A Deep Learning Framework for Diagnosis and Survival Prognosis of Central Nervous System Tumors
DOI:
https://doi.org/10.47611/jsrhs.v13i1.6311Keywords:
Deep Learning, Artificial Intelligence, MRI, brain tumors, cancer diagnosisAbstract
Diagnosis and prognosis of central nervous system (CNS) tumors rely on manual and algorithmic approaches that are subject to variations, inefficiencies and bias. With 5-year survival rates as low as 6%, timely tumor assessment is crucial to ensure patient health. Machine learning and deep learning techniques have been used over the past decade to reduce the assessment burden and augment physician diagnoses. Traditional machine learning models require manual feature extraction and engineering, introducing further variability of the results. On the other hand, automated deep learning models require complicated engineering and workflow implementations that need to be managed and updated for new datasets. This study endeavors to define a generalizable, two-phase neural network pipeline and user interface that can be applied to clinical assessment of any tumor with 3D MRI scans, allowing for improved personalization of patient diagnosis and treatment options. In the first diagnostic phase, radiomic features are used to predict tumor severity and extent. The outputs of this phase are then passed to a survival prognosis model along with the patients’ clinical data to predict the 5-year overall survival rate. The diagnostic model achieved a F1-Score, a measure of classification accuracy, of 94% and the prognostic model achieved a risk-adjusted, time-dependent Harrell’s Concordance Index score of 0.92, indicating the framework’s generalizability to new datasets. The mobile app developed as part of this study offer ease of access to physicians and radiologists in reviewing predicted results and subsequent patient interactions.
Downloads
References or Bibliography
Alzubaidi, L., et al. (2021). Review of deep learning: concepts, CNN architectures, challenges, applications, future directions. Journal of Big Data. https://doi.org/10.1186%2Fs40537-021-00444-8
Ambale-Venkatesh et al. (2017). Cardiovascular Event Prediction by Machine Learning: The Multi-Ethnic Study of Atherosclerosis. Circulation Research. https://doi.org/10.1161/CIRCRESAHA.117.311312
Amin, J. et al. (2020). Brain tumor classification based on DWT fusion of MRI sequences using convolutional neural network. Pattern Recognition Letters. https://doi.org/10.1016/j.patrec.2019.11.016
Appin, Christina L. et al. (2013). Glioblastoma with Oligodendroglioma Component (GBM‐O): Molecular Genetic and Clinical Characteristics. Brain Pathology. https://doi.org/10.1111/bpa.12018
Bressem, Keno K. et al. (2020). Comparing different deep learning architectures for classification of chest radiographs. Scientific Reports. https://doi.org/10.1038/s41598-020-70479-z
Cancer Stat Facts: Brain and Other Nervous System Cancer. (2022). Accessed April 10, 2023. https://seer.cancer.gov/statfacts/html/brain.html
Chen, S. et al. (2019). Med3D: Transfer Learning for 3D Medical Image Analysis. arXiv. https://doi.org/10.48550/arXiv.1904.00625
Clark, K. et al. (2013). The Cancer Imaging Archive (TCIA): maintaining and operating a public information repository. Journal of Digital Imaging. https://doi.org/10.1007/s10278-013-9622-7
Cousin, F. et al. (2023). Radiomics and Delta-Radiomics Signatures to Predict Response and Survival in Patients with Non-Small-Cell Lung Cancer Treated with Immune Checkpoint Inhibitors. Cancers. https://doi.org/10.3390/cancers15071968
European Society of Radiologists. (2022). Attracting the next generation of radiologists: a statement by the European Society of Radiology (ESR). Insights Imaging. https://doi.org/10.1186/s13244-022-01221-8
