Artificial intelligence aided precise detection of local recurrence on MRI for nasopharyngeal carcinoma: a multicenter cohort study

Pu-Yun OuYang; Yun He; Jian-Gui Guo; Jia-Ni Liu; Zhi-Long Wang; Anwei Li; Jiajian Li; Shan-Shan Yang; Xu Zhang; Wei Fan; Yi-Shan Wu; Zhi-Qiao Liu; Bao-Yu Zhang; Ya-Nan Zhao; Ming-Yong Gao; Wei-Jun Zhang; Chuan-Miao Xie; Fang-Yun Xie

doi:10.1016/j.eclinm.2023.102202

Artificial intelligence aided precise detection of local recurrence on MRI for nasopharyngeal carcinoma: a multicenter cohort study

EClinicalMedicine. 2023 Aug 30:63:102202. doi: 10.1016/j.eclinm.2023.102202. eCollection 2023 Sep.

Authors

Pu-Yun OuYang¹, Yun He², Jian-Gui Guo³, Jia-Ni Liu⁴, Zhi-Long Wang⁵, Anwei Li⁶, Jiajian Li⁶, Shan-Shan Yang⁷, Xu Zhang⁸, Wei Fan⁸, Yi-Shan Wu⁹, Zhi-Qiao Liu¹, Bao-Yu Zhang¹, Ya-Nan Zhao¹, Ming-Yong Gao¹⁰, Wei-Jun Zhang¹¹, Chuan-Miao Xie², Fang-Yun Xie¹

Affiliations

¹ Department of Radiation Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
² Department of Radiology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
³ Department of Radiation Oncology, The First People's Hospital of Foshan, Foshan, China.
⁴ Department of Head and Neck Oncology, The Cancer Center of the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
⁵ Department of Radiology, Zhongshan City People's Hospital, Zhongshan, China.
⁶ CVTE Research, Guangzhou, China.
⁷ Department of Radiation Oncology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.
⁸ Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
⁹ Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China.
¹⁰ Department of Radiology, The First People's Hospital of Foshan, Foshan, China.
¹¹ Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.

Abstract

Background: MRI is the routine examination to surveil the recurrence of nasopharyngeal carcinoma, but it has relatively lower sensitivity than PET/CT. We aimed to find if artificial intelligence (AI) could be competent pre-inspector for MRI radiologists and whether AI-aided MRI could perform better or even equal to PET/CT.

Methods: This multicenter study enrolled 6916 patients from five hospitals between September 2009 and October 2020. A 2.5D convolutional neural network diagnostic model and a nnU-Net contouring model were developed in the training and test cohorts and used to independently predict and visualize the recurrence of patients in the internal and external validation cohorts. We evaluated the area under the ROC curve (AUC) of AI and compared AI with MRI and PET/CT in sensitivity and specificity using the McNemar test. The prospective cohort was randomized into the AI and non-AI groups, and their sensitivity and specificity were compared using the Chi-square test.

Findings: The AI model achieved AUCs of 0.92 and 0.88 in the internal and external validation cohorts, corresponding to the sensitivity of 79.5% and 74.3% and specificity of 91.0% and 92.8%. It had comparable sensitivity to MRI (e.g., 74.3% vs. 74.7%, P = 0.89) but lower sensitivity than PET/CT (77.9% vs. 92.0%, P < 0.0001) at the same individual-specificities. The AI model achieved moderate precision with a median dice similarity coefficient of 0.67. AI-aided MRI improved specificity (92.5% vs. 85.0%, P = 0.034), equaled PET/CT in the internal validation subcohort, and increased sensitivity (81.9% vs. 70.8%, P = 0.021) in the external validation subcohort. In the prospective cohort of 1248 patients, the AI group had higher sensitivity than the non-AI group (78.6% vs. 67.3%, P = 0.23), albeit nonsignificant. In future randomized controlled trials, a sample size of 3943 patients in each arm would be required to demonstrate the statistically significant difference.

Interpretation: The AI model equaled MRI by expert radiologists, and AI-aided MRI by expert radiologists equaled PET/CT. A larger randomized controlled trial is warranted to demonstrate the AI's benefit sufficiently.

Funding: The Sun Yat-sen University Clinical Research 5010 Program (2015020), Guangdong Basic and Applied Basic Research Foundation (2022A1515110356), and Guangzhou Science and Technology Program (2023A04J1788).

Keywords: Artificial intelligence; Diagnosis; Magnetic resonance imaging; Nasopharyngeal carcinoma; Recurrence.