title: An evidential reasoning based model for diagnosis of lymph node metastasis in gastric cancer.
abstract: BACKGROUND
  Lymph node metastasis (LNM) in gastric cancer is a very important prognostic factor affecting long-term survival. Currently, several common imaging techniques are used to evaluate the lymph node status. However, they are incapable of achieving both high sensitivity and specificity simultaneously. In order to deal with this complex issue, a new evidential reasoning (ER) based model is proposed to support diagnosis of LNM in gastric cancer.
  
  
  METHODS
  There are 175 consecutive patients who went through multidetector computed tomography (MDCT) consecutively before the surgery. Eight indicators, which are serosal invasion, tumor classification, tumor enhancement pattern, tumor thickness, number of lymph nodes, maximum lymph node size, lymph node station and lymph node enhancement are utilized to evaluate the tumor and lymph node through CT images. All of the above indicators reflect the biological behavior of gastric cancer. An ER based model is constructed by taking the above indicators as input index. The output index determines whether LNM occurs for the patients, which is decided by the surgery and histopathology. A technique called k-fold cross-validation is used for training and testing the new model. The diagnostic capability of LNM is evaluated by receiver operating characteristic (ROC) curves. A Radiologist classifies LNM by adopting lymph node size for comparison.
  
  
  RESULTS
  134 out of 175 cases are cases of LNM, and the remains are not. Eight indicators have statistically significant difference between the positive and negative groups. The sensitivity, specificity and AUC of the ER based model are 88.41%, 77.57% and 0.813, respectively. However, for the radiologist evaluating LNM by maximum lymph node size, the corresponding values are only 63.4%, 75.6% and 0.757. Therefore, the proposed model can obtain better performance than the radiologist. Besides, the proposed model also outperforms other machine learning methods.
  
  
  CONCLUSIONS
  According to the biological behavior information of gastric cancer, the ER based model can diagnose LNM effectively and preoperatively.
authors.forename: Zhi-Guo
authors.initials: ZG
authors.lastname: Zhou
authors.affiliation: School of Computer Science and Technology, Xidian University, Xi'an 710071, P, R, China. F63liu@163.com.
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.forename: Li-Cheng
authors.initials: LC
authors.lastname: Jiao
authors.forename: Zhi-Long
authors.initials: ZL
authors.lastname: Wang
authors.forename: Xiao-Peng
authors.initials: XP
authors.lastname: Zhang
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Wang
authors.forename: Xiao-Zhuo
authors.initials: XZ
authors.lastname: Luo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007600:Judgment; D008207:Lymphatic Metastasis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013274:Stomach Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed