrence rate compared to PSP
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