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The Potential of Radiomic-Based Phenotyping in Precision MedicineA Review

Educational Objective
To learn the potential of radiomic-based imaging in defining tumor phenotype.
1 Credit CME

Importance  Advances in genomics have led to the recognition that tumors are populated by distinct genotypic subgroups that drive tumor development and progression. The spatial and temporal heterogeneity of solid tumors has been a critical barrier to the development of precision medicine approaches because the standard approach to tumor sampling, often invasive needle biopsy, is unable to fully capture the spatial state of the tumor. Image-based phenotyping, which represents quantification of the tumor phenotype through medical imaging, is a promising development for precision medicine.

Observations  Medical imaging can provide a comprehensive macroscopic picture of the tumor phenotype and its environment that is ideally suited to quantifying the development of the tumor phenotype before, during, and after treatment. As a noninvasive technique, medical imaging can be performed at low risk and inconvenience to the patient. The semantic features approach to tumor phenotyping, accomplished by visual assessment of radiologists, is compared with a computational radiomics approach that relies on automated processing of imaging assays. Together, these approaches capture important information for diagnostic, prognostic, and predictive purposes.

Conclusions and Relevance  Although imaging technology is already embedded in clinical practice for diagnosis, staging, treatment planning, and response assessment, the transition of these computational methods to the clinic has been surprisingly slow. This review outlines the promise of these novel technologies for precision medicine and the obstacles to clinical application.

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Article Information

Corresponding Author: Hugo J. W. L. Aerts, PhD, Departments of Radiation Oncology and Radiology, Dana-Farber Cancer Institute, Harvard Institutes of Medicine, Ste HIM 343, 77 Avenue Louis Pasteur, Boston, MA 02115 (hugo_aerts@dfci.harvard.edu).

Accepted for Publication: May 19, 2016.

Correction: This article was corrected on March 23, 2017, for a typographical error in the abstract.

Published Online: August 18, 2016. doi:10.1001/jamaoncol.2016.2631

Conflict of Interest Disclosures: Dr Aerts reported owning shares in Genospace LLC and Sphera Inc, informatics companies directed at imaging and genomic data. No other disclosures were reported.

Funding/Support: This study was supported by awards U01CA190234 and U24CA194354 from the National Institutes of Health.

Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

Additional Contributions: Elizabeth Huynh, PhD, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, assisted with the figures. She received no compensation.

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