Auto-detection and segmentation of involved lymph nodes in HPV-associated oropharyngeal cancer using a convolutional deep learning neural network

Nicolette Taku, Kareem A. Wahid, Lisanne V. van Dijk, Jaakko Sahlsten, Joel Jaskari, Kimmo Kaski, Clifton D. Fuller, Mohamed A. Naser*

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

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    Purpose: Segmentation of involved lymph nodes on head and neck computed tomography (HN-CT) scans is necessary for the radiotherapy planning of early-stage human papilloma virus (HPV) associated oropharynx cancers (OPC). We aimed to train a deep learning convolutional neural network (DL-CNN) to segment involved lymph nodes on HN-CT scans.

    Methods: Ground-truth segmentation of involved nodes was performed on pre-surgical HN-CT scans for 90 patients who underwent levels II-IV neck dissection for node-positive HPV-OPC (training/validation [n = 70] and testing [n = 20]). A 5-fold cross validation approach was used to train 5 DL-CNN sub-models based on a residual U-net architecture. Validation and testing segmentation masks were compared to ground-truth masks using predetermined metrics. A lymph auto-detection model to discriminate between "node-positive" and "node-negative" HN-CT scans was developed by thresholding segmentation model outputs and evaluated using the area under the receiver operating characteristic curve (AUC).

    Results: In the DL-CNN validation phase, all sub-models yielded segmentation masks with median Dice >= 0.90 and median volume similarity score of >= 0.95. In the testing phase, the DL-CNN produced consensus segmentation masks with median Dice of 0.92 (IQR, 0.89-0.95), median volume similarity of 0.97 (IQR, 0.94-0.99), and median Hausdorff distance of 4.52 mm (IQR, 1.22-8.38). The detection model achieved an AUC of 0.98.

    Conclusion: The results from this single-institution study demonstrate the successful automation of lymph node segmentation for patients with HPV-OPC using a DL-CNN. Future studies, including validation with an external dataset, are necessary to clarify its role in the larger radiation oncology treatment planning workflow.

    Original languageEnglish
    Pages (from-to)47-55
    Number of pages9
    JournalClinical and Translational Radiation Oncology
    Publication statusPublished - Sep-2022



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