Background: Gastrointestinal stromal tumors (GISTs), which are the most common mesenchymal tumors of the digestive system, are treated varyingly according to the malignancy. The purpose of this study is to develop and validate a nomogram for preoperative prediction of the malignant potential in patients with GIST.Methods: A total of 440 patients with pathologically confirmed GIST after surgery in our hospital from January 2011 to July 2019 were retrospectively analyzed. They were randomly divided into the training set (n = 308) and validation set (n = 132). CT signs and texture features of each patient were analyzed and predictive model were developed using the least absolute shrinkage and selection operator (lasso) regression. Then a nomogram based on selected parameters was developed. The predictive effectiveness of nomogram was evaluated by the area under receiver operating characteristic (ROC) curve (AUC). Concordance index (C-index) and calibration plots were formulated to evaluate the reliability and accuracy of the nomogram by bootstrapping based on internal (training set) and external (validation set) validity. The clinical application value of the nomogram was determined through the decision curve analysis (DCA).Results: Totally 156 GIST patients with low-malignant (very low and low risk) and 284 ones with high-malignant potential (intermediate and high risk) are enrolled in this study. The prediction nomogram consisting of size, cystoid variation and meanValue had an excellent discrimination both in training and validation sets (AUCs (95% confidence interval(CI)): 0.935 (0.908, 0.961), 0.933 (0.892, 0.974); C-indices (95% CI): 0.941 (0.912, 0.956), 0.935 (0.901, 0.982); sensitivity: 81.4, 90.6%; specificity: 75.0, 75.7%; accuracy: 88.0, 88.6%, respectively). The calibration curves indicated a good consistency between the actual observation and nomogram prediction for differentiating GIST malignancy. Decision curve analysis demonstrated that the nomogram was clinically useful.Conclusion: This study presents a prediction nomogram that incorporates the CT signs and texture parameter, which can be conveniently used to facilitate the preoperative individualized prediction of malignancy in GIST patients.

Purpose of the Report: Accurate clinical axillary evaluation plays an important role in the diagnosis and treatment planning for early-stage breast cancer (BC). This study aimed to develop a scalable, non-invasive and robust machine learning model for predicting of the pathological node status using dedicated-PET integrating the clinical characteristics in early-stage BC. Materials and Methods: A total of 420 BC patients confirmed by postoperative pathology were retrospectively analyzed. 18F-fluorodeoxyglucose (¹⁸F-FDG) Mammi-PET, ultrasound, physical examination, Lymph-PET, and clinical characteristics were analyzed. The least absolute shrinkage and selection operator (LASSO) regression analysis were used in developing prediction models. The characteristic curve (ROC) of the area under receiver-operator (AUC) and DeLong test were used to evaluate and compare the performance of the models. The clinical utility of the models was determined via decision curve analysis (DCA). Then, a nomogram was developed based on the model with the best predictive efficiency and clinical utility and was validated using the calibration plots. Results: A total of 290 patients were enrolled in this study. The AUC of the integrated model diagnosed performance was 0.94 (95% confidence interval (CI), 0.91–0.97) in the training set (n = 203) and 0.93 (95% CI, 0.88–0.99) in the validation set (n = 87) (both p < 0.05). In clinical N0 subgroup, the negative predictive value reached 96.88%, and in clinical N1 subgroup, the positive predictive value reached 92.73%. Conclusions: The use of a machine learning integrated model can greatly improve the true positive and true negative rate of identifying clinical axillary lymph node status in early-stage BC.

