Towards Machine Learning-Aided Lung Cancer Clinical Routines: Approaches and Open Challenges

Comparison between vision transformers and convolutional neural networks to predict non-small lung cancer recurrence

Non-Small cell lung cancer (NSCLC) is one of the most dangerous cancers, with 85% of all new lung cancer diagnoses and a 30-55% of recurrence rate after surgery. Thus, an accurate prediction of recurrence risk in NSCLC patients during diagnosis could be essential to drive targeted therapies preventing either overtreatment or undertreatment of cancer patients. The radiomic analysis of CT images has already shown great potential in solving this task; specifically, Convolutional Neural Networks (CNNs) have already been proposed providing good performances. Recently, Vision Transformers (ViTs) have been introduced, reaching comparable and even better performances than traditional CNNs in image classification. The aim of the proposed paper was to compare the performances of different state-of-the-art deep learning algorithms to predict cancer recurrence in NSCLC patients. In this work, using a public database of 144 patients, we implemented a transfer learning approach, involving different Transformers architectures like pre-trained ViTs, pre-trained Pyramid Vision Transformers, and pre-trained Swin Transformers to predict the recurrence of NSCLC patients from CT images, comparing their performances with state-of-the-art CNNs. Although, the best performances in this study are reached via CNNs with AUC, Accuracy, Sensitivity, Specificity, and Precision equal to 0.91, 0.89, 0.85, 0.90, and 0.78, respectively, Transformer architectures reach comparable ones with AUC, Accuracy, Sensitivity, Specificity, and Precision equal to 0.90, 0.86, 0.81, 0.89, and 0.75, respectively. Based on our preliminary experimental results, it appears that Transformers architectures do not add improvements in terms of predictive performance to the addressed problem.

Single Modality vs. Multimodality: What Works Best for Lung Cancer Screening?

In a clinical context, physicians usually take into account information from more than one data modality when making decisions regarding cancer diagnosis and treatment planning. Artificial intelligence-based methods should mimic the clinical method and take into consideration different sources of data that allow a more comprehensive analysis of the patient and, as a consequence, a more accurate diagnosis. Lung cancer evaluation, in particular, can benefit from this approach since this pathology presents high mortality rates due to its late diagnosis. However, many related works make use of a single data source, namely imaging data. Therefore, this work aims to study the prediction of lung cancer when using more than one data modality. The National Lung Screening Trial dataset that contains data from different sources, specifically, computed tomography (CT) scans and clinical data, was used for the study, the development and comparison of single-modality and multimodality models, that may explore the predictive capability of these two types of data to their full potential. A ResNet18 network was trained to classify 3D CT nodule regions of interest (ROI), whereas a random forest algorithm was used to classify the clinical data, with the former achieving an area under the ROC curve (AUC) of 0.7897 and the latter 0.5241. Regarding the multimodality approaches, three strategies, based on intermediate and late fusion, were implemented to combine the information from the 3D CT nodule ROIs and the clinical data. From those, the best model-a fully connected layer that receives as input a combination of clinical data and deep imaging features, given by a ResNet18 inference model-presented an AUC of 0.8021. Lung cancer is a complex disease, characterized by a multitude of biological and physiological phenomena and influenced by multiple factors. It is thus imperative that the models are capable of responding to that need. The results obtained showed that the combination of different types may have the potential to produce more comprehensive analyses of the disease by the models.

Computational Intelligence in Cancer Diagnostics: A Contemporary Review of Smart Phone Apps, Current Problems, and Future Research Potentials

Cancer is a dangerous and sometimes life-threatening disease that can have several negative consequences for the body, is a leading cause of mortality, and is becoming increasingly difficult to detect. Each form of cancer has its own set of traits, symptoms, and therapies, and early identification and management are important for a positive prognosis. Doctors utilize a variety of approaches to detect cancer, depending on the kind and location of the tumor. Imaging tests such as X-rays, Computed Tomography scans, Magnetic Resonance Imaging scans, and Positron Emission Tomography (PET) scans, which may provide precise pictures of the body's interior structures to spot any abnormalities, are some of the tools that doctors use to diagnose cancer. This article evaluates computational-intelligence approaches and provides a means to impact future work by focusing on the relevance of machine learning and deep learning models such as K Nearest Neighbour (KNN), Support Vector Machine (SVM), Naïve Bayes, Decision Tree, Deep Neural Network, Deep Boltzmann machine, and so on. It evaluates information from 114 studies using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). This article explores the advantages and disadvantages of each model and provides an outline of how they are used in cancer diagnosis. In conclusion, artificial intelligence shows significant potential to enhance cancer imaging and diagnosis, despite the fact that there are a number of clinical issues that need to be addressed.

