Preoperative prediction of lymph node metastasis in patients with ovarian cancer using contrast-enhanced computed tomography-based intratumoral and peritumoral radiomics features.

Purpose: To develop and validate computed tomography (CT)-based intratumoral and peritumoral radiomics signatures for preoperative prediction of lymph node metastasis (LNM) in patients with ovarian cancer (OC). Methods: Patients with pathological diagnosis of OC were retrospectively included. Intratumoral and peritumoral radiomics features were extracted from contrast-enhanced CT images. Intratumoral and peritumoral radiomics features were extracted from contrast-enhanced CT images. Intratumoral, peritumoral, and combined radiomics signatures were constructed, and their radiomics scores were calculated. Univariate and multivariate logistic regression analyses were performed to identify predictors of clinical outcomes. A radiomics nomogram was developed by incorporating the combined radiomics signature with clinical risk factors. The prediction efficiency of the various models was evaluated using the accuracy value, the area under the receiver-operating characteristic curve (AUC) and decision curve analysis (DCA). Results: Two hundred and seventy-three patients with OC were enrolled and randomly divided into a training cohort (n=190) and a test cohort (n=83) in a 7:3 ratio. The intratumoral, peritumoral, and combined radiomics signatures were constructed using 18, 11, and 17 radiomics features, respectively. The combined radiomics signature showed the best prediction ability, with accuracy of 0.783 and an AUC of 0.860 (95% confidence interval 0.779-0.941). The DCA results showed that the combined radiomics signature had better clinical application than the clinical model and the radiomics nomogram. Conclusions: A CT-based combined radiomics signature incorporating intratumoral and peritumoral radiomics features can predict LNM in patients with OC before surgery.