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  • 2022-RA-767-ESGO Machine learning to implement the accuracy of magnetic resonance imaging (MRI) in the detection of lymph node metastasis in patients with locally advance cervical cancer treated with neoadjuvant chemotherapy

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Diagnostics
2022-RA-767-ESGO Machine learning to implement the accuracy of magnetic resonance imaging (MRI) in the detection of lymph node metastasis in patients with locally advance cervical cancer treated with neoadjuvant chemotherapy
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  1. Francesca Arezzo1,
  2. Vera Loizzi2,
  3. Gerardo Cazzato3,
  4. Michele Mongelli4,
  5. Nicola Di Lillo4,
  6. Erica Silvestris5,
  7. Claudio Lombardi4 and
  8. Gennaro Cormio6
  1. 1Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, Bari, Italy
  2. 2Interdisciplinar Department of Medicine, Obstetrics and Gynecology Unit, University of Bari ‘Aldo Moro’, Bari, Italy
  3. 3Department of Emergency and Organ Transplantation, Pathology Section, University of Bari ‘Aldo Moro’, Bari, Italy
  4. 4Department of Biomedical Sciences and Human Oncology, Obstetrics and Gynecology Unit, University of Bari ‘Aldo Moro’, Bari, Italy
  5. 5Gynecologic Oncology Unit, IRCCS Istituto Tumori ‘Giovanni Paolo II’, Bari, Italy
  6. 6Gynecologic Oncology Unit, IRCCS Istituto Tumori ‘Giovanni Paolo II’, Interdisciplinar Department of Medicine, University of Bari ‘Aldo Moro’, Bari, Italy

Abstract

Introduction/Background Concurrent cisplatin-based chemotherapy and radiotherapy plus brachytherapy is standard treatment for locally advanced cervical cancer (LACC). Platinum-based neoadjuvant chemotherapy (NACT) followed by radical hysterectomy is an alternative approach reserves for patients with stage IB2-IIB disease. Therefore the correct pre-treatment staging is essential to the proper management of this disease. Pelvic magnetic resonance imaging (MRI) is the gold standard examination but studies about MRI accuracy in the detection of lymph node metastasis in LACC patients show conflicting data. Machine learning (ML) is emerging as a promising tool for unraveling complex non-linear relationships between patient attributes that cannot be solved by traditional statistical methods. Here we investigated whether ML might improve the accuracy of MRI in the detection of lymph node metastasis in LACC patients.

Methodology We analyzed retrospectively LACC patients who underwent NACT and radical hysterectomy from 2014 to 2020. Demographic, clinical and MRI characteristics before and after NACT were collected, as well as information about post-surgery histopathology. Random features elimination wrapper was used to determine an attribute core set. A ML algorithm,namely Extreme Gradient Boosting(XGBoost) was trained and validated with 10-fold cross-validation.The performances of the algorithm were assessed.

Abstract 2022-RA-767-ESGO Figure 1
Abstract 2022-RA-767-ESGO Figure 1

Panel A. Feature importance of the attribute coreset. Panel B. ROC curve for XGBoost algorithm

Results Our analysis included n.92 patients. FIGO stage was IB2 in n.4/92(4.3%), IB3 in n.42/92(45%), IIA1 in n.1/92(1.1%), IIA2 in n.16/92(17.4%) and IIB in n.29/92(31.5%). Despite detected neither at pre-treatment and post-treatment MRI in any patients, lymph node metastasis occurred in n.16/92(17%)patients.The attribute core set used to train ML algorithms included grading, histotypes, age, parity, largest diameter of lesion at either pre and post-treatment MRI,presence/absence of fornix infiltration at pre-treatment MRI and FIGO stage(Figure1-PanelA). XGBoost showed a good performance(accuracy 89%, precision 83%, recall 78%, AUROC 0.79, Figure 2-PanelB).

Conclusion We developed an accurate model to predict lymph node metastasis in LACC patients in NACT,based on a ML algorithm requiring few easy-to-collect attributes.

https://doi.org/10.1136/ijgc-2022-ESGO.160

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