title: A new endoscopic ultrasonography image processing method to evaluate the prognosis for pancreatic cancer treated with interstitial brachytherapy.
abstract: OBJECTIVE
  To develop a fuzzy classification method to score the texture features of pancreatic cancer in endoscopic ultrasonography (EUS) images and evaluate its utility in making prognosis judgments for patients with unresectable pancreatic cancer treated by EUS-guided interstitial brachytherapy.
  
  
  METHODS
  EUS images from our retrospective database were analyzed. The regions of interest were drawn, and texture features were extracted, selected, and scored with a fuzzy classification method using a C++ program. Then, patients with unresectable pancreatic cancer were enrolled to receive EUS-guided iodine 125 radioactive seed implantation. Their fuzzy classification scores, tumor volumes, and carbohydrate antigen 199 (CA199) levels before and after the brachytherapy were recorded. The association between the changes in these parameters and overall survival was analyzed statistically.
  
  
  RESULTS
  EUS images of 153 patients with pancreatic cancer and 63 non-cancer patients were analyzed. A total of 25 consecutive patients were enrolled, and they tolerated the brachytherapy well without any complications. There was a correlation between the change in the fuzzy classification score and overall survival (Spearman test, r = 0.616, P = 0.001), whereas no correlation was found to be significant between the change in tumor volume (P = 0.663), CA199 level (P = 0.659), and overall survival. There were 15 patients with a decrease in their fuzzy classification score after brachytherapy, whereas the fuzzy classification score increased in another 10 patients. There was a significant difference in overall survival between the two groups (67 d vs 151 d, P = 0.001), but not in the change of tumor volume and CA199 level.
  
  
  CONCLUSIONS
  Using the fuzzy classification method to analyze EUS images of pancreatic cancer is feasible, and the method can be used to make prognosis judgments for patients with unresectable pancreatic cancer treated by interstitial brachytherapy.
authors.affiliation: Wei Xu, Zheng Lu, Zhen-Dong Jin, Yu-Hong Hu, Zhao-Shen Li, Department of Gastroenterology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Xu
authors.forename: Yan
authors.initials: Y
authors.lastname: Liu
authors.forename: Zheng
authors.initials: Z
authors.lastname: Lu
authors.forename: Zhen-Dong
authors.initials: ZD
authors.lastname: Jin
authors.forename: Yu-Hong
authors.initials: YH
authors.lastname: Hu
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Yu
authors.forename: Zhao-Shen
authors.initials: ZS
authors.lastname: Li
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000097:blood; D001918:Brachytherapy; D019160:Endosonography / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D017143:Fuzzy Logic; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D015295:Antigens, Tumor-Associated, Carbohydrate; C578959:carbohydrate antigen 199, human
keywords: Digital image processing; Endoscopic ultrasonography; Fuzzy classification; Interstitial brachytherapy; Pancreatic cancer; Prognosis