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Meng Q, Zheng C, Guo L, Gao P, Liu W, Ge H, Liu T, Peng H, Lu J, Chen X. Construction and validation of a risk score system for diagnosing invasive adenocarcinoma presenting as pulmonary pure ground-glass nodules: a multi-center cohort study in China. Quant Imaging Med Surg 2024; 14:4864-4877. [PMID: 39022278 PMCID: PMC11250337 DOI: 10.21037/qims-24-170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/29/2024] [Indexed: 07/20/2024]
Abstract
Background Anxiety-driven clinical interventions have been queried due to the nondeterminacy of pure ground-glass nodules (pGGNs). Although radiomics and radiogenomics aid diagnosis, standardization and reproducibility challenges persist. We aimed to assess a risk score system for invasive adenocarcinoma in pGGNs. Methods In a retrospective, multi-center study, 772 pGGNs from 707 individuals in The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital were grouped into training (509 patients with 558 observations) and validation (198 patients with 214 observations) sets consecutively from January 2017 to November 2021. An additional test set of 143 observations in Hainan Cancer Hospital was analyzed in the same period. Computed tomography (CT) signs and clinical features were manually collected, and the quantitative parameters were achieved by artificial intelligence (AI). The positive cutoff score was ≥3. Risk scores system 3 combined carcinoma history, chronic obstructive pulmonary disease (COPD), maximum diameters, nodule volume, mean CT values, type II or III vascular supply signs, and other radiographic characteristics. The evaluation included the area under the curves (AUCs), accuracy, sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) for both the risk score systems 1, 2, 3 and the AI model. Results The risk score system 3 [AUC, 0.840; 95% confidence interval (CI): 0.789-0.890] outperformed the AI model (AUC, 0.553; 95% CI: 0.487-0.619), risk score system 1 (AUC, 0.802; 95% CI: 0.754-0.851), and risk score system 2 (AUC, 0.816; 95% CI: 0.766-0.867), with 88.0% (0.850-0.904) accuracy, 95.6% (0.932-0.972) PPV, 0.620 (0.535-0.702) NPV, 89.6% (0.864-0.920) sensitivity, and 80.6% (0.717-0.872) specificity in the training sets. In the validation and test sets, risk score system 3 performed best with AUCs of 0.769 (0.678-0.860) and 0.801 (0.669-0.933). Conclusions An AI-based risk scoring system using quantitative image parameters, clinical features, and radiographic characteristics effectively predicts invasive adenocarcinoma in pulmonary pGGNs.
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Affiliation(s)
- Qingcheng Meng
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Changbao Zheng
- Department of Radiology, The Hainan Cancer Hospital, Haikou, China
| | - Lanwei Guo
- Henan Office for Cancer Control and Research, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Pengrui Gao
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Wentao Liu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Hong Ge
- Department of Radiotherapy, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Tong Liu
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Hui Peng
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
| | - Jie Lu
- Department of Radiology, The People’s Hospital of Xingyang Country, Zhengzhou, China
| | - Xuejun Chen
- Department of Radiology, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China
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Li WJ, Chu ZG, Li D, Jing WW, Shi QL, Lv FJ. Accuracy of solid portion size measured on multiplanar volume rendering images for assessing invasiveness in lung adenocarcinoma manifesting as subsolid nodules. Quant Imaging Med Surg 2024; 14:1971-1984. [PMID: 38415120 PMCID: PMC10895121 DOI: 10.21037/qims-23-942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 12/13/2023] [Indexed: 02/29/2024]
Abstract
Background The solid component of subsolid nodules (SSNs) is closely associated with the invasiveness of lung adenocarcinoma, and its accurate assessment is crucial for selecting treatment method. Therefore, this study aimed to evaluate the accuracy of solid component size within SSNs measured on multiplanar volume rendering (MPVR) and compare it with the dimensions of invasive components on pathology. Methods A pilot study was conducted using a chest phantom to determine the optimal MPVR threshold for the solid component within SSN, and then clinical validation was carried out by retrospective inclusion of patients with pathologically confirmed solitary SSN from October 2020 to October 2021. The radiological tumor size on MPVR and solid component size on MPVR (RSSm) and on lung window (RSSl) were measured. The size of the tumor and invasion were measured on the pathological section, and the invasion, fibrosis, and inflammation within SSNs were also recorded. The measurement difference between computed tomography (CT) and pathology, inter-observer and inter-measurement agreement were analyzed. Receiver operating characteristic (ROC) analysis and Bland-Altman plot were performed to evaluate the diagnostic efficiency of MPVR. Results A total of 142 patients (mean age, 54±11 years, 39 men) were retrospectively enrolled in the clinical study, with 26 adenocarcinomas in situ, 92 minimally invasive adenocarcinomas (MIAs), and 24 invasive adenocarcinomas (IAs). The RSSl was significantly smaller than pathological invasion size with fair inter-measurement agreement [intraclass correlation coefficient (ICC) =0.562, P<0.001] and moderate interobserver agreement (ICC =0.761, P<0.001). The RSSm was significantly larger than pathological invasion size with the excellent inter-measurement agreement (ICC =0.829, P<0.001) and excellent (ICC =0.952, P<0.001) interobserver agreement. ROC analysis showed that the cutoff value of RSSm for differentiating adenocarcinoma in situ from MIA and MIA from IA was 1.85 and 6.45 mm (sensitivity: 93.8% and 95.5%, specificity: 85.7% and 88.2%, 95% confidence internal: 0.914-0.993 and 0.900-0.983), respectively. The positive predictive value-and negative predictive value of MPVR in predicting invasiveness were 92.8% and 100%, respectively. Conclusions Using MPVR to predict the invasive degree of SSN had high accuracy and good inter-observer agreement, which is superior to lung window measurements and helpful for clinical decision-making.
