Objective: To compare the radiomic features of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and intratumoral heterogeneity according to tumor budding (TB) status and to develop a prediction model for the TB status using the radiomic feature of 18F-FDG PET/CT in patients with cervical cancer. Materials and Methods: Seventy-six patients with cervical cancer who underwent radical hysterectomy and preoperative 18F-FDG PET/CT were included. We assessed the status of intratumoral budding (ITP) and peritumoral budding (PTB) in all available hematoxylin and eosin-stained specimens. Three conventional metabolic parameters and fifty-nine features were extracted and analyzed. Univariate analysis was used to identify significant metabolic parameters and radiomic findings for TB status. The prediction model for TB status was built using 3 machine learning classifiers (random forest, support vector machine, and neural network). Results: Univariate analysis led to the identification of 2 significant metabolic parameters and 12 significant radiomic features according to intratumoral budding (ITB) status. Among these parameters, following multivariate analysis for the ITB status, only compacity remained significant (odds ratio, 5.0047; 95% confidence interval, 1.1636–21.5253; p = 0.0305). Two conventional metabolic parameters and 25 radiomic features were selected by the Lasso regularization, and the prediction model for the ITB status had a mean area under the curve of 0.762 in the test dataset. Conclusion: Radiomic features of 18F-FDG PET/CT were associated with the ITB status. The prediction model using radiomic features successfully predicted the TB status in patients with cervical cancer. The prediction models for the ITB status may contribute to personalized medicine in the management of patients with cervical cancer.
[18F]FDG-PET/CT metabolic parameters as useful prognostic factors in cervical cancer patients treated with chemo-radiotherapy