Article ; Online: Functional 4-D clustering for characterizing intratumor heterogeneity in dynamic imaging: evaluation in FDG PET as a prognostic biomarker for breast cancer.
European journal of nuclear medicine and molecular imaging
2021 Volume 48, Issue 12, Page(s) 3990–4001
Abstract: Purpose: Probe-based dynamic (4-D) imaging modalities capture breast intratumor heterogeneity ... clinical decision making.: Methods: We propose an unsupervised clustering algorithm for 4-D imaging ... intratumor heterogeneity. We applied this to dynamic FDG PET scans by identifying distinct time-activity ...
Abstract | Purpose: Probe-based dynamic (4-D) imaging modalities capture breast intratumor heterogeneity both spatially and kinetically. Characterizing heterogeneity through tumor sub-populations with distinct functional behavior may elucidate tumor biology to improve targeted therapy specificity and enable precision clinical decision making. Methods: We propose an unsupervised clustering algorithm for 4-D imaging that integrates Markov-Random Field (MRF) image segmentation with time-series analysis to characterize kinetic intratumor heterogeneity. We applied this to dynamic FDG PET scans by identifying distinct time-activity curve (TAC) profiles with spatial proximity constraints. We first evaluated algorithm performance using simulated dynamic data. We then applied our algorithm to a dataset of 50 women with locally advanced breast cancer imaged by dynamic FDG PET prior to treatment and followed to monitor for disease recurrence. A functional tumor heterogeneity (FTH) signature was then extracted from functionally distinct sub-regions within each tumor. Cross-validated time-to-event analysis was performed to assess the prognostic value of FTH signatures compared to established histopathological and kinetic prognostic markers. Results: Adding FTH signatures to a baseline model of known predictors of disease recurrence and established FDG PET uptake and kinetic markers improved the concordance statistic (C-statistic) from 0.59 to 0.74 (p = 0.005). Unsupervised hierarchical clustering of the FTH signatures identified two significant (p < 0.001) phenotypes of tumor heterogeneity corresponding to high and low FTH. Distributions of FDG flux, or Ki, were significantly different (p = 0.04) across the two phenotypes. Conclusions: Our findings suggest that imaging markers of FTH add independent value beyond standard PET imaging metrics in predicting recurrence-free survival in breast cancer and thus merit further study. |
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MeSH term(s) | Biomarkers ; Breast Neoplasms/diagnostic imaging ; Cluster Analysis ; Female ; Fluorodeoxyglucose F18 ; Humans ; Neoplasm Recurrence, Local ; Positron-Emission Tomography ; Prognosis |
Chemical Substances | Biomarkers ; Fluorodeoxyglucose F18 (0Z5B2CJX4D) |
Language | English |
Publishing date | 2021-03-07 |
Publishing country | Germany |
Document type | Journal Article ; Research Support, N.I.H., Extramural |
ZDB-ID | 8236-3 |
ISSN | 1619-7089 ; 0340-6997 ; 1619-7070 |
ISSN (online) | 1619-7089 |
ISSN | 0340-6997 ; 1619-7070 |
DOI | 10.1007/s00259-021-05265-8 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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