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Affiliation(s)
- Wang-Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhi-Gang Chu
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dan Li
- Molecular Medicine Diagnostic and Testing Center, Chongqing Medical University, Chongqing, China
| | - Wei-Wei Jing
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiu-Ling Shi
- State Key Laboratory of Ultrasound in Medicine and Engineering, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Fa-Jin Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- State Key Laboratory of Ultrasound in Medicine and Engineering, College of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Biomedical Engineering, Chongqing Medical University, Chongqing, China
- Institute of Medical Data, Chongqing Medical University, Chongqing, China
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Fan W, Liu H, Zhang Y, Chen X, Huang M, Xu B. Diagnostic value of artificial intelligence based on computed tomography (CT) density in benign and malignant pulmonary nodules: a retrospective investigation. PeerJ 2024; 12:e16577. [PMID: 38188164 PMCID: PMC10768667 DOI: 10.7717/peerj.16577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/13/2023] [Indexed: 01/09/2024] Open
Abstract
Objective To evaluate the diagnostic value of artificial intelligence (AI) in the detection and management of benign and malignant pulmonary nodules (PNs) using computed tomography (CT) density. Methods A retrospective analysis was conducted on the clinical data of 130 individuals diagnosed with PNs based on pathological confirmation. The utilization of AI and physicians has been employed in the diagnostic process of distinguishing benign and malignant PNs. The CT images depicting PNs were integrated into AI-based software. The gold standard for evaluating the accuracy of AI diagnosis software and physician interpretation was the pathological diagnosis. Results Out of 226 PNs screened from 130 patients diagnosed by AI and physician reading based on CT, 147 were confirmed by pathology. AI had a sensitivity of 94.69% and radiologists had a sensitivity of 85.40% in identifying PNs. The chi-square analysis indicated that the screening capacity of AI was superior to that of physician reading, with statistical significance (p < 0.05). 195 of the 214 PNs suggested by AI were confirmed pathologically as malignant, and 19 were identified as benign; among the 29 PNs suggested by AI as low risk, 13 were confirmed pathologically as malignant, and 16 were identified as benign. From the physician reading, 193 PNs were identified as malignant, 183 were confirmed malignant by pathology, and 10 appeared benign. Physician reading also identified 30 low-risk PNs, 19 of which were pathologically malignant and 11 benign. The physician readings and AI had kappa values of 0.432 and 0.547, respectively. The physician reading and AI area under curves (AUCs) were 0.814 and 0.798, respectively. Both of the diagnostic techniques had worthy diagnostic value, as indicated by their AUCs of >0.7. Conclusion It is anticipated that the use of AI-based CT diagnosis in the detection of PNs would increase the precision in early detection of lung carcinoma, as well as yield more precise evidence for clinical management.
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Affiliation(s)
- Wei Fan
- Department of Radiology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Huitong Liu
- Department of Orthopaedics, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Yan Zhang
- Department of Radiology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Xiaolong Chen
- Department of Radiology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Minggang Huang
- Department of Radiology, Shaanxi Provincial People’s Hospital, Xi’an, China
| | - Bingqiang Xu
- Department of Radiology, Shaanxi Provincial People’s Hospital, Xi’an, China
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Li S, Chen M, Wang Y, Li X, Gao G, Luo X, Tang L, Liu X, Wu N. An Effective Malignancy Prediction Model for Incidentally Detected Pulmonary Subsolid Nodules Based on Current and Prior CT Scans. Clin Lung Cancer 2023; 24:e301-e310. [PMID: 37596166 DOI: 10.1016/j.cllc.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION It is challenging to diagnose and manage incidentally detected pulmonary subsolid nodules due to their indolent nature and heterogeneity. The objective of this study is to construct a decision tree-based model to predict malignancy of a subsolid nodule based on radiomics features and evolution over time. MATERIALS AND METHODS We derived a training set (2947 subsolid nodules), a test set (280 subsolid nodules) from a cohort of outpatient CT scans, and a second test set (5171 subsolid nodules) from the National Lung Cancer Screening Trial (NLST). A Computer-Aided Diagnosis system (CADs) automatically extracted 28 preselected radiomics features, and we calculated the feature change rates as the change of the quantitative measure per time unit between the prior and current CT scans. We built classification models based on XGBoost and employed 5-fold cross validation to optimize the parameters. RESULTS The model that combined radiomics features with their change rates performed the best. The Areas Under Curve (AUCs) on the outpatient test set and on the NLST test set were 0.977 (95% CI, 0.958-0.996) and 0.955 (95% CI, 0.930-0.980), respectively. The model performed consistently well on subgroups stratified by nodule diameters, solid components, and CT scan intervals. CONCLUSION This decision tree-based model trained with the outpatient dataset gives promising predictive performance on the malignancy of pulmonary subsolid nodules. Additionally, it can assist clinicians to deliver more accurate diagnoses and formulate more in-depth follow-up strategies.
