Clinical Trials Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 14, 2024; 30(38): 4211-4220
Published online Oct 14, 2024. doi: 10.3748/wjg.v30.i38.4211
Whole-volume histogram analysis of spectral-computed tomography iodine maps characterizes HER2 expression in gastric cancer
Wei-Ling Zhang, Jing Sun, Rong-Fang Huang, Yi Zeng, Shu Chen, Xiao-Peng Wang, Jin-Hu Chen, Yun-Bin Chen, Chun-Su Zhu, Zai-Sheng Ye, You-Ping Xiao
Wei-Ling Zhang, Jing Sun, Yun-Bin Chen, You-Ping Xiao, Department of Radiology, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital (Fujian Branch of Fudan University Affiliated Cancer Hospital), Fuzhou 350014, Fujian Province, China
Rong-Fang Huang, Department of Pathology, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital (Fujian Branch of Fudan University Affiliated Cancer Hospital), Fuzhou 350014, Fujian Province, China
Yi Zeng, Shu Chen, Xiao-Peng Wang, Jin-Hu Chen, Zai-Sheng Ye, Department of Gastric Surgery, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital (Fujian Branch of Fudan University Affiliated Cancer Hospital), Fuzhou 350014, Fujian Province, China
Chun-Su Zhu, Department of Epidemiology, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital (Fujian Branch of Fudan University Affiliated Cancer Hospital), Fuzhou 350014, Fujian Province, China
Co-first authors: Wei-Ling Zhang and Jing Sun.
Co-corresponding authors: Zai-Sheng Ye and You-Ping Xiao.
Author contributions: Xiao YP, Ye ZS and Chen YB designed the study; Zhang WL, Sun J, Zeng Y, Chen S, Wang XP and Chen JH performed the research; Huang RF and Zhu CS contributed new reagents and analytical tools; Zhang WL, Sun J, Ye ZS and Xiao YP analyzed the data and wrote the manuscript. All authors have read and approved the final manuscript. Zhang WL and Sun J contributed equally to this work as co-first authors. Xiao YP and Ye ZS worked together to design the study and supervise the entire research process. Xiao YP is a radiologist who was responsible for conducting the spectral computed tomography examinations and managing the imaging database. Ye ZS is a surgical oncologist who was responsible for the clinical treatment of patients with gastric cancer and the management of the clinical database. Moreover, Xiao YP participated in the data analysis and manuscript writing and revision. Thus, Xiao YP and Ye ZS are co-corresponding authors for this paper.
Supported by Science and Technology Program of Fujian Province, No. 2021J01430; and Joint Funds for the Innovation of Science and Technology of Fujian Province, No. 2021Y9229.
Institutional review board statement: The study was reviewed and approved by the Fujian Cancer Hospital Institutional Review Board (No. K2022-152-01).
Clinical trial registration statement: Not applicable for this study is not a registered clinical trial.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest regarding the publication of this paper.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at xyp999@yeah.net.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: You-Ping Xiao, MD, Doctor, Department of Radiology, Clinical Oncology School of Fujian Medical University & Fujian Cancer Hospital (Fujian Branch of Fudan University Affiliated Cancer Hospital), No. 420 Fuma Road, Jin'an District, Fuzhou 350014, Fujian Province, China. xyp999@yeah.net
Received: May 21, 2024
Revised: September 4, 2024
Accepted: September 18, 2024
Published online: October 14, 2024
Processing time: 131 Days and 8.8 Hours
Abstract
BACKGROUND

Although surgery remains the primary treatment for gastric cancer (GC), the identification of effective alternative treatments for individuals for whom surgery is unsuitable holds significance. HER2 overexpression occurs in approximately 15%-20% of advanced GC cases, directly affecting treatment-related decisions. Spectral-computed tomography (sCT) enables the quantification of material compositions, and sCT iodine concentration parameters have been demonstrated to be useful for the diagnosis of GC and prediction of its invasion depth, angiogenesis, and response to systemic chemotherapy. No existing report describes the prediction of GC HER2 status through histogram analysis based on sCT iodine maps (IMs).

AIM

To investigate whether whole-volume histogram analysis of sCT IMs enables the prediction of the GC HER2 status.

METHODS

This study was performed with data from 101 patients with pathologically confirmed GC who underwent preoperative sCT examinations. Nineteen parameters were extracted via sCT IM histogram analysis: The minimum, maximum, mean, standard deviation, variance, coefficient of variation, skewness, kurtosis, entropy, percentiles (1st, 5th, 10th, 25th, 50th, 75th, 90th, 95th, and 99th), and lesion volume. Spearman correlations of the parameters with the HER2 status and clinicopathological parameters were assessed. Receiver operating characteristic curves were used to evaluate the parameters’ diagnostic performance.

RESULTS

Values for the histogram parameters of the maximum, mean, standard deviation, variance, entropy, and percentiles were significantly lower in the HER2+ group than in the HER2– group (all P < 0.05). The GC differentiation and Lauren classification correlated significantly with the HER2 status of tumor tissue (P = 0.001 and 0.023, respectively). The 99th percentile had the largest area under the curve for GC HER2 status identification (0.740), with 76.2%, sensitivity, 65.0% specificity, and 67.3% accuracy. All sCT IM histogram parameters correlated positively with the GC HER2 status (r = 0.237-0.337, P = 0.001-0.017).

CONCLUSION

Whole-lesion histogram parameters derived from sCT IM analysis, and especially the 99th percentile, can serve as imaging biomarkers of HER2 overexpression in GC.

Keywords: Gastric cancer; Spectral computed tomography; Iodine map; Histogram analysis

Core Tip: Anti-HER2 receptor is a critical biomarker in gastric cancer (GC). In this study, a total of 101 GC patients underwent preoperative spectral-computed tomography (sCT) and nineteen parameters were extracted from the iodine maps of sCT by histogram analysis. The relationship between parameters derived from whole volume histogram analysis of sCT and HER-2 status of GC were further investigated. Our present results indicated that parameters derived from sCT, particularly the 99th percentiles, could be utilized as an imaging biomarker in assessing the HER2 overexpression of GC. This founding would help Gastrointestinal Oncologists to develop an effective treatment strategy for patients with GC.