Computer-Aided Nodule Assessment and Risk Yield Risk Management of Adenocarcinoma: The Future of Imaging? Finbar Foley, MD, MPH, Srinivasan Rajagopalan,

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Computer-Aided Nodule Assessment and Risk Yield Risk Management of Adenocarcinoma: The Future of Imaging? Finbar Foley, MD, MPH, Srinivasan Rajagopalan, PhD, Sushravya M. Raghunath, PhD, Jennifer M. Boland, MD, Ronald A. Karwoski, BA, Fabien Maldonado, MD, Brian J. Bartholmai, MD, Tobias Peikert, MD Seminars in Thoracic and Cardiovascular Surgery Volume 28, Issue 1, Pages 120-126 (March 2016) DOI: 10.1053/j.semtcvs.2015.12.015 Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 1 (A) CANARY pattern identification. Based on arbitrarily selected 774 9 × 9 regions of interest (ROI) from 37 lung adenocarcinoma nodules, 9 natural clusters were identified. The most “central” ROI of each cluster was selected as the cluster׳s texture exemplar and the exemplars were color coded. (B) When processing a new nodule, each voxel and its surrounding ROI is compared with the 9 exemplars (texemes) and the voxel is color coded to the nearest texeme. The relative distribution of the texemes is displayed in a glyph. (Color version of figure is available online at http://www.semthorcardiovascsurg.com.) Seminars in Thoracic and Cardiovascular Surgery 2016 28, 120-126DOI: (10.1053/j.semtcvs.2015.12.015) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 2 CANARY user interface. The CANARY results are overlaid on representative orthogonal computed tomography sections. The glyph and the associated risk group provides a succinct overview of the nodule. Kaplan-Meier curves for the risk groups are provided as reference. (Color version of figure is available online at http://www.semthorcardiovascsurg.com.) Seminars in Thoracic and Cardiovascular Surgery 2016 28, 120-126DOI: (10.1053/j.semtcvs.2015.12.015) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 3 Radiologic-histopathologic correlation of tissue invasion between CANARY-based nodule assessment and consensus histopathology. Selected adenocarcinoma nodules are displayed earlier their superimposed CANARY signatures. Nodules are grouped according to degree of histologic invasion specified in percentage within each panel. (Color version of figure is available online at http://www.semthorcardiovascsurg.com.) Seminars in Thoracic and Cardiovascular Surgery 2016 28, 120-126DOI: (10.1053/j.semtcvs.2015.12.015) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 4 CANARY facilitates radiological-pathological correlation. Column 1 shows representative axial HRCT slices of representative lung nodules. Column 2 displays the corresponding CANARY analysis of these nodules, which by consensus histology were identified as adenocarcinoma in situ (AIS), minimally invasive adenocarcinoma (MIA) or invasive adenocarcinoma (IA), respectively. Column 3 shows histological examples of AIS, MIA, and IA. (Color version of figure is available online at http://www.semthorcardiovascsurg.com.) Seminars in Thoracic and Cardiovascular Surgery 2016 28, 120-126DOI: (10.1053/j.semtcvs.2015.12.015) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 5 CANARY analysis allows the noninvasive risk stratification of lung adenocarcinomas. Kaplan-Meier analysis of the PFS, for 558 patients (264 Mayo Clinic cohort and 294 National lung screening trial study), with lung adenocarcinoma based on the CANARY risk groups (G = good, I = intermediate, and P = poor).28,26 The glyphs displayed in conjunction with each curve represent the exemplar glyph for the corresponding CANARY risk group. (Color version of figure is available online at http://www.semthorcardiovascsurg.com.) Seminars in Thoracic and Cardiovascular Surgery 2016 28, 120-126DOI: (10.1053/j.semtcvs.2015.12.015) Copyright © 2016 Elsevier Inc. Terms and Conditions

CANARY: Validated, clinically relevant noninvasive lung nodule risk stratification. Seminars in Thoracic and Cardiovascular Surgery 2016 28, 120-126DOI: (10.1053/j.semtcvs.2015.12.015) Copyright © 2016 Elsevier Inc. Terms and Conditions