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Affiliation(s)
- Shaolei Li
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Mailin Chen
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Yaqi Wang
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | - Xiang Li
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | | | | | - Lei Tang
- Department of Radiology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China
| | | | - Nan Wu
- Department of Thoracic Surgery II, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, China.
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Chen J, Cao R, Jiao S, Dong Y, Wang Z, Zhu H, Luo Q, Zhang L, Wang H, Yin X. Application value of a computer-aided diagnosis and management system for the detection of lung nodules. Quant Imaging Med Surg 2023; 13:6929-6941. [PMID: 37869302 PMCID: PMC10585542 DOI: 10.21037/qims-22-1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 08/22/2023] [Indexed: 10/24/2023]
Abstract
Background Computer-aided diagnosis (CAD) systems can help reduce radiologists' workload. This study assessed the value of a CAD system for the detection of lung nodules on chest computed tomography (CT) images. Methods The study retrospectively analyzed the CT images of patients who underwent routine health checkups between August 2019 and November 2019 at 3 hospitals in China. All images were first assessed by 2 radiologists manually in a blinded manner, which was followed by assessment with the CAD system. The location and classification of the lung nodules were determined. The final diagnosis was made by a panel of experts, including 2 associate chief radiologists and 1 chief radiologist at the radiology department. The sensitivity for nodule detection and false-positive nodules per case were calculated. Results A total of 1,002 CT images were included in the study, and the process was completed for 999 images. The sensitivity of the CAD system and manual detection was 90.19% and 49.88% (P<0.001), respectively. Similar sensitivity was observed between manual detection and the CAD system in lung nodules >15 mm (P=0.08). The false-positive nodules per case for the CAD system were 0.30±0.84 and those for manual detection were 0.24±0.68 (P=0.12). The sensitivity of the CAD system was higher than that of the radiologists, but the increase in the false-positive rate was only slight. Conclusions In addition to reducing the workload for medical professionals, a CAD system developed using a deep-learning model was highly effective and accurate in detecting lung nodules and did not demonstrate a meaningfully higher the false-positive rate.
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Affiliation(s)
- Jingwen Chen
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rong Cao
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | - Zilong Wang
- Department of R&D, VoxelCloud, Shanghai, China
| | - Hua Zhu
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Luo
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lei Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Han Wang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaorui Yin
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Cellina M, Cacioppa LM, Cè M, Chiarpenello V, Costa M, Vincenzo Z, Pais D, Bausano MV, Rossini N, Bruno A, Floridi C. Artificial Intelligence in Lung Cancer Screening: The Future Is Now. Cancers (Basel) 2023; 15:4344. [PMID: 37686619 PMCID: PMC10486721 DOI: 10.3390/cancers15174344] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Lung cancer has one of the worst morbidity and fatality rates of any malignant tumour. Most lung cancers are discovered in the middle and late stages of the disease, when treatment choices are limited, and patients' survival rate is low. The aim of lung cancer screening is the identification of lung malignancies in the early stage of the disease, when more options for effective treatments are available, to improve the patients' outcomes. The desire to improve the efficacy and efficiency of clinical care continues to drive multiple innovations into practice for better patient management, and in this context, artificial intelligence (AI) plays a key role. AI may have a role in each process of the lung cancer screening workflow. First, in the acquisition of low-dose computed tomography for screening programs, AI-based reconstruction allows a further dose reduction, while still maintaining an optimal image quality. AI can help the personalization of screening programs through risk stratification based on the collection and analysis of a huge amount of imaging and clinical data. A computer-aided detection (CAD) system provides automatic detection of potential lung nodules with high sensitivity, working as a concurrent or second reader and reducing the time needed for image interpretation. Once a nodule has been detected, it should be characterized as benign or malignant. Two AI-based approaches are available to perform this task: the first one is represented by automatic segmentation with a consequent assessment of the lesion size, volume, and densitometric features; the second consists of segmentation first, followed by radiomic features extraction to characterize the whole abnormalities providing the so-called "virtual biopsy". This narrative review aims to provide an overview of all possible AI applications in lung cancer screening.