A CT-based transfer learning approach to predict NSCLC recurrence: The added-value of peritumoral region

Non-small cell lung cancer (NSCLC) represents 85% of all new lung cancer diagnoses and presents a high recurrence rate after surgery. Thus, an accurate prediction of recurrence risk in NSCLC patients at diagnosis could be essential to designate risk patients to more aggressive medical treatments. In this manuscript, we apply a transfer learning approach to predict recurrence in NSCLC patients, exploiting only data acquired during its screening phase. Particularly, we used a public radiogenomic dataset of NSCLC patients having a primary tumor CT image and clinical information. Starting from the CT slice containing the tumor with maximum area, we considered three different dilatation sizes to identify three Regions of Interest (ROIs): CROP (without dilation), CROP 10 and CROP 20. Then, from each ROI, we extracted radiomic features by means of different pre-trained CNNs. The latter have been combined with clinical information; thus, we trained a Support Vector Machine classifier to predict the NSCLC recurrence. The classification performances of the devised models were finally evaluated on both the hold-out training and hold-out test sets, in which the original sample has been previously divided. The experimental results showed that the model obtained analyzing CROP 20 images, which are the ROIs containing more peritumoral area, achieved the best performances on both the hold-out training set, with an AUC of 0.73, an Accuracy of 0.61, a Sensitivity of 0.63, and a Specificity of 0.60, and on the hold-out test set, with an AUC value of 0.83, an Accuracy value of 0.79, a Sensitivity value of 0.80, and a Specificity value of 0.78. The proposed model represents a promising procedure for early predicting recurrence risk in NSCLC patients.

The transcultural adaptation and validation of the Chinese version of the Attitudes Toward Recognizing Early and Noticeable Deterioration scale

Background

In China, clinical deterioration events present a real problem for every clinical nurse. Patient deterioration is determined in part by nurses' attitudes toward early recognition of clinical deterioration. However, research on attitudes toward the early identification of clinical deterioration is still in its infancy, and even less research has been done on ward nurses' attitudes toward the early identification of clinical deterioration. To drive behavioral change and improve the care of deteriorating patients, nurses need comprehensive, valid, and reliable tools to assess their attitudes toward early identification of deterioration.

Objective

In this study, we aimed to translate the Attitudes Toward Recognizing Early and Noticeable Deterioration (ATREND) scale into Chinese and to assess its validity and reliability tests.

Methods

From March 2022 to July 2022, the ATREND scale was translated, back-translated, and cross-culturally adapted into the Chinese version using a modified Brislin translation model. Then, 460 ward nurses were recruited from tertiary Grade A general hospitals in two cities: Shenyang and Jinzhou in Liaoning Province, China. Reliability analyses were conducted using internal consistency, split-half, and test-retest reliability. We convened a committee of experts to determine the validity of the content. Tests of the structural validity of the scale were conducted using exploratory and validation factor analyses.

Results

The Cronbach's α value of the Chinese version of the ATREND scale was 0.804, and the Cronbach's α value of the dimensions ranged from 0.782 to 0.863. The split-half reliability and test-retest reliability were 0.846 and 0.711, respectively. Furthermore, the scale has an index of content validity of 0.922, indicating a high level of content validity. In exploratory factor analysis, eigenvalues, total variance explained, and scree plot supported a three-factor structure. The three-factor model supported by this study was confirmed by confirmatory factor analysis (CFA). Moreover, the model fitting indexes (e.g., χ ²/DF = 1.498, GFI = 0.954, RMSEA = 0.047) were all within acceptable limits based on the CFA.

Conclusion

The Chinese version of the scale is reliable and valid among ward nurses. Nursing educators and clinicians will be able to develop targeted educational programs to enhance the competence and behaviors of Chinese ward nurses in recognizing clinical deterioration. It will be based on the developed scale to assess Chinese nurses' attitudes and practices regarding early recognition of clinical deterioration. As a result, it is necessary to consider the Chinese scale's three-factor structure. The developed three-factor structured scale will assess Chinese ward nurses' attitudes and practices toward patient observation and vital sign-monitoring empowerment, enlightening them on the importance of patient observation, encouraging ward nurses to use a wider range of patient assessment techniques to capture early signs of clinical deterioration, and helping ward nurses to develop clinical confidence to monitor clinical deterioration.

