title: Combining radiomic features with a miRNA classifier may improve prediction of malignant pathology for pancreatic intraductal papillary mucinous neoplasms.
abstract: Intraductal papillary mucinous neoplasms (IPMNs) are pancreatic cancer precursors incidentally discovered by cross-sectional imaging. Consensus guidelines for IPMN management rely on standard radiologic features to predict pathology, but they lack accuracy. Using a retrospective cohort of 38 surgically-resected, pathologically-confirmed IPMNs (20 benign; 18 malignant) with preoperative computed tomography (CT) images and matched plasma-based 'miRNA genomic classifier (MGC)' data, we determined whether quantitative 'radiomic' CT features (+/- the MGC) can more accurately predict IPMN pathology than standard radiologic features 'high-risk' or 'worrisome' for malignancy. Logistic regression, principal component analyses, and cross-validation were used to examine associations. Sensitivity, specificity, positive and negative predictive value (PPV, NPV) were estimated. The MGC, 'high-risk,' and 'worrisome' radiologic features had area under the receiver operating characteristic curve (AUC) values of 0.83, 0.84, and 0.54, respectively. Fourteen radiomic features differentiated malignant from benign IPMNs (p<0.05) and collectively had an AUC=0.77. Combining radiomic features with the MGC revealed an AUC=0.92 and superior sensitivity (83%), specificity (89%), PPV (88%), and NPV (85%) than other models. Evaluation of uncertainty by 10-fold cross-validation retained an AUC>0.80 (0.87 (95% CI:0.84-0.89)). This proof-of-concept study suggests a noninvasive radiogenomic approach may more accurately predict IPMN pathology than 'worrisome' radiologic features considered in consensus guidelines.
authors: Cancer Epidemiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.|Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Jennifer B
authors: JB
authors: Permuth
authors: Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Jung
authors: J
authors: Choi
authors: Cancer Imaging and Metabolism, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Yoganand
authors: Y
authors: Balarunathan
authors: Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Jongphil
authors: J
authors: Kim
authors: Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Dung-Tsa
authors: DT
authors: Chen
authors: Biostatistics and Bioinformatics, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Lu
authors: L
authors: Chen
authors: Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Sonia
authors: S
authors: Orcutt
authors: Department of Clinical Surgery/Surgical Oncology, Palmetto Health/USC School of Medicine, Columbia, South Carolina, USA.
authors: Matthew P
authors: MP
authors: Doepker
authors: Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Kenneth
authors: K
authors: Gage
authors: Cancer Imaging and Metabolism, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.|Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Geoffrey
authors: G
authors: Zhang
authors: Cancer Imaging and Metabolism, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.|Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Kujtim
authors: K
authors: Latifi
authors: Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.|Radiation Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Sarah
authors: S
authors: Hoffe
authors: Anatomic Pathology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Kun
authors: K
authors: Jiang
authors: Anatomic Pathology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Domenico
authors: D
authors: Coppola
authors: Anatomic Pathology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Barbara A
authors: BA
authors: Centeno
authors: Anatomic Pathology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Anthony
authors: A
authors: Magliocco
authors: Cancer Imaging and Metabolism, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.|Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.
authors: Qian
authors: Q
authors: Li
authors: Department of Surgery, Division of General Surgery, University of Florida Health Sciences Center, Gainesville, Florida, USA.
authors: Jose
authors: J
authors: Trevino
authors: Department of Surgery, Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, Miami, Florida, USA.
authors: Nipun
authors: N
authors: Merchant
authors: Cancer Imaging and Metabolism, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Robert
authors: R
authors: Gillies
authors: Gastrointestinal Oncology, Moffitt Cancer Center and Research Institute, Tampa, Florida, USA.
authors: Mokenge
authors: M
authors: Malafa
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000000981:diagnostic imaging / Q000473:pathology*; D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D035683:MicroRNAs / Q000097:blood*; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D014057:Tomography, X-Ray Computed
chemical_list: D035683:MicroRNAs
keywords: miRNA; pancreas; pre-malignant lesions; radiomics; risk stratification