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Affiliation(s)
- Michaela Cellina
- Radiology Department, Fatebenefratelli Hospital, ASST Fatebenefratelli Sacco, 20121 Milano, Italy;
| | - Laura Maria Cacioppa
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (L.M.C.); (N.R.); (A.B.)
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
| | - Maurizio Cè
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Vittoria Chiarpenello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Marco Costa
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Zakaria Vincenzo
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Daniele Pais
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Maria Vittoria Bausano
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy; (M.C.); (V.C.); (M.C.); (Z.V.); (D.P.); (M.V.B.)
| | - Nicolò Rossini
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (L.M.C.); (N.R.); (A.B.)
| | - Alessandra Bruno
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (L.M.C.); (N.R.); (A.B.)
| | - Chiara Floridi
- Department of Clinical, Special and Dental Sciences, University Politecnica delle Marche, 60126 Ancona, Italy; (L.M.C.); (N.R.); (A.B.)
- Division of Interventional Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
- Division of Radiology, Department of Radiological Sciences, University Hospital “Azienda Ospedaliera Universitaria delle Marche”, 60126 Ancona, Italy
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Computer-Aided Detection of Subsolid Nodules on Chest Computed Tomography: Assessment of Visualization on Vessel-Suppressed Images. J Comput Assist Tomogr 2023; 47:412-417. [PMID: 36877791 DOI: 10.1097/rct.0000000000001444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVES This study aimed to clarify the performance of automatic detection of subsolid nodules by commercially available software on computed tomography (CT) images of various slice thicknesses and compare it with visualization on the accompanying vessel-suppression CT (VS-CT) images. METHODS A total of 95 subsolid nodules from 84 CT examinations of 84 patients were included. The reconstructed CT image series of each case with 3-, 2-, and 1-mm slice thicknesses were loaded into a commercially available software application (ClearRead CT) for automatic detection of subsolid nodules and generation of VS-CT images. Automatic nodule detection sensitivity was assessed for 95 nodules on each series of images acquired at 3 slice thicknesses. Four radiologists subjectively evaluated visual assessment of the nodules on VS-CT. RESULTS ClearRead CT automatically detected 69.5% (66/95 nodules), 68.4% (65/95 nodules), and 70.5% (67/95 nodules) of all subsolid nodules in 3-, 2-, and 1-mm slices, respectively. The detection rate was higher for part-solid nodules than for pure ground-glass nodules at all slice thicknesses. In the visualization assessment on VS-CT, 3 nodules at each slice thickness (3.2%) were judged as invisible, while 26 of 29 (89.7%), 27 of 30 (90.0%), and 25 of 28 (89.3%) nodules, which were missed by computer-aided detection, were judged as visible in 3-, 2-, and 1-mm slices, respectively. CONCLUSIONS The automatic detection rate of subsolid nodules by ClearRead CT was approximately 70% at all slice thicknesses. More than 95% of subsolid nodules were visualized on VS-CT, including nodules undetected by the automated software. Computed tomography acquisition at slices thinner than 3 mm did not confer any benefits.
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de Margerie-Mellon C, Chassagnon G. Artificial intelligence: A critical review of applications for lung nodule and lung cancer. Diagn Interv Imaging 2023; 104:11-17. [PMID: 36513593 DOI: 10.1016/j.diii.2022.11.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
Artificial intelligence (AI) is a broad concept that usually refers to computer programs that can learn from data and perform certain specific tasks. In the recent years, the growth of deep learning, a successful technique for computer vision tasks that does not require explicit programming, coupled with the availability of large imaging databases fostered the development of multiple applications in the medical imaging field, especially for lung nodules and lung cancer, mostly through convolutional neural networks (CNN). Some of the first applications of AI is this field were dedicated to automated detection of lung nodules on X-ray and computed tomography (CT) examinations, with performances now reaching or exceeding those of radiologists. For lung nodule segmentation, CNN-based algorithms applied to CT images show excellent spatial overlap index with manual segmentation, even for irregular and ground glass nodules. A third application of AI is the classification of lung nodules between malignant and benign, which could limit the number of follow-up CT examinations for less suspicious lesions. Several algorithms have demonstrated excellent capabilities for the prediction of the malignancy risk when a nodule is discovered. These different applications of AI for lung nodules are particularly appealing in the context of lung cancer screening. In the field of lung cancer, AI tools applied to lung imaging have been investigated for distinct aims. First, they could play a role for the non-invasive characterization of tumors, especially for histological subtype and somatic mutation predictions, with a potential therapeutic impact. Additionally, they could help predict the patient prognosis, in combination to clinical data. Despite these encouraging perspectives, clinical implementation of AI tools is only beginning because of the lack of generalizability of published studies, of an inner obscure working and because of limited data about the impact of such tools on the radiologists' decision and on the patient outcome. Radiologists must be active participants in the process of evaluating AI tools, as such tools could support their daily work and offer them more time for high added value tasks.