Ewart, M. H. et al. (2021). A Comparison of Magnetic Resonance Imaging Methods to Assess Multiple Sclerosis Lesions: Implications for Patient Characterization and Clinical Trial Design. Diagnostics. https://doi.org/10.3390%2Fdiagnostics12010077
Frija, G. et al. (2021). How to improve access to medical imaging in low- and middle-income countries? eClinicalMedicine. https://doi.org/10.1016/j.eclinm.2021.101034
Gerds, Thomas A. et al. “Estimating a Time-Dependent Concordance Index for Survival Prediction Models with Covariate Dependent Censoring”, Statistics in Medicine, Nov 2012, https://doi.org/10.1002/sim.5681
George, B. et al. (2014). Survival analysis and regression models. Journal of Nuclear Cardiology. https://doi.org/10.1007/s12350-014-9908-2
Goldstein-Greenwood, J. A Brief on Brier Scores. University of Virginia Library Research Data Services + Sciences. Accessed Jul 31, 2023. https://data.library.virginia.edu/a-brief-on-brier-scores/
Henderson, M., Radiology Facing a Global Shortage”, Accessed September 15, 2023, https://www.rsna.org/news/2022/may/Global-Radiologist-Shortage
Houwelingen, Hans C. and Putter, H. (2015). Comparison of stopped Cox regression with direct methods such as pseudo-values and binomial regression. Lifetime Data Analysis. https://doi.org/ 10.1007/s10985-014-9299-3
Cho, H. and Park, H. (2017). Classification of low-grade and high-grade glioma using multi-modal image radiomics features. IEEE Xplore. https://doi.org/10.1109/EMBC.2017.8037508
In, J and Lee, D. K. (2018). Survival analysis: Part I — analysis of time-to-event”, Korean Journal of Anesthesiology. https://doi.org/10.4097%2Fkja.d.18.00067
Kalafi E Y. et al. (2023). Machine Learning and Deep Learning Approaches in Breast Cancer Survival Prediction Using Clinical Data. Folia Biologica, Accessed September 16, 2023, https://pubmed.ncbi.nlm.nih.gov/32362304/
Kathleen, A. C. 2022. Annual report to the nation on the status of cancer, part 1: National cancer statistics Interpretation. Accessed March 15, 2023. https://academic.oup.com/jncimono/article/2014/49/145/904712
Klaveren, D., et al. (2014). Assessing discriminative ability of risk models in clustered data. BMC Medical Research Methodology. https://doi.org/10.1186/1471-2288-14-5
Liu, F. et al. (2017). Epidemiology and survival outcome of breast cancer in a nationwide study. Oncotarget. https://doi.org/10.18632/oncotarget.15207
Loshchilov, I., and Hutter, F. (2019). Decoupled Weight Decay Regularization. arXiv. https://doi.org/10.48550/arXiv.1711.05101
Mariotto, Angela B. et al. (2014). Cancer Survival: An Overview of Measures, Uses, and Interpretation. JNCI Monographs. https://doi.org/10.1093/jncimonographs/lgu024
Matsuo, K. et al. (2018). Survival outcome prediction in cervical cancer: Cox models vs deep-learning model. American Journal of Obstetrics and Gynecology. https://doi.org/10.1016/j.ajog.2018.12.030
Meola, A. et al. (2018). Gold Nanoparticles for Brain Tumor Imaging: A Systematic Review. Frontiers in Neurology. https://doi.org/10.3389/fneur.2018.00328
Moreau, J. T. et al. (2020). Individual-patient prediction of meningioma malignancy and survival using the Surveillance, Epidemiology, and End Results database. npj Digital Medicine. https://doi.org/10.1038/s41746-020-0219-5
Palsson, S. et al. (2022). Predicting survival of glioblastoma from automatic whole-brain and tumor segmentation of MR images. Scientific Reports. https://doi.org/10.1038/s41598-022-19223-3
Painuli D., et al. (2022). Recent advancement in cancer diagnosis using machine learning and deep learning techniques: A comprehensive review. Computers in Biology and Medicine. https://pubmed.ncbi.nlm.nih.gov/35551012/
