The Case for Pancreatic Cancer Radiomics

Mayo Clinic researchers added to the growing field of evidence suggesting that CT radiomics can be used to detect signs of pancreatic ductal adenocarcinoma (PDAC) well before they are visible to radiologists, potentially allowing much earlier and more effective surgical interventions.

The researchers first extracted pancreatic cancer’s radiomics features using pre-diagnostic CTs from 155 patients who were later diagnosed with PDAC and 265 CTs from healthy patients. The pre-diagnostic CTs were performed for unrelated reasons a median of 398 days before cancer diagnosis.

They then trained and tested four different radiomics-based machine learning models using the same internal dataset (training: 292 CTs; testing: 128 CTs), with the top model identifying future pancreatic cancer patients with promising results:

  • AUC – 0.98
  • Accuracy – 92.2%
  • Sensitivity – 95.5%
  • Specificity – 90.3% 

Interestingly, the same ML model had even better specificity in follow-up tests using an independent internal dataset (n= 176; 92.6%) and an external NIH dataset (n= 80; 96.2%).

Mayo Clinic’s ML radiomics approach also significantly outperformed two radiologists, who achieved “only fair” inter-reader agreement (Cohen’s kappa 0.3) and produced far lower AUCs (rads’ 0.66 vs. ML’s 0.95 – 0.98). That’s understandable, given that these early pancreatic cancer “imaging signatures” aren’t visible to humans.

The Takeaway

Although radiomics-based pancreatic cancer detection is still immature, this and other recent studies certainly support its potential to detect early-stage pancreatic cancer while it’s treatable. 
That evidence should grow even more conclusive in the future, noting that members of this same Mayo Clinic team are operating a 12,500-patient prospective/randomized trial exploring CT-based pancreatic cancer screening.

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-- The Imaging Wire team