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Affiliation(s)
- Constance de Margerie-Mellon
- Université Paris Cité, Laboratory of Imaging Biomarkers, Center for Research on Inflammation, UMR 1149, INSERM, 75018 Paris, France; Department of Radiology, Hôpital Saint-Louis APHP, 75010 Paris, France
| | - Guillaume Chassagnon
- Université Paris Cité, Faculté de Médecine, 75006 Paris, France; Department of Radiology, Hôpital Cochin APHP, 75014 Paris, France
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Artificial Intelligence (AI) for Lung Nodules, From the AJR Special Series on AI Applications. AJR Am J Roentgenol 2022; 219:703-712. [PMID: 35544377 DOI: 10.2214/ajr.22.27487] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Interest in artificial intelligence (AI) applications for lung nodules continues to grow among radiologists, particularly with the expanding eligibility criteria and clinical utilization of lung cancer screening CT. AI has been heavily investigated for detecting and characterizing lung nodules and for guiding prognostic assessment. AI tools have also been used for image postprocessing (e.g., rib suppression on radiography or vessel suppression on CT) and for noninterpretive aspects of reporting and workflow, including management of nodule follow-up. Despite growing interest in and rapid development of AI tools and FDA approval of AI tools for pulmonary nodule evaluation, integration into clinical practice has been limited. Challenges to clinical adoption have included concerns about generalizability, regulatory issues, technical hurdles in implementation, and human skepticism. Further validation of AI tools for clinical use and demonstration of benefit in terms of patient-oriented outcomes also are needed. This article provides an overview of potential applications of AI tools in the imaging evaluation of lung nodules and discusses the challenges faced by practices interested in clinical implementation of such tools.
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Liao RQ, Li AW, Yan HH, Lin JT, Liu SY, Wang JW, Fang JS, Liu HB, Hou YH, Song C, Yang HF, Li B, Jiang BY, Dong S, Nie Q, Zhong WZ, Wu YL, Yang XN. Deep learning-based growth prediction for sub-solid pulmonary nodules on CT images. Front Oncol 2022; 12:1002953. [PMID: 36313666 PMCID: PMC9597322 DOI: 10.3389/fonc.2022.1002953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background Estimating the growth of pulmonary sub-solid nodules (SSNs) is crucial to the successful management of them during follow-up periods. The purpose of this study is to (1) investigate the measurement sensitivity of diameter, volume, and mass of SSNs for identifying growth and (2) seek to establish a deep learning-based model to predict the growth of SSNs. Methods A total of 2,523 patients underwent at least 2-year examination records retrospectively collected with sub-solid nodules. A total of 2,358 patients with 3,120 SSNs from the NLST dataset were randomly divided into training and validation sets. Patients from the Yibicom Health Management Center and Guangdong Provincial People’s Hospital were collected as an external test set (165 patients with 213 SSN). Trained models based on LUNA16 and Lndb19 datasets were employed to automatically obtain the diameter, volume, and mass of SSNs. Then, the increase rate in measurements between cancer and non-cancer groups was studied to evaluate the most appropriate way to identify growth-associated lung cancer. Further, according to the selected measurement, all SSNs were classified into two groups: growth and non-growth. Based on the data, the deep learning-based model (SiamModel) and radiomics model were developed and verified. Results The double time of diameter, volume, and mass were 711 vs. 963 days (P = 0.20), 552 vs. 621 days (P = 0.04) and 488 vs. 623 days (P< 0.001) in the cancer and non-cancer groups, respectively. Our proposed SiamModel performed better than the radiomics model in both the NLST validation set and external test set, with an AUC of 0.858 (95% CI 0.786–0.921) and 0.760 (95% CI 0.646–0.857) in the validation set and 0.862 (95% CI 0.789–0.927) and 0.681 (95% CI 0.506–0.841) in the external test set, respectively. Furthermore, our SiamModel could use the data from first-time CT to predict the growth of SSNs, with an AUC of 0.855 (95% CI 0.793–0.908) in the NLST validation set and 0.821 (95% CI 0.725–0.904) in the external test set. Conclusion Mass increase rate can reflect more sensitively the growth of SSNs associated with lung cancer than diameter and volume increase rates. A deep learning-based model has a great potential to predict the growth of SSNs.
