Utilisation of a thoracic oncology database to capture radiological and pathological images for evaluation of response to chemotherapy in patients with malignant pleural mesothelioma

Our plain-English summary of Utilisation of a thoracic oncology database to capture radiological and pathological images for evaluation of response to chemotherapy in patients with malignant pleural mesothelioma, by G.B. Carey, S. Kazantsev, M. Surati, et al (BMJ Open, 2012).

The study

• Authors: G.B. Carey, S. Kazantsev, M. Surati, C.E. Rolle, A. Kanteti, A. Sadiq, N. Bahroos, B. Raumann, R. Madduri, P. Dave, A. Starkey, T. Hensing, A.N. Husain, E.E. Vokes, W. Vigneswaran, S.G. Armato, H.L. Kindler, R. Salgia
• Journal: BMJ Open
• Published: 2012;2(5)
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: An area of need in cancer informatics is the ability to store images in a comprehensive database as part of translational cancer research. To meet this need, we have implemented a novel tandem database infrastructure that facilitates image storage and utilisation.

Background: We had previously implemented the Thoracic Oncology Program Database Project (TOPDP) database for our translational cancer research needs. While useful for many research endeavours, it is unable to store images, hence our need to implement an imaging database which could communicate easily with the TOPDP database.

Methods: The Thoracic Oncology Research Program (TORP) imaging database was designed using the Research Electronic Data Capture (REDCap) platform, which was developed by Vanderbilt University. To demonstrate proof of principle and evaluate utility, we performed a retrospective investigation into tumour response for malignant pleural mesothelioma (MPM) patients treated at the University of Chicago Medical Center with either of two analogous chemotherapy regimens and consented to at least one of two UCMC IRB protocols, 9571 and 13473A.

Results: A cohort of 22 MPM patients was identified using clinical data in the TOPDP database. After measurements were acquired, two representative CT images and 0-35 histological images per patient were successfully stored in the TORP database, along with clinical and demographic data.

Discussion: We implemented the TORP imaging database to be used in conjunction with our comprehensive TOPDP database. While it requires an additional effort to use two databases, our database infrastructure facilitates more comprehensive translational research.

Conclusions: The investigation described herein demonstrates the successful implementation of this novel tandem imaging database infrastructure, as well as the potential utility of investigations enabled by it. The data model presented here can be utilised as the basis for further development of other larger, more streamlined databases in the future.

In plain English

This article described a database system built at the University of Chicago Medical Center to store selected CT scan images and tissue-slide images alongside an existing thoracic cancer research database. To test it, the authors carried out a small retrospective study of patients with malignant pleural mesothelioma treated with two or more cycles of carboplatin-pemetrexed or cisplatin-pemetrexed chemotherapy. Of 129 consented mesothelioma patients in the database, 22 met the study criteria. Eighteen of the 22 reported past occupational and/or paraoccupational asbestos exposure. Images and clinical data for all 22 were stored. On CT, the mean percentage change in pleural thickness between the two scans was −25% in the 14 carboplatin-pemetrexed patients and −11% in the 8 cisplatin-pemetrexed patients. The authors stressed that these measurements did not follow the standard mesothelioma response method (Modified RECIST), were taken at only two time points, and cannot be used to draw clinical conclusions. The authors concluded that the linked database system worked and was useful for small datasets, but that uploading images by hand would likely rule out large studies.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Description of a research database system, tested with a small retrospective proof-of-principle study of tumour measurements on CT scans
• Who was studied: 22 patients with malignant pleural mesothelioma treated at the University of Chicago Medical Center, selected from 129 consented mesothelioma patients in the program's database. The group was 21 men and 1 woman, aged 47 to 80 with a median age of 65. Sixteen had epithelial, 2 sarcomatoid and 4 mixed-type mesothelioma. Study dates are not stated.
• Exposure: The exposure studied was chemotherapy: 14 patients received 2 to 4 cycles of carboplatin-pemetrexed and 8 received 4 to 6 cycles of cisplatin-pemetrexed. Asbestos exposure was recorded as background only: 18 patients reported occupational and/or paraoccupational asbestos exposure, 2 reported unknown exposure, and 2 had no exposure data recorded. No fiber types were given.
• Main results:
  • For each patient, two CT section images (one from a baseline scan and one anatomically matched image from a follow-up scan) and between 0 and 35 histological (tissue-slide) images were stored in the new database, along with clinical and demographic data.
  • The mean percentage change in pleural thickness between the two CT scans was −20% for all 22 patients, −25% for the carboplatin-pemetrexed group and −11% for the cisplatin-pemetrexed group. Median changes were −19%, −18% and −19% respectively. The authors stated these measurements are not valid for drawing clinical conclusions.
  • At the time of the study, 13 of 22 patients (59%) were alive: 9 of 14 (64%) in the carboplatin-pemetrexed group and 4 of 8 (50%) in the cisplatin-pemetrexed group.
• The authors' conclusion: The authors concluded that the linked (tandem) database system was successfully implemented and is useful for small datasets. They found that the need to upload images by hand would most likely preclude large-scale studies, and said they were working on a single SQL database to address this.
• Limitations the authors state:
  • Small sample size (22 patients).
  • Lack of standardisation: patients received different numbers of chemotherapy cycles, and some follow-up CT scans were only available after the third or fourth cycle.
  • Tumour measurements were not taken using Modified RECIST and so cannot be treated as valid data for clinical conclusions.
  • Some patient data were missing because they could not be found in physician notes.
  • Data entry was manual, tedious and subject to error, and manual image uploading would likely be prohibitive for studies of hundreds or thousands of patients.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Pleural Mesothelioma.

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