# Application value of dual-sequence MRI based nomogram of radiomics and morphologic features in predicting tumor differentiation degree and lymph node metastasis of Oral squamous cell carcinoma

## TL;DR

This study creates a non-invasive MRI-based model to predict tumor differentiation and lymph node metastasis in oral cancer before surgery.

## Contribution

A novel combined MRI radiomics and morphological nomogram model for preoperative prediction of OSCC tumor differentiation and lymph node metastasis.

## Key findings

- The nomogram for lymph node metastasis achieved an AUC of 0.90 in validation.
- The tumor differentiation prediction nomogram had an AUC of 0.87 in validation.
- Calibration curves and decision analysis confirmed the model's clinical accuracy.

## Abstract

Oral squamous cell carcinoma is a highly invasive tumor. The degree of histological differentiation and lymph node metastasis are important factors in the treatment and prognosis of patients. There is a lack of non-invasive and accurate preoperative risk prediction model in the existing clinical work.

This study sought to develop and validate a combined model including MRI radiomics and morphological analysis to predict lymph node metastasis and degree of tumor differentiation prior to surgical intervention for oral squamous cell carcinoma (OSCC).

This study retrospectively included 119 patients which were divided into a training cohort (n=83) and a validation cohort (n=36). To predict lymph node metastasis (LNM) and degree of tumor differentiation, both univariate and multivariate analyses were performed to identify significant features and develop morphological prediction models. Radiomics features were extracted from T2-FS and DWI sequences, followed by feature selection and the establishment of Rad-scores using the LASSO method. Two nomograms was constructed by integrating MRI morphological features with radiomics features. The performance of the models was assessed using the AUC and the Delong test. Calibration curves and DCA were employed to further evaluate the models’ practical applicability.

Nine radiomics features were selected to develop the Rad-scores. The morphological features for predicting LNM are depth of invasion and tumor thickness. The morphological features for predicting the degree of tumor differentiation are ADC value and intratumoral necrosis.In the validation cohort, the nomogram for predicting LNM achieved an area under the curve (AUC) of 0.90 (95% CI: 0.84, 0.97), while the nomogram for tumor grade prediction achieved an AUC of 0.87 (95% CI: 0.76, 0.98), demonstrating excellent diagnostic performance. Calibration curve and decision curve further confirmed the accuracy of nomograms prediction.

Nomograms derived from MRI radiomics and morphological characteristics offer a noninvasive and precise method for predicting degree of tumor differentiation and LNM in OSCC preoperatively. The combined model is an accurate risk prediction model with good clinical benefits and prediction accuracy.