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Affiliation(s)
- Ri-qiang Liao
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - An-wei Li
- Guangzhou Shiyuan Electronics Co., Ltd, Guangzhou, China
| | - Hong-hong Yan
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jun-tao Lin
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Si-yang Liu
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing-wen Wang
- Guangzhou Shiyuan Electronics Co., Ltd, Guangzhou, China
| | | | - Hong-bo Liu
- Guangzhou Shiyuan Electronics Co., Ltd, Guangzhou, China
| | - Yong-he Hou
- Yibicom Health Management Center, CVTE, Guangzhou, China
| | - Chao Song
- Yibicom Health Management Center, CVTE, Guangzhou, China
| | - Hui-fang Yang
- Yibicom Health Management Center, CVTE, Guangzhou, China
| | - Bin Li
- Automation Science and Engineering, South China University of Technology, Guangzhou, China
| | - Ben-yuan Jiang
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Song Dong
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Qiang Nie
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wen-zhao Zhong
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yi-long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Xue-ning Yang, ; Yi-long Wu,
| | - Xue-ning Yang
- Guangdong Lung Cancer Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- *Correspondence: Xue-ning Yang, ; Yi-long Wu,
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11
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Lancaster HL, Zheng S, Aleshina OO, Yu D, Yu Chernina V, Heuvelmans MA, de Bock GH, Dorrius MD, Gratama JW, Morozov SP, Gombolevskiy VA, Silva M, Yi J, Oudkerk M. Outstanding negative prediction performance of solid pulmonary nodule volume AI for ultra-LDCT baseline lung cancer screening risk stratification. Lung Cancer 2022; 165:133-140. [PMID: 35123156 DOI: 10.1016/j.lungcan.2022.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/04/2021] [Accepted: 01/03/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate performance of AI as a standalone reader in ultra-low-dose CT lung cancer baseline screening, and compare it to that of experienced radiologists. METHODS 283 participants who underwent a baseline ultra-LDCT scan in Moscow Lung Cancer Screening, between February 2017-2018, and had at least one solid lung nodule, were included. Volumetric nodule measurements were performed by five experienced blinded radiologists, and independently assessed using an AI lung cancer screening prototype (AVIEW LCS, v1.0.34, Coreline Soft, Co. ltd, Seoul, Korea) to automatically detect, measure, and classify solid nodules. Discrepancies were stratified into two groups: positive-misclassification (PM); nodule classified by the reader as a NELSON-plus /EUPS-indeterminate/positive nodule, which at the reference consensus read was < 100 mm3, and negative-misclassification (NM); nodule classified as a NELSON-plus /EUPS-negative nodule, which at consensus read was ≥ 100 mm3. RESULTS 1149 nodules with a solid-component were detected, of which 878 were classified as solid nodules. For the largest solid nodule per participant (n = 283); 61 [21.6 %; 53 PM, 8 NM] discrepancies were reported for AI as a standalone reader, compared to 43 [15.1 %; 22 PM, 21 NM], 36 [12.7 %; 25 PM, 11 NM], 29 [10.2 %; 25 PM, 4 NM], 28 [9.9 %; 6 PM, 22 NM], and 50 [17.7 %; 15 PM, 35 NM] discrepancies for readers 1, 2, 3, 4, and 5 respectively. CONCLUSION Our results suggest that through the use of AI as an impartial reader in baseline lung cancer screening, negative-misclassification results could exceed that of four out of five experienced radiologists, and radiologists' workload could be drastically diminished by up to 86.7%.
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Affiliation(s)
- Harriet L Lancaster
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Institute for Diagnostic Accuracy, Groningen, Netherlands
| | - Sunyi Zheng
- Department of Radiotherapy, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Institute for Diagnostic Accuracy, Groningen, Netherlands
| | - Olga O Aleshina
- State Budget-Funded Health Care Institution of the City of Moscow «Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russian Federation
| | | | - Valeria Yu Chernina
- State Budget-Funded Health Care Institution of the City of Moscow «Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russian Federation
| | - Marjolein A Heuvelmans
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Institute for Diagnostic Accuracy, Groningen, Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Monique D Dorrius
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Sergey P Morozov
- State Budget-Funded Health Care Institution of the City of Moscow «Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russian Federation
| | - Victor A Gombolevskiy
- State Budget-Funded Health Care Institution of the City of Moscow «Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies of the Moscow Health Care Department, Moscow, Russian Federation; AIRI, Moscow, Russian Federation
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | | | - Matthijs Oudkerk
- Institute for Diagnostic Accuracy, Groningen, Netherlands; Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands.
