{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T18:14:03Z","timestamp":1788200043664,"version":"build-2803163510"},"reference-count":30,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non-small cell lung cancer (NSCLC) staging relies on accurate assessment of mediastinal lymph nodes. This study investigates the utility of radiomic features derived from contrast-enhanced thoracic CT scans in predicting malignancy in clinically positive (cN+) mediastinal lymph nodes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort of 110 NSCLC patients with cN\u2009+\u2009who underwent surgical resection was analyzed. 3D segmentations of up to three lymph nodes per patient were performed. Radiomic features, encompassing heterogeneity measures, were extracted. A radiomics model was constructed using a random forest and XGboost algorithm. To ensure robustness and minimize bias, 100 iterations of data splitting were conducted to create distinct training and test sets for reproducibility and statistical reliability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The radiomics model achieved an area under the curve (AUC) of 0.703 for Forest model and 063 for XGboost model. Three recurrent features in the radiomic signatures, \u201cRootMeanSquared\u201d, \u201cGrey Level Co-Occurrence Matrix Imc2\u201d, and \u201cGrey Level Run Length Matrix RunEntropy\u201d, highlighted the importance of nodal heterogeneity features in the model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Radiomic features extracted from contrast-enhanced thoracic CT scans could predict malignancy in cN+ mediastinal lymph nodes of NSCLC patients (AUC\u2009=\u20090.703). Three features of heterogeneity were recurrent in radiomic signature, emphasizing the potential importance of incorporating nodal heterogeneity criteria in addition to size assessment.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355650","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:24:39Z","timestamp":1788197079000},"page":"e0355650","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["CT radiomics-histopathological correlation for mediastinal lymph node staging in non-small cell lung cancer"],"prefix":"10.1371","volume":"21","author":[{"given":"Judith","family":"Legrand","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antoine","family":"Decoux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lo\u00efc","family":"Duron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9cile","family":"Di-Rocco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2015-5600","authenticated-orcid":true,"given":"Manuel","family":"Gargiulo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armelle","family":"Arnoux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathia","family":"Chaumoitre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Yves","family":"Gaubert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laure","family":"Fournier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2510-2727","authenticated-orcid":true,"given":"Paul","family":"Habert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"pone.0355650.ref001","unstructured":"National Cancer Institute. Cancer Stat Facts: Lung and Bronchus Cancer. https:\/\/seer.cancer.gov\/statfacts\/html\/lungb.html 2020."},{"issue":"1","key":"pone.0355650.ref002","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jtho.2015.09.009","article-title":"The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer","volume":"11","author":"P Goldstraw","year":"2016","journal-title":"J Thorac Oncol"},{"issue":"5","key":"pone.0355650.ref003","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1093\/ejcts\/ezu028","article-title":"Revised ESTS guidelines for preoperative mediastinal lymph node staging for non-small-cell lung cancer","volume":"45","author":"P De Leyn","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"issue":"11","key":"pone.0355650.ref004","doi-asserted-by":"crossref","first-page":"879","DOI":"10.7326\/0003-4819-139-11-200311180-00013","article-title":"Test performance of positron emission tomography and computed tomography for mediastinal staging in patients with non-small-cell lung cancer: a meta-analysis","volume":"139","author":"MK Gould","year":"2003","journal-title":"Ann Intern