Pei, L. et al. (2020). Context aware deep learning for brain tumor segmentation, subtype classification, and survival prediction using radiology images. Scientific Reports. https://doi.org/10.1038/s41598-020-74419-9
Raykar, V. C., et al. (2007). On Ranking in Survival Analysis: Bounds on the Concordance Index. https://proceedings.neurips.cc/paper/2007/file/33e8075e9970de0cfea955afd4644bb2-Paper.pdf
Rezaianzadeh, A. et al. (2017). The overall 5-year survival rate of breast cancer among Iranian women: A systematic review and meta-analysis of published studies. Breast Disease. https://doi.org/10.3233/bd-160244
Roshanei, G. et al. (2022). Factors affecting the survival of patients with colorectal cancer using random survival forest. Journal of gastrointestinal cancer. https://doi.org/10.1007/s12029-020-00544-3
Sarveazad, A. et al. (2018). 5-Year Survival Rates and Prognostic Factors in Patients with Synchronous and Metachronous Breast Cancer from 2010 to 2015. Asian Pacific journal of cancer prevention. https://doi.org/10.31557/apjcp.2018.19.12.3489
Swinburne, N. C. et al. (2019). Machine learning for semiautomated classification of glioblastoma, brain metastasis and central nervous system lymphoma using magnetic resonance advanced imaging. Annals of Translational Medicine. https://doi.org/10.21037%2Fatm.2018.08.05
University of Virginia Library Research Data Services + Sciences. (2022). A Brief on Brier Scores. Accessed on July 8, 2023. https://data.library.virginia.edu/a-brief-on-brier-scores/
Vagvala, S., et al. (2022). Imaging diagnosis and treatment selection for brain tumors in the era of molecular therapeutics. Cancer Imaging. https://doi.org/10.1186/s40644-022-00455-5
Walter K. K. (2007). Concordance for Survival Time Data: Fixed and Time-Dependent Covariates and Possible Ties in Predictor and Time. Accessed March 20, 2023. https://www.mayo.edu/research/documents/biostat-80pdf/doc-10027891
Wang, J. et al. (2020). SurvNet: A Novel Deep Neural Network for Lung Cancer Survival Analysis With Missing Values. Frontiers in Oncology. https://doi.org/10.3389/fonc.2020.588990
Wu, W. et al. (2020). An Intelligent Diagnosis Method of Brain MRI Tumor Segmentation Using Deep Convolutional Neural Network and SVM Algorithm. Computational and Mathematical Methods in Medicine. https://doi.org/10.1155%2F2020%2F6789306
Wuni, A. et al. (2020). Developing a policy framework to support role extension in diagnostic radiography in Ghana. Journal of Medical Imaging and Radiation Sciences. https://doi.org/10.1016/j.jmir.2020.09.013
Xue, C. et al. (2021). Radiomics feature reliability assessed by intraclass correlation coefficient: a systematic review. Quantitative Imaging in Medicine and Surgery. https://doi.org/10.21037/qims-21-86
Yamashita, R. et al. (2018). Convolutional neural networks: an overview and application in radiology. Insights into Imaging. https://doi.org/10.1007/s13244-018-0639-9
Yan, P. et al. (2016). Accuracy of conventional MRI for preoperative diagnosis of intracranial tumors: A retrospective cohort study of 762 cases. International Journal of Surgery. https://doi.org/10.1016/j.ijsu.2016.10.023
Zhang, Z. et al. (2023). Bayesian inference for Cox proportional hazard models with partial likelihoods, nonlinear covariate effects and correlated observations. Statistical methods in medical research. https://doi.org/10.1177/09622802221134172
Zhang, Y. et al. (2023). Artificial intelligence-driven radiomics study in cancer: the role of feature engineering and modeling. Military Medical Research. https://doi.org/10.1186/s40779-023-00458-8
Published
How to Cite
Issue
Section
Copyright (c) 2024 Diya Sreedhar; Ashok David
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright holder(s) granted JSR a perpetual, non-exclusive license to distriute & display this article.