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12
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Abstract
Background: Lung-RADS category 3 and 4 nodules account for most cancers among screening-detected lung cancers and are considered actionable nodules with management implications. The cancer frequency among such nodules is estimated in the Lung-RADS recommendations and has been investigated primarily using retrospectively assigned Lung-RADS classifications. Objective: To assess the frequency of cancer among lung nodules assigned Lung-RADS category 3 or 4 at lung cancer screening (LCS) in clinical practice and factors that impact the cancer frequency within each category. Methods: This retrospective study was based on review of clinical radiology reports of 9148 consecutive low-dose CT LCS examinations performed in 4798 patients between June 2014 and January 2021 as part of an established LCS program. Unique nodules assigned Lung-RADS category 3 or 4 (4A, 4B, or 4X) that were clinically categorized as benign or malignant by a multidisciplinary conference, considering histologic analysis and follow-up imaging, were selected for further analysis; benign diagnoses based on stability required at least 12 months of follow-up imaging. Indeterminate nodules were excluded. Cancer frequencies were evaluated. Results: Of the 9148 LCS examinations, 857 (9.4%) were assigned Lung-RADS category 3, and 721 (7.9%) were assigned category 4. The final analysis included 1297 unique nodules in 1139 patients (598 men, 541 women; mean age, 66.0±6.3 years). A total of 1108/1297 (85.4%) nodules were deemed benign, and 189/1297 (14.6%) were deemed malignant. Frequencies of malignancy for category 3, 4A, 4B, and 4X nodules were 3.9%, 15.5%, 36.3%, and 76.8%, respectively. A total of 45/46 (97.8%) endobronchial nodules (all category 4A) were deemed benign based on resolution. Cancer frequency was 13.1%, 24.4%, and 13.5% for solid, part-solid, and ground-glass nodules, respectively. Conclusions: When applying Lung-RADS for LCS clinical practice, the frequency of Lung-RADS category 3 and 4 nodules, as well as cancer frequency in these categories, were higher than prevalence and cancer risk estimated for category 3 and 4 nodules in the Lung-RADS recommendations and reported in earlier studies using retrospective category assignments. Nearly all endobronchial category 4A nodules were benign. Clinical Impact: Future Lung-RADS iterations should consider these findings from real-world practice to improve the system's clinical utility.
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13
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Lu XF, Min XP, Lu B, Fan GH, Zhu TY. Bronchial morphological changes are associated with postoperative intractable cough after right upper lobectomy in lung cancer patients. Quant Imaging Med Surg 2022; 12:196-206. [PMID: 34993071 DOI: 10.21037/qims-21-368] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/11/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND To date, postoperative intractable cough (PIC) has not received adequate attention, and the complex perioperative factors when performing pulmonary resection often prevent researchers from addressing this issue. This study aimed to investigate the clinicopathological and radiographic indicators related to PIC in lung cancer patients. METHODS In all, 112 patients who had had right upper lobectomy for primary lung cancer from January 2019 to December 2020 were retrospectively reviewed. We collected data via the electronic medical database of our department. Bronchial morphological features were investigated comprehensively via three-dimensional chest computer tomography reconstruction images. RESULTS During outpatient follow-up visits, 41 (36.6%) patients complained about persistent dry cough after surgery. Compared with the non-cough group, patients in the refractory cough group showed significant differences in smoking history, right upper lobe stump length, changes of right bronchus intermedius (RBI) diameter, changes of right lower lobe (RLL) basal bronchus diameter, changes of RBI/RLL bronchial angle, and bronchial kink. However, according to multivariable regression analysis, stump length, bronchial kink, and diameter change of the right lower lobe basal bronchus were independently associated with postoperative refractory cough. A nebulization drug was prescribed for the 41 patients diagnosed with PIC, and 33 (80.5%) patients had improved by the next visit. CONCLUSIONS After right upper lobectomy, the morphology of the remaining bronchial tree in the residual lung changed significantly. The bronchial morphological alterations were independent risk factors for PIC.
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Affiliation(s)
- Xue-Fang Lu
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xin-Ping Min
- Department of Cardiovascular Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Biao Lu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Guo-Hua Fan
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Tie-Yuan Zhu
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, China
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Li D, Pehrson LM, Lauridsen CA, Tøttrup L, Fraccaro M, Elliott D, Zając HD, Darkner S, Carlsen JF, Nielsen MB. The Added Effect of Artificial Intelligence on Physicians' Performance in Detecting Thoracic Pathologies on CT and Chest X-ray: A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11122206. [PMID: 34943442 PMCID: PMC8700414 DOI: 10.3390/diagnostics11122206] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/18/2021] [Accepted: 11/23/2021] [Indexed: 12/20/2022] Open
Abstract
Our systematic review investigated the additional effect of artificial intelligence-based devices on human observers when diagnosing and/or detecting thoracic pathologies using different diagnostic imaging modalities, such as chest X-ray and CT. Peer-reviewed, original research articles from EMBASE, PubMed, Cochrane library, SCOPUS, and Web of Science were retrieved. Included articles were published within the last 20 years and used a device based on artificial intelligence (AI) technology to detect or diagnose pulmonary findings. The AI-based device had to be used in an observer test where the performance of human observers with and without addition of the device was measured as sensitivity, specificity, accuracy, AUC, or time spent on image reading. A total of 38 studies were included for final assessment. The quality assessment tool for diagnostic accuracy studies (QUADAS-2) was used for bias assessment. The average sensitivity increased from 67.8% to 74.6%; specificity from 82.2% to 85.4%; accuracy from 75.4% to 81.7%; and Area Under the ROC Curve (AUC) from 0.75 to 0.80. Generally, a faster reading time was reported when radiologists were aided by AI-based devices. Our systematic review showed that performance generally improved for the physicians when assisted by AI-based devices compared to unaided interpretation.
