Risk stratification of gallbladder masses by machine learning-based ultrasound radiomics models: a prospective and multi-institutional study

ObjectiveThis study aimed to evaluate the diagnostic performance of machine learning (ML)-based ultrasound (US) radiomics models for risk stratification of gallbladder (GB) masses.MethodsWe prospectively examined 640 pathologically confirmed GB masses obtained from 640 patients between August 2019 and October 2022 at four institutions. Radiomics features were extracted from grayscale US images and germane features were selected. Subsequently, 11 ML algorithms were separately used with the selected features to construct optimum US radiomics models for risk stratification of the GB masses. Furthermore, we compared the diagnostic performance of these models with the conventional US and contrast-enhanced US (CEUS) models.ResultsThe optimal XGBoost-based US radiomics model for discriminating neoplastic from non-neoplastic GB lesions showed higher diagnostic performance in terms of areas under the curves (AUCs) than the conventional US model (0.822-0.853 vs. 0.642-0.706, p < 0.05) and potentially decreased unnecessary cholecystectomy rate in a speculative comparison with performing cholecystectomy for lesions sized over 10 mm (2.7-13.8% vs. 53.6-64.9%, p < 0.05) in the validation and test sets. The AUCs of the XGBoost-based US radiomics model for discriminating carcinomas from benign GB lesions were higher than the conventional US model (0.904-0.979 vs. 0.706-0.766, p < 0.05). The XGBoost-US radiomics model performed better than the CEUS model in discriminating GB carcinomas (AUC: 0.995 vs. 0.902, p = 0.011).ConclusionsThe proposed ML-based US radiomics models possess the potential capacity for risk stratification of GB masses and may reduce the unnecessary cholecystectomy rate and use of CEUS.

Automated summary

This study aimed to evaluate the diagnostic performance of machine learning-based ultrasound radiomics models for risk stratification of gallbladder masses. Radiomics features were extracted from grayscale ultrasound images and relevant features were selected. The results showed that the optimal XGBoost-based ultrasound radiomics model performed better than the conventional ultrasound model in discriminating neoplastic from non-neoplastic gallbladder lesions. It also showed higher diagnostic performance in discriminating carcinomas from benign gallbladder lesions compared to the conventional ultrasound model.