Unravelling Tumour Biology In Ovarian Cancer With Precision Imaging

High-grade serous ovarian cancer (HGSOC) is the most common subtype of ovarian cancer. The early rapid onset of chemoresistance poses a major clinical challenge. Recent research highlighted high tumor heterogeneity (TH) and identified key mutational signatures that associate with prognosis and may aid in individualized treatment selection. Since HGSOC often presents with multisite disease and distinct populations of malignant cells, multi-region analysis of multimodal data is essential to study HGSOC. Single time point, single site biopsies cannot assess entire tumor while multiple biopsies at several time points are not feasible in clinical routine. Limitations of invasive sampling may be addressed with non-invasive imaging that captures morphologic and functional information about the entire tumor in space and, if repeated, in time. Radiomics has the potential for whole tumour virtual sampling using a single or serial non-invasive examinations in place of biopsies. To date, no study has evaluated the value of radiomics at macroscopic (in vivo 1.5T/3TMRI) and microscopic (ex vivo 9.4TMRI) scales to better understand the black box of radiomics features (explainable radiomics) or examine whether radiomics habitats are underpinned by tumour biology to provide a better insight into TH of HGSOC. Specifically, in this project, I will implement a model to capture imaging-based TH with multiscale radiomics approach by obtaining the mirror tumor image at in vivo MRI, ex vivo MRI and at histology. I will evaluate if imaging-based TH reflects underlying tumor histology by testing associations with imaging features and tumor-stroma proportion, infiltrative lymphocytes density and HRD status. Finally, I will unravel HGSOC TH biology through habitat imaging combined to an integrated Multi-O-Mics approach. Successful completion of this proposal will lead to a comprehensive characterization of HGSOC TH which will be then accessible non-invasively through radiomics.