Korean Journal of Radiology

  • 제22권5호
  • /
  • Pages.751-758
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  • 2021
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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MRI Predictors of Malignant Transformation in Patients with Inverted Papilloma: A Decision Tree Analysis Using Conventional Imaging Features and Histogram Analysis of Apparent Diffusion Coefficients

  • Chong Hyun Suh (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jeong Hyun Lee (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Mi Sun Chung (Department of Radiology, Chung-Ang University Hospital, Chung-Ang University College of Medicine) ;
  • Xiao Quan Xu (Department of Radiology, The First Affiliated Hospital of Nanjing Medical University) ;
  • Yu Sub Sung (Clinical Research Center, Asan Medical Center, Department of Convergence Medicine, University of Ulsan College of Medicine) ;
  • Sae Rom Chung (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Young Jun Choi (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Jung Hwan Baek (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center)
  • 투고 : 2020.05.08
  • 심사 : 2020.08.01
  • 발행 : 2021.05.01
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초록

Objective: Preoperative differentiation between inverted papilloma (IP) and its malignant transformation to squamous cell carcinoma (IP-SCC) is critical for patient management. We aimed to determine the diagnostic accuracy of conventional imaging features and histogram parameters obtained from whole tumor apparent diffusion coefficient (ADC) values to predict IP-SCC in patients with IP, using decision tree analysis. Materials and Methods: In this retrospective study, we analyzed data generated from the records of 180 consecutive patients with histopathologically diagnosed IP or IP-SCC who underwent head and neck magnetic resonance imaging, including diffusion-weighted imaging and 62 patients were included in the study. To obtain whole tumor ADC values, the region of interest was placed to cover the entire volume of the tumor. Classification and regression tree analyses were performed to determine the most significant predictors of IP-SCC among multiple covariates. The final tree was selected by cross-validation pruning based on minimal error. Results: Of 62 patients with IP, 21 (34%) had IP-SCC. The decision tree analysis revealed that the loss of convoluted cerebriform pattern and the 20th percentile cutoff of ADC were the most significant predictors of IP-SCC. With these decision trees, the sensitivity, specificity, accuracy, and C-statistics were 86% (18 out of 21; 95% confidence interval [CI], 65-95%), 100% (41 out of 41; 95% CI, 91-100%), 95% (59 out of 61; 95% CI, 87-98%), and 0.966 (95% CI, 0.912-1.000), respectively. Conclusion: Decision tree analysis using conventional imaging features and histogram analysis of whole volume ADC could predict IP-SCC in patients with IP with high diagnostic accuracy.

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참고문헌

  1. Lawson W, Kaufman MR, Biller HF. Treatment outcomes in the management of inverted papilloma: an analysis of 160 cases. Laryngoscope 2003;113:1548-1556 
  2. Yu HX, Liu G. Malignant transformation of sinonasal inverted papilloma: a retrospective analysis of 32 cases. Oncol Lett 2014;8:2637-2641 
  3. Yan CH, Tong CCL, Penta M, Patel VS, Palmer JN, Adappa ND, et al. Imaging predictors for malignant transformation of inverted papilloma. Laryngoscope 2019;129:777-782 
  4. Jeon TY, Kim HJ, Chung SK, Dhong HJ, Kim HY, Yim YJ, et al. Sinonasal inverted papilloma: value of convoluted cerebriform pattern on MR imaging. AJNR Am J Neuroradiol 2008;29:1556-1560 
  5. Jeon TY, Kim HJ, Choi JY, Lee IH, Kim ST, Jeon P, et al. 18F-FDG PET/CT findings of sinonasal inverted papilloma with or without coexistent malignancy: comparison with MR imaging findings in eight patients. Neuroradiology 2009;51:265-271 
  6. Fujima N, Nakamaru Y, Sakashita T, Homma A, Tsukahara A, Kudo K, et al. Differentiation of squamous cell carcinoma and inverted papilloma using non-invasive MR perfusion imaging. Dentomaxillofac Radiol 2015;44:20150074 
  7. Ramkumar S, Ranjbar S, Ning S, Lal D, Zwart CM, Wood CP, et al. MRI-based texture analysis to differentiate sinonasal squamous cell carcinoma from inverted papilloma. AJNR Am J Neuroradiol 2017;38:1019-1025 
  8. Maroldi R, Farina D, Palvarini L, Lombardi D, Tomenzoli D, Nicolai P. Magnetic resonance imaging findings of inverted papilloma: differential diagnosis with malignant sinonasal tumors. Am J Rhinol 2004;18:305-310 
  9. Gencturk M, Ozturk K, Caicedo-Granados E, Li F, Cayci Z. Application of diffusion-weighted MR imaging with ADC measurement for distinguishing between the histopathological types of sinonasal neoplasms. Clin Imaging 2019;55:76-82 
  10. Das A, Bhalla AS, Sharma R, Kumar A, Thakar A, Vishnubhatla SM, et al. Can diffusion weighted imaging aid in differentiating benign from malignant sinonasal masses?: a useful adjunct. Pol J Radiol 2017;82:345-355 
  11. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig L, et al. STARD 2015: an updated list of essential items for reporting diagnostic accuracy studies. Radiology 2015;277:826-832 
  12. Choi YJ, Lee JH, Kim HO, Kim DY, Yoon RG, Cho SH, et al. Histogram analysis of apparent diffusion coefficients for occult tonsil cancer in patients with cervical nodal metastasis from an unknown primary site at presentation. Radiology 2016;278:146-155 
  13. Youden WJ. Index for rating diagnostic tests. Cancer 1950;3:32-35 
  14. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-174