Noninvasive Prediction of Occult Peritoneal Metastasis in Gastric Cancer Using Deep Learning | Gastroenterology | JAMA Network Open | JAMA Network
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    Original Investigation
    Imaging
    January 5, 2021

    Noninvasive Prediction of Occult Peritoneal Metastasis in Gastric Cancer Using Deep Learning

    Author Affiliations
    • 1Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
    • 2Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, China
    • 3Shenzhen Colleges of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, Guangdong, China
    • 4Department of Gastric Surgery, Sun Yat-sen University Cancer Center, Guangzhou, China
    • 5Department of Medical Imaging Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
    • 6Department of Radiology, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
    • 7Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China
    JAMA Netw Open. 2021;4(1):e2032269. doi:10.1001/jamanetworkopen.2020.32269
    Key Points

    Question  Can occult peritoneal metastasis be accurately assessed before surgery and without any invasive intervention?

    Findings  In this cohort study of 1978 patients, a deep neural network, the Peritoneal Metastasis Network, was developed for predicting occult peritoneal metastasis in gastric cancer based on preoperative computed tomography images. The model had excellent discrimination in external validation and substantially outperformed clinical factors.

    Meaning  The proposed deep learning model may be useful in preoperative treatment decision-making for avoiding unnecessary surgery and complications in certain patients.

    Abstract

    Importance  Occult peritoneal metastasis frequently occurs in patients with advanced gastric cancer and is poorly diagnosed with currently available tools. Because the presence of peritoneal metastasis precludes the possibility of curative surgery, there is an unmet need for a noninvasive approach to reliably identify patients with occult peritoneal metastasis.

    Objective  To assess the use of a deep learning model for predicting occult peritoneal metastasis based on preoperative computed tomography images.

    Design, Setting, and Participants  In this multicenter, retrospective cohort study, a deep convolutional neural network, the Peritoneal Metastasis Network (PMetNet), was trained to predict occult peritoneal metastasis based on preoperative computed tomography images. Data from a cohort of 1225 patients with gastric cancer who underwent surgery at Sun Yat-sen University Cancer Center (Guangzhou, China) were used for training purposes. To externally validate the model, data were collected from 2 independent cohorts comprising a total of 753 patients with gastric cancer who underwent surgery at Nanfang Hospital (Guangzhou, China) or the Third Affiliated Hospital of Southern Medical University (Guangzhou, China). The status of peritoneal metastasis for all patients was confirmed by pathological examination of pleural specimens obtained during surgery. Detailed clinicopathological data were collected for each patient. Data analysis was performed between September 1, 2019, and January 31, 2020.

    Main Outcomes and Measures  The area under the receiver operating characteristic curve (AUC) and decision curve were analyzed to evaluate performance in predicting occult peritoneal metastasis.

    Results  A total of 1978 patients (mean [SD] age, 56.0 [12.2] years; 1350 [68.3%] male) were included in the study. The PMetNet model achieved an AUC of 0.946 (95% CI, 0.927-0.965), with a sensitivity of 75.4% and a specificity of 92.9% in external validation cohort 1. In external validation cohort 2, the AUC was 0.920 (95% CI, 0.848-0.992), with a sensitivity of 87.5% and a specificity of 98.2%. The discrimination performance of PMetNet was substantially higher than conventional clinicopathological factors (AUC range, 0.51-0.63). In multivariable logistic regression analysis, PMetNet was an independent predictor of occult peritoneal metastasis.

    Conclusions and Relevance  The findings of this cohort study suggest that the PMetNet model can serve as a reliable noninvasive tool for early identification of patients with clinically occult peritoneal metastasis, which will inform individualized preoperative treatment decision-making and may avoid unnecessary surgery and complications. These results warrant further validation in prospective studies.

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