Radiomics Approach to Prediction of Occult Mediastinal Lymph Node Metastasis of Lung Adenocarcinoma

The purpose of this study was to evaluate the prognostic impact of radiomic features from CT scans in predicting occult mediastinal lymph node (LN) metastasis of lung adenocarcinoma. A total of 492 patients with lung adenocarcinoma who underwent preoperative unenhanced chest CT were enrolled in the study. A total of 300 radiomics features quantifying tumor intensity, texture, and wavelet were extracted from the segmented entire-tumor volume of interest of the primary tumor. A radiomics signature was generated by use of the relief-based feature method and the support vector machine classification method. A ROC regression curve was drawn for the predictive performance of radiomics features. Multivariate logistic regression models based on clinicopathologic and radiomics features were compared for discriminating mediastinal LN metastasis. Clinical variables (sex, tumor diameter, tumor location) and predominant subtype were risk factors for pathologic mediastinal LN metastasis. The accuracy of radiomics signature for predicting mediastinal LN metastasis was 91.1% in ROC analysis (AUC, 0.972; sensitivity, 94.8%; specificity, 92%). Radiomics signature (Akaike information criterion [AIC] value, 80.9%) showed model fit superior to that of the clinicohistopathologic model (AIC value, 61.1%) for predicting mediastinal LN metastasis. The radiomics signature of a primary tumor based on CT scans can be used for quantitative and noninvasive prediction of occult mediastinal LN metastasis of lung adenocarcinoma.