Med"},{"issue":"1","key":"pone.0355650.ref005","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.lungcan.2007.11.007","article-title":"Value of PET\/CT versus enhanced CT for locoregional lymph nodes in non-small cell lung cancer","volume":"61","author":"W Yang","year":"2008","journal-title":"Lung Cancer"},{"key":"pone.0355650.ref006","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/resp.13901","article-title":"Preoperative staging of the mediastinum is an essential and multidisciplinary task","author":"J Sanz-Santos","year":"2020","journal-title":"Respirology"},{"issue":"12","key":"pone.0355650.ref007","doi-asserted-by":"crossref","first-page":"1356","DOI":"10.1200\/JCO.21.02528","article-title":"Management of Stage III Non\u2013Small-Cell Lung Cancer: ASCO Guideline","volume":"40","author":"ME Daly","year":"2022","journal-title":"J Clin Oncol"},{"key":"pone.0355650.ref008","doi-asserted-by":"crossref","unstructured":"Schmidt-Hansen M, Baldwin DR, Hasler E, Zamora J, Abraira V, Roqu\u00e9 I, Figuls M. PET-CT for assessing mediastinal lymph node involvement in patients with suspected resectable non-small cell lung cancer. Cochrane Lung Cancer Group, editor. Cochrane Database Syst Rev. 2014 Nov 13.","DOI":"10.1002\/14651858.CD009519.pub2"},{"issue":"6","key":"pone.0355650.ref009","article-title":"EBUS-TBNA versus surgical mediastinoscopy for mediastinal lymph node staging in potentially operable non-small cell lung cancer: a systematic review and meta-analysis","volume":"46","author":"VR Figueiredo","year":"2020","journal-title":"J Bras Pneumol"},{"issue":"2","key":"pone.0355650.ref010","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1378\/chest.13-2349","article-title":"Endosonographic Mediastinal Lymph Node Staging of Lung Cancer","volume":"146","author":"M Liberman","year":"2014","journal-title":"Chest"},{"issue":"20","key":"pone.0355650.ref011","doi-asserted-by":"crossref","first-page":"2245","DOI":"10.1001\/jama.2010.1705","article-title":"Mediastinoscopy vs endosonography for mediastinal nodal staging of lung cancer: a randomized trial","volume":"304","author":"JT Annema","year":"2010","journal-title":"JAMA"},{"issue":"9","key":"pone.0355650.ref012","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1016\/S1470-2045(18)30429-7","article-title":"Can radiomics personalise immunotherapy?","volume":"19","author":"I El Naqa","year":"2018","journal-title":"Lancet Oncol"},{"issue":"3","key":"pone.0355650.ref013","article-title":"The future of radiomics in lung cancer","volume":"2","author":"R Thawani","year":"2020","journal-title":"Lancet Digit Health"},{"key":"pone.0355650.ref014","doi-asserted-by":"crossref","first-page":"558428","DOI":"10.3389\/fonc.2020.558428","article-title":"Preoperatively estimating the malignant potential of mediastinal lymph nodes: A pilot study toward establishing a robust radiomics model based on contrast-enhanced CT imaging","volume":"10","author":"M Dong","year":"2021","journal-title":"Front Oncol"},{"issue":"3","key":"pone.0355650.ref015","doi-asserted-by":"crossref","DOI":"10.1148\/radiol.2020209020","article-title":"Diagnostic Algorithm to Differentiate Benign Atypical Leiomyomas from Malignant Uterine Sarcomas with Diffusion-weighted MRI","volume":"297","author":"C Abdel Wahab","year":"2020","journal-title":"Radiology"},{"issue":"3","key":"pone.0355650.ref016","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1097\/RLI.0000000000000722","article-title":"A Magnetic Resonance Imaging Radiomics Signature to Distinguish Benign From Malignant Orbital Lesions","volume":"56","author":"L Duron","year":"2021","journal-title":"Invest Radiol"},{"issue":"2","key":"pone.0355650.ref017","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1148\/radiol.2020191145","article-title":"The Image Biomarker Standardization Initiative: Standardized Quantitative Radiomics for High-Throughput Image-based Phenotyping","volume":"295","author":"A Zwanenburg","year":"2020","journal-title":"Radiology"},{"issue":"21","key":"pone.0355650.ref018","doi-asserted-by":"crossref","DOI":"10.1158\/0008-5472.CAN-17-0339","article-title":"Computational Radiomics System to Decode the Radiographic Phenotype","volume":"77","author":"JJM van Griethuysen","year":"2017","journal-title":"Cancer