3133 Prognostic value of texture analysis and correlation with molecular profile in EGFR mutated/ALK rearranged advanced non-small cell lung cancer (NSCLC)

Radiologist Engagement as a Potential Barrier to the Clinical Translation of Quantitative Imaging for the Assessment of Tumor Heterogeneity

“…The two CTTA parameters reported in this study both demonstrated a statistically significant relationship with survival using the cut-off thresholds pre-determined by review of published literature and local audit. However, the levels of statistical significance we observed were lower than those reported previously [7,9]. Establishment of local cut-off thresholds could potentially improve the effectiveness of tumor heterogeneity imaging but would increase the complexity of implementation on account of the need to determine optimum local cut-off thresholds in a training cohort before introduction of the technology into clinical workflows.…”

“…The quantitative imaging method for assessing tumor heterogeneity adopted in this study was CT texture analysis (CTTA) which has been shown to be related to risk of mediastinal metastasis and overall prognosis for patients with Non-Small Cell Lung Cancer (NSCLC). The reasons for this selection were: a) the high incidence of NSCLC, b) the established role of CT in the clinical management of patients with this tumour, including routine presentation of imaging findings at the MDT meeting, c) the ability to extract heterogeneity information from images currently acquired in routine clinical practice, thereby avoiding the need for additional imaging procedures, and d) increasing research evidence for the prognostic value of CTTA in this patient population [6][7][8][9][10][11]. CTTA parameters were derived using TexRAD software (Feedback, Cambridge, UK) which implements the filtration-histogram method [15].…”

“…For lesions known to be malignant, imaging measures of heterogeneity can potentially provide correlates for biological features such as gene mutations when tissue-based assays are contra-indicated or have failed [4][5][6][7]. Heterogeneity measures may also be useful in providing an indicate of tumor aggression as illustrated by the association of heterogeneity within CT images of primary lung cancers with the likelihood of mediastinal metastases [8] and overall prognosis [6,7,[9][10][11]. Heterogeneity imaging can also potentially provide an indication of likely response to treatment.…”

Can CT measures of tumour heterogeneity stratify risk for nodal metastasis in patients with non-small cell lung cancer?

“…Furthermore, the spatial separation between sub-clones needs to be sufficiently large relative to the spatial resolution of CT (See Figure 4). The first requirement is shown to be met by radiogenomic studies demonstrating correlations between genomic aberrations and specific CT features in NSCLC and other tumours (5,(10)(11)(12)(13)(14)(15). Spatial separation of subclones has also been reported and may be sufficiently large to result in sampling error during image-guided biopsy (9).…”

Radiogenomics: bridging imaging and genomics

“…However, the first article that most resembled a conventional radiogenomics study by linking specific imaging features to specific mutations was the work of Halpenny et al, investigating the predictive value of CT radiomics for ALK rearrangements [91]. Early on, different projects selected clinically relevant mutations, like ALK [92], EGFR [93,94], and KRAS [88]), with various technical methodologies (purely correlative studies vs. predictive models [95]).…”