Radiomics and liquid biopsy in oncology: the holons of systems medicine

Emanuele Neri, Marzia Del Re, Fabiola Paiar, Paola Erba, Paola Cocuzza, Daniele Regge, Romano Danesi, Emanuele Neri, Marzia Del Re, Fabiola Paiar, Paola Erba, Paola Cocuzza, Daniele Regge, Romano Danesi

Abstract

Radiomics is a process of extraction and analysis of quantitative features from diagnostic images. Liquid biopsy is a test done on a sample of blood to look for cancer cells or for pieces of tumourigenic DNA circulating in the blood. Radiomics and liquid biopsy have great potential in oncology, since both are minimally invasive, easy to perform, and can be repeated in patient follow-up visits, enabling the extraction of valuable information regarding tumour type, aggressiveness, progression, and response to treatment. Both methods are in their infancy, with major evidence of application in lung and gastrointestinal cancer, while still undergoing evaluation in other cancer types. In this paper, the main oncologic applications of radiomics and liquid biopsy are reviewed, and a synergistic approach incorporating both tests for cancer diagnosis and follow-up is discussed within the context of systems medicine. TEACHING POINTS: • Radiomics is a process of extraction and analysis of quantitative features from diagnostic images. • Most clinical applications of radiomics are in the field of oncologic imaging. • Radiomics applies to all imaging modalities. • A cluster of radiomic features is a "radiomic signature". • Machine learning may improve the efficacy of radiomics analysis.

Keywords: Imaging biobanks; Imaging biomarkers; Liquid biopsy; Personalised medicine; Radiomics.

Figures

Fig. 1
Fig. 1
Example of texture analysis in MRI of rectal cancer performed with QUIBIM software (QUIBIM S.L., Valencia, Spain). The region of interest for the texture is defined by manual segmentation (1). The texture model is extracted by the software through a grey-level co-occurrence matrix analysis (2) that enables the extraction of a set of features that are shown in a structured report (3). The same region of interest can be used to extract other features based on intensity histogram, shape, and so on.
Fig. 2
Fig. 2
Publications including the terms “radiomic” and “liquid biopsy” (source PubMed.gov). The number of publications in 2018 has tripled for radiomics (actual number at March 2018 is 106) and doubled for liquid biopsy, reflecting the growth trend over the years
Fig. 3
Fig. 3
The multiple systems (omics) of systems medicine. Since it is an evolving/growing community, the sets including a question mark represent potential new “omics” that will be part of systems medicine

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