Moddicom: a Complete and Easily Accessible Library for Prognostic Evaluations Relying on Image Features

Decision Support Systems (DSSs) are increasingly exploited in the area of prognostic evaluations. For predicting the effect of therapies on patients, the trend is now to use image features, i.e. information that can be automatically computed by considering images resulting by analysis. The DSSs application as predictive tools is particularly suitable for cancer treatment, given the peculiarities of the disease –which is highly localised and lead to significant social costs– and the large number of images that are available for each patient. At the state of the art, there exists tools that allow to handle image features for prognostic evaluations, but they are not designed for medical experts. They require either a strong engineering or computer science background since they do not integrate all the required functions, such as image retrieval and storage. In this paper we fill this gap by proposing Moddicom, a user-friendly complete library specifically designed to be exploited by physicians. A preliminary experimental analysis, performed by a medical expert that used the tool, demonstrates the efficiency and the effectiveness of Moddicom

The role of apparent diffusion coefficient (ADC) in the evaluation of lymph node status in patients with locally advanced cervical cancer : our experience and a review

Purpose: To evaluate the role of apparent diffusion coefficient (ADC) value measurement in the diagnosis of metastatic lymph nodes (LNs) in patients with locally advanced cervical cancer (LACC) and to present a systematic review of the literature. Material and methods: Magnetic resonance imaging (MRI) exams of patients with LACC were retrospectively eva luated. Mean ADC, relative ADC (rADC), and correct ADC (cADC) values of enlarged LNs were measured and compared between positron emission tomography (PET)-positive and PET-negative LNs. Comparisons were made using the Mann-Whitney U-test and Student’s t-test. ROC curves were generated for each parameter to identify the optimal cut-off value for differentiation of the LNs. A systematic search in the literature was performed, exploring several databases, including PubMed, Scopus, the Cochrane library, and Embase. Results: A total of 105 LNs in 34 patients were analysed. The median ADC value of PET-positive LNs (0.907 × 10-3 mm2/s [0.780-1.080]) was lower than that in PET-negative LNs (1.275 × 10-3 mm2/s [1.063-1.525]) (p < 0.05). rADC and cADC values were lower in PET-positive LNs (rADC: 0.120 × 10-3 mm2/s [–0.060-0.270]; cADC: 1.130 [0.980-1.420]) than in PET-negative LNs (rADC: 0.435 × 10-3 mm2/s [0.225-0.673]; cADC: 1.615 [1.210-1.993]) LNs (p < 0.05). ADC showed the highest area under the curve (AUC 0.808). Conclusions: Mean ADC, rADC, and cADC were significantly lower in the PET-positive group than in the PET-negative group. The ADC cut-off value of 1.149 × 10-3 mm2/s showed the highest sensitivity. These results confirm the usefulness of ADC in differentiating metastatic from non-metastatic LNs in LACC

Nomogram for predicting radiation maculopathy in patients treated with Ruthenium-106 plaque brachytherapy for uveal melanoma

Purpose: To develop a predictive model and nomogram for maculopathy occurrence at 3 years after106Ru/106Rh plaque brachytherapy in uveal melanoma. Material and methods: Clinical records of patients affected by choroidal melanoma and treated with106Ru/106Rh plaque from December 2006 to December 2014 were retrospectively reviewed. Inclusion criteria were: dome-shaped melanoma, distance to the fovea &gt; 1.5 mm, tumor thickness &gt; 2 mm, and follow-up &gt; 4 months. The delivered dose to the tumor apex was 100 Gy. Primary endpoint of this investigation was the occurrence of radiation maculopathy at 3 years. Analyzed factors were as follows: gender, age, diabetes, tumor size (volume, area, largest basal diameter and apical height), type of plaque, distance to the fovea, presence of exudative detachment, drusen, orange pigment, radiation dose to the fovea and sclera. Univariate and multivariate Cox proportional hazards analyses were used to define the impact of baseline patient factors on the occurrence of maculopathy. Kaplan-Meier curves were used to estimate freedom from the occurrence of the maculopathy. The model performance was evaluated through internal validation using area under the ROC curve (AUC), and calibration with Gronnesby and Borgan tests. Results: One hundred ninety-seven patients were considered for the final analysis. Radiation-related maculopathy at 3 years was observed in 41 patients. The proposed nomogram can predict maculopathy at 3 years with an AUC of 0.75. Distance to fovea appeared to be the main prognostic factor of the predictive model (hazard ratio of 0.83 [0.76-0.90], p &lt; 0.01). Diabetes (hazard radio of 2.92 [1.38-6.20], p &lt; 0.01), and tumor volume (hazard radio of 21.6 [1.66-281.14], p = 0.02) were significantly predictive for maculopathy occurrence. The calibration showed no statistical difference between actual and predicted maculopathy (p = 1). Conclusions: Our predictive model, together with its nomogram, could be a useful tool to predict the occurrence of radiation maculopathy at 3 years after the treatment

HPV and EBV Infections in Neck Metastases from Occult Primary Squamous Cell Carcinoma: Another Virus-Related Neoplastic Disease in the Head and Neck Region

Approximately 1-9 % of all head and neck squamous cell carcinomas are neck metastases from clinically undetectable primary tumors. Human papillomavirus (HPV) and Epstein-Barr virus (EBV) are proven carcinogenic factors that are associated with oropharyngeal squamous cell carcinoma and nasopharyngeal carcinoma, respectively. In the present study, we evaluated the prevalence of these viruses in neck metastases from unknown primary squamous cell carcinoma

Prevalence of silent prostatic adenocarcinoma in 165 patients undergone cystoprostatectomy: A retrospective study

The reported prevalence of prostatic adenocarcinoma (PCa) in adults represents only the 'tip of the iceberg'. The present retrospective study was carried out to estimate the prevalence of the silent PCa in 165 subjects (median age: 69 years; range: 40-82) undergone radical cystoprostatectomy for bladder cancer. To this aim, 38 subjects had routinely prostatic sampling by histology (group A), whereas 127 had systematic pathological sampling of the gland (group B). Silent PCa was diagnosed in 17 subjects (9.7%): 1 subject was in the group A (0.7%) and 16 were in the group B (9%). The data suggest that systematic examination of the prostatic specimens should be performed in order to approach the real prevalence of silent PCa in adult population

RadioBio data: a Moddicom Module to Predict Tumor Control Probability and Normal Tissue Complication Probability in Radiotherapy

In this work a system for analysing radiotherapy treatment planning dose-volume data is proposed. The work starts from the definition of a framework inside a statistical scripting environment (R) used for creating a software package. The analysis of dose-volume data in radiotherapy of malignant tumours is mandatory for evaluating the prescribed treatment and for feedback analysis of outcome, both in the direction of tumour control and in detection of parameters for estimating and predicting toxicity outcome. The statistical analysis of large amount of clinical data can be slowed by the lack of practice in statistical tools needed, by clinicians, to perform such kind of analysis. This is the reason that lead our working group in the creation of such a tool. Finally an example of clinical application of our software is given for the analysis of the outcome of patients undergoing to radiotherapy for prostate cancer