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Affiliation(s)
- Dana Li
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (L.M.P.); (C.A.L.); (J.F.C.); (M.B.N.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
- Correspondence:
| | - Lea Marie Pehrson
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (L.M.P.); (C.A.L.); (J.F.C.); (M.B.N.)
| | - Carsten Ammitzbøl Lauridsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (L.M.P.); (C.A.L.); (J.F.C.); (M.B.N.)
- Department of Technology, Faculty of Health and Technology, University College Copenhagen, 2200 Copenhagen, Denmark
| | - Lea Tøttrup
- Unumed Aps, 1055 Copenhagen, Denmark; (L.T.); (M.F.)
| | | | - Desmond Elliott
- Department of Computer Science, University of Copenhagen, 2100 Copenhagen, Denmark; (D.E.); (H.D.Z.); (S.D.)
| | - Hubert Dariusz Zając
- Department of Computer Science, University of Copenhagen, 2100 Copenhagen, Denmark; (D.E.); (H.D.Z.); (S.D.)
| | - Sune Darkner
- Department of Computer Science, University of Copenhagen, 2100 Copenhagen, Denmark; (D.E.); (H.D.Z.); (S.D.)
| | - Jonathan Frederik Carlsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (L.M.P.); (C.A.L.); (J.F.C.); (M.B.N.)
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (L.M.P.); (C.A.L.); (J.F.C.); (M.B.N.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
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Xu Y, Li Y, Yin H, Tang W, Fan G. Consecutive Serial Non-Contrast CT Scan-Based Deep Learning Model Facilitates the Prediction of Tumor Invasiveness of Ground-Glass Nodules. Front Oncol 2021; 11:725599. [PMID: 34568054 PMCID: PMC8461974 DOI: 10.3389/fonc.2021.725599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/19/2021] [Indexed: 01/31/2023] Open
Abstract
Introduction Tumors are continuously evolving biological systems which can be monitored by medical imaging. Previous studies only focus on single timepoint images, whether the performance could be further improved by using serial noncontrast CT imaging obtained during nodule follow-up management remains unclear. In this study, we evaluated DL model for predicting tumor invasiveness of GGNs through analyzing time series CT images. Methods A total of 168 pathologically confirmed GGN cases (48 noninvasive lesions and 120 invasive lesions) were retrospectively collected and randomly assigned to the development dataset (n = 123) and independent testing dataset (n = 45). All patients underwent consecutive noncontrast CT examinations, and the baseline CT and 3-month follow-up CT images were collected. The gross region of interest (ROI) patches containing only tumor region and the full ROI patches including both tumor and peritumor regions were cropped from CT images. A baseline model was built on the image features and demographic features. Four DL models were proposed: two single-DL model using gross ROI (model 1) or full ROI patches (model 3) from baseline CT images, and two serial-DL models using gross ROI (model 2) or full ROI patches (model 4) from consecutive CT images (baseline scan and 3-month follow-up scan). In addition, a combined model integrating serial full ROI patches and clinical information was also constructed. The performance of these predictive models was assessed with respect to discrimination and clinical usefulness. Results The area under the curve (AUC) of the baseline model, models 1, 2, 3, and 4 were 0.562 [(95% confidence interval (C)], 0.406~0.710), 0.693 (95% CI, 0.538-0.822), 0.787 (95% CI, 0.639-0.895), 0.727 (95% CI, 0.573-0.849), and 0.811 (95% CI, 0.667-0.912) in the independent testing dataset, respectively. The results indicated that the peritumor region had potential to contribute to tumor invasiveness prediction, and the model performance was further improved by integrating imaging scans at multiple timepoints. Furthermore, the combined model showed best discrimination ability, with AUC, sensitivity, specificity, and accuracy achieving 0.831 (95% CI, 0.690-0.926), 86.7%, 73.3%, and 82.2%, respectively. Conclusion The DL model integrating full ROIs from serial CT images shows improved predictive performance in differentiating noninvasive from invasive GGNs than the model using only baseline CT images, which could benefit the clinical management of GGNs.
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Affiliation(s)
- Yao Xu
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yu Li
- Department of Radiology, Dushuhu Public Hospital Affiliated of Soochow University, Suzhou, China
| | - Hongkun Yin
- Department of Advanced Research, Infervision Medical Technology Co. Ltd, Beijing, China
| | - Wen Tang
- Department of Advanced Research, Infervision Medical Technology Co. Ltd, Beijing, China
| | - Guohua Fan
- Department of Radiology, Second Affiliated Hospital of Soochow University, Suzhou, China
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