Abstract
How to differentiate with MRI-based techniques testicular germ (TGCTs) and testicular non-germ cell tumors (TNGCTs) is still under debate and Radiomics may be the turning key. Our purpose is to investigate the performance of MRI-based Radiomics signatures for the preoperative prediction of testicular neoplasm histology. The aim is twofold: (i), differentiating TGCTs and TNGCTs status and (ii) differentiating seminomas (SGCTs) from non-seminomatous (NSGCTs). Forty-two patients with pathology-proven testicular neoplasms and referred for pre-treatment MRI, were retrospectively enrolled. Thirty-two out of 44 lesions were TGCTs. Twelve out of 44 were TNGCTs or other histologies. Two radiologists segmented the volume of interest on T2-weighted images. Approximately 500 imaging features were extracted. Least Absolute Shrinkage and Selection Operator (LASSO) was applied as method for variable selection. A linear model and a linear support vector machine (SVM) were trained with selected features to assess discrimination scores for the two endpoints. LASSO identified 3 features that were employed to build fivefold validated linear discriminant and linear SVM classifiers for the TGCT-TNGCT endpoint giving an overall accuracy of 89%. Four features were employed to build another SVM for the SGCT-SNGCT endpoint with an overall accuracy of 86%. The data obtained proved that T2-weighted-based Radiomics is a promising tool in the diagnostic workup of testicular neoplasms by discriminating germ cell from non-gem cell tumors, and seminomas from non-seminomas.
Highlights
testicular non-germ cell tumors (TNGCTs) Testicular non germ cell tumor true positive rate (TPR) True positive rate US Ultrasonography VD Volume density VFDI Volume fraction difference between 10 and 90% Intensity VOI Volume of interest
In the pool of features identified by Least Absolute Shrinkage and Selection Operator (LASSO) and after evaluating the correlations with spearman ρ we identified 3 features for the association with testicular germ cell tumors (TGCTs)-TNGCT discrimination endpoint and 4 features for the SGCT-non-seminomatous germ cell tumors (NSGCTs) status
VD, Area density (AD), Quartile coefficient of dispersion and energy were identified by LASSO to discriminate the SGCT-NSGCT status
Summary
TNGCT Testicular non germ cell tumor TPR True positive rate US Ultrasonography VD Volume density VFDI Volume fraction difference between 10 and 90% Intensity VOI Volume of interest. There has been a steady worldwide increase in the incidence of testicular cancer[1] The majority of these tumors are the testicular germ cell tumors (TGCTs), which are divided into two broad classes: seminomatous (SGCTs) and non-seminomatous germ cell tumors (NSGCTs). Previous studies have underlined the role of qualitative radiological assessment based on T1- and T2-weighted MR images that help to differentiate between seminomas and nonseminomatous tumors[7] These studies have been further supported by quantitative investigation on diffusion weighted imaging (DWI) which have reported similar accuracy in discriminating SGCT–NSGCT statu[8,9]; current existing data do not unequivocally support the role of DWI in being able to differentiate TGCT from testicular non-germ cell tumors (TNGCT)[10]. Our findings show that in this field, MRI and Radiomics together allow accurate characterization of testicular lesions, successfully guiding clinical decision-making
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