WCLC 2025 - Posters & ePosters-EP.04.40 Preoperative Prediction of Occult Lymph Node Metastasis in Clinical Stage I NSCLC Using CT Radiomics, PET, and ctDNA

EP.04.40 Preoperative Prediction of Occult Lymph Node Metastasis in Clinical Stage I NSCLC Using CT Radiomics, PET, and ctDNA

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This study aimed to develop a multimodal predictive model for preoperatively identifying occult lymph node metastasis (OLNM) in clinical stage I non-small cell lung cancer (NSCLC) patients by integrating clinical data, CT radiomics, PET/CT imaging, and circulating tumor DNA (ctDNA) analysis. OLNM occurs in 10–20% of stage I NSCLC cases post-surgery and is linked to poor prognosis, making accurate preoperative detection crucial for improving surgical decision-making and patient outcomes.<br /><br />Researchers analyzed data from 554 stage I NSCLC patients who underwent preoperative ctDNA methylation assays and imaging (CT and PET/CT) at Samsung Medical Center (2014-2020). Variables included clinical factors (age, sex, BMI, smoking history, tumor pathology), CT metrics (tumor size, solidity, volume, radiomics features), PET/CT quantifications (SUVmax, total lesion glycolysis), and ctDNA positivity. Logistic regression and LASSO with cross-validation were used for feature selection and model building.<br /><br />Key findings showed that tumor solidity, consolidation-to-tumor ratio, and ctDNA positivity were strong individual predictors of OLNM. In the PET/CT subgroup, tumor edge SUVmax also predicted nodal metastasis. Radiomics features indicating tumor heterogeneity (e.g., kurtosis, lacunarity) were additionally significant. Two predictive models were developed: Model 1 combined clinical, CT radiomics, and ctDNA data (AUC 0.80, accuracy 85%); Model 2 incorporated PET data with similar performance (AUC 0.81, accuracy 86%).<br /><br />The study concludes that multimodal integration of CT radiomics, PET/CT metrics, and ctDNA analysis offers accurate preoperative risk stratification for OLNM in stage I NSCLC. This approach may enable improved treatment planning. However, limitations include its retrospective, single-center design, limited PET/CT sample size, and lack of external validation, which may affect generalizability. Further multicenter prospective studies are warranted.

Asset Subtitle

You Jin Oh

Meta Tag

Speaker You Jin Oh

Topic Screening and Early Detection

Keywords

occult lymph node metastasis

stage I non-small cell lung cancer

multimodal predictive model

CT radiomics

PET/CT imaging

circulating tumor DNA

ctDNA methylation assay

tumor heterogeneity

logistic regression

risk stratification