Res"},{"issue":"1","key":"pone.0355650.ref019","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1186\/s12880-020-0416-3","article-title":"Discrimination of mediastinal metastatic lymph nodes in NSCLC based on radiomic features in different phases of CT imaging","volume":"20","author":"X Sha","year":"2020","journal-title":"BMC Med Imaging"},{"issue":"6","key":"pone.0355650.ref020","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1177\/0284185115598808","article-title":"CT texture analysis can help differentiate between malignant and benign lymph nodes in the mediastinum in patients suspected for lung cancer","volume":"57","author":"MB Andersen","year":"2016","journal-title":"Acta Radiol"},{"issue":"2","key":"pone.0355650.ref021","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1148\/radiol.211597","article-title":"Radiomic analysis: study design, statistical analysis, and other bias mitigation strategies","volume":"304","author":"CS Moskowitz","year":"2022","journal-title":"Radiology"},{"issue":"1","key":"pone.0355650.ref022","article-title":"CT texture analysis and node-RADS CT score of mediastinal lymph nodes - diagnostic performance in lung cancer patients","volume":"22","author":"H-J Meyer","year":"2022","journal-title":"Cancer Imaging"},{"key":"pone.0355650.ref023","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.ejrad.2018.02.026","article-title":"Utility of MRI with morphologic and diffusion weighted imaging in the detection of post-treatment nodal disease in head and neck squamous cell carcinoma","volume":"101","author":"P Mundada","year":"2018","journal-title":"Eur J Radiol"},{"issue":"3","key":"pone.0355650.ref024","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1148\/radiol.2017161517","article-title":"Functional and Targeted Lymph Node Imaging in Prostate Cancer: Current Status and Future Challenges","author":"HC Thoeny","year":"2017","journal-title":"Radiology"},{"issue":"6","key":"pone.0355650.ref025","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.3390\/cancers12061432","article-title":"Association of a CT-Based Clinical and Radiomics Score of Non-Small Cell Lung Cancer (NSCLC) with Lymph Node Status and Overall Survival","volume":"12","author":"F Botta","year":"2020","journal-title":"Cancers (Basel)"},{"issue":"6","key":"pone.0355650.ref026","doi-asserted-by":"crossref","first-page":"876","DOI":"10.21037\/tlcr.2019.11.18","article-title":"CT-based radiomics signature for the stratification of N2 disease risk in clinical stage I lung adenocarcinoma","volume":"8","author":"M Yang","year":"2019","journal-title":"Transl Lung Cancer Res"},{"issue":"6","key":"pone.0355650.ref027","doi-asserted-by":"crossref","first-page":"2283","DOI":"10.1016\/j.chest.2021.05.062","article-title":"A Prediction Model to Optimize Invasive Mediastinal Staging Procedures for Non-small Cell Lung Cancer in Patients With a Radiologically Normal Mediastinum: The Quebec Prediction Model","volume":"160","author":"J Guinde","year":"2021","journal-title":"Chest"},{"issue":"3","key":"pone.0355650.ref028","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0173104","article-title":"Comparison of 18F-FDG PET\/CT and DWI for detection of mediastinal nodal metastasis in non-small cell lung cancer: A meta-analysis","volume":"12","author":"G Shen","year":"2017","journal-title":"PLoS One"},{"issue":"5","key":"pone.0355650.ref029","doi-asserted-by":"crossref","DOI":"10.1378\/chest.12-2355","article-title":"Methods for Staging Non-small Cell Lung Cancer","volume":"143","author":"GA Silvestri","year":"2013","journal-title":"Chest"},{"issue":"5","key":"pone.0355650.ref030","doi-asserted-by":"crossref","first-page":"3173","DOI":"10.1007\/s00330-021-08431-6","article-title":"Bridging gaps between images and data: a systematic update on imaging biobanks","volume":"32","author":"M Gabelloni","year":"2022","journal-title":"Eur Radiol"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355650","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T17:24:44Z","timestamp":1788197084000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355650"}},"subtitle":[],"editor":[{"given":"Lorenzo","family":"Faggioni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,31]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0355650","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,31]]}}}