Background: Thymic epithelial tumors (TETs) are the most common primary tumors in the anterior mediastinum, which have considerable histologic heterogeneity. This study aimed to develop and validate a nomogram based on computed tomography (CT) and texture analysis (TA) for preoperatively predicting the pathological classifications for TET patients.Methods: Totally TET 172 patients confirmed by postoperative pathology between January 2011 to April 2019 were retrospectively analyzed and randomly divided into training (n = 120) and validation (n = 52) cohorts. Preoperative clinical factors, CT signs and texture features of each patient were analyzed, and prediction models were developed using the least absolute shrinkage and selection operator (LASSO) regression. The performance of the models was evaluated and compared by the area under receiver-operator characteristic (ROC) curve (AUC) and the DeLong test. The clinical application value of the models was determined via the decision curve analysis (DCA). Then, a nomogram was developed based on the model with the best predictive efficiency and clinical utility and validated using the calibration plots.Results: Totally 87 patients with low-risk TET (LTET) (types A, AB, B1) and 85 patients with high-risk TET (HTET) (types B2, B3, C) were enrolled in this study. We separately constructed 4 prediction models for differentiating LTET from HTET using clinical, CT, texture features, and their combination. These 4 prediction models achieved AUCs of 0.66, 0.79, 0.82, 0.88 in the training cohort and 0.64, 0.82, 0.86, 0.94 in the validation cohort, respectively. The DeLong test and DCA showed that the Combined model, consisting of 2 CT signs and 2 texture parameters, held the highest predictive efficiency and clinical utility (p < 0.05). A prediction nomogram was subsequently developed using the 4 independently risk factors from the Combined model. The calibration curves indicated a good consistency between the actual observations and nomogram predictions for differentiating TET classifications.Conclusion: A prediction nomogram incorporating both the CT and texture parameters was constructed and validated in our study, which can be conveniently used for the preoperative individualized prediction of the simplified histologic subtypes in TET patients.

Owing to a large amount of multi-modal data in modern medical systems, such as medical images and reports, Medical Vision-Language Pre-training (Med-VLP) has demonstrated incredible achievements in coarse-grained downstream tasks (i.e., medical classification, retrieval, and visual question answering). However, the problem of transferring knowledge learned from Med-VLP to fine-grained multi-organ segmentation tasks has barely been investigated. Multi-organ segmentation is challenging mainly due to the lack of large-scale fully annotated datasets and the wide variation in the shape and size of the same organ between individuals with different diseases. In this paper, we propose a novel pre-training & fine-tuning framework for Multi-Organ Segmentation by harnessing Medical repOrt Supervision (MOSMOS). Specifically, we first introduce global contrastive learning to maximally align the medical image-report pairs in the pre-training stage. To remedy the granularity discrepancy, we further leverage multi-label recognition to implicitly learn the semantic correspondence between image pixels and organ tags. More importantly, our pre-trained models can be transferred to any segmentation model by introducing the pixel-tag attention maps. Different network settings, i.e., 2D U-Net and 3D UNETR, are utilized to validate the generalization. We have extensively evaluated our approach using different diseases and modalities on BTCV, AMOS, MMWHS, and BRATS datasets. Experimental results in various settings demonstrate the effectiveness of our framework. This framework can serve as the foundation to facilitate future research on automatic annotation tasks under the supervision of medical reports.

Background: Thymic epithelial tumors (TETs) are the most common primary tumors in the anterior mediastinum with considerable histologic heterogeneity. This study aimed to develop and validate a nomogram based on computed tomography (CT) and texture analysis (TA) for preoperatively predicting pathological classification for TET patients.Methods: Totally 172 patients with pathologically confirmed TET after surgery were retrospectively analyzed and randomly divided into a training cohort (n=120) and a validation cohort (n=52). Preoperative clinical demographic, CT signs and texture features of each patient were analyzed and prediction models were developed using the least absolute shrinkage and selection operator (LASSO) regression. The performance of models was evaluated and compared by the area under receiver operating characteristic (ROC) curve (AUC) and DeLong test. The clinical application value of models was determined through the decision curve analysis (DCA). Then a nomogram was developed based on the model with the best predictive accuracy and clinical utility and validated using the calibration plots.Results: Totally 87 patients with low-risk TET (LTET) (types A, AB, B1) and 85 patients with high-risk TET (HTET) (types B2, B3, C) were enrolled in this study. We separately constructed 4 prediction models for differentiating LTET from HTET using clinical, CT, texture features and their combination. These 4 prediction models achieved AUC values of 0.66, 0.79, 0.82, 0.88 in the training cohort and 0.64, 0.82, 0.86, 0.94 in the validation cohort, respectively. DeLong test and DCA analysis showed that the Combined model consisting of 2 CT signs and 2 texture parameters held the highest predictive efficiency and clinical utility ( p <0.05). A prediction nomogram was subsequently developed using the combined model’s 4 independently risk factors. The calibration curves indicated a good consistency between the actual observation and nomogram prediction for differentiating TET classifications.Conclusion: A prediction nomogram incorporating both the CT and texture parameters was constructed and validated in our study, which was conveniently used to facilitate the preoperative individualized prediction of simplified histologic subtypes in TET patients, assisting in clinical treatment decision making and achieving precision treatment.