Prediction of Lymph Node Metastasis in Endometrial Cancer Based on Color Doppler Ultrasound Radiomics.

Rationale And Objectives: To construct a model using radiomics features based on ultrasound images and evaluate the feasibility of noninvasive assessment of lymph node status in endometrial cancer (EC) patients.

Methods: In this multicenter retrospective study, a total of 186 EC patients who underwent hysterectomy and lymph node dissection were included, Pathology confirmed the presence or absence of lymph node metastasis (LNM). The study encompassed patients from seven centers, spanning from September 2018 to November 2023, with 93 patients in each group (with or without LNM). Extracted ultrasound radiomics features from transvaginal ultrasound images, used five machine learning (ML) algorithms to establish US radiomics models, screened clinical features through univariate and multivariate logistic regression to establish a clinical model, and combined clinical and radiomics features to establish a nomogram model. The diagnostic ability of the three models for LNM with EC was compared, and the diagnostic performance and accuracy of the three models were evaluated using receiver operating characteristic curve analysis.

Results: Among the five ML models, the XGBoost model performed the best, with AUC values of 0.900 (95% CI, 0.847-0.950) and 0.865 (95% CI, 0.763-0.950) for the training and testing sets, respectively. In the final model, the nomogram based on clinical features and the ultrasound radiomics showed good resolution, with AUC values of 0.919 (95% CI, 0.874-0.964) and 0.884 (0.801-0.967) in the training and testing sets, respectively. The decision curve analysis verified the clinical practicality of the nomogram.

Conclusion: The ML model based on ultrasound radiomics has potential value in the noninvasive differential diagnosis of LNM in patients with EC. The nomogram constructed by combining ultrasound radiomics and clinical features can provide clinical doctors with more comprehensive and personalized image information, which is highly important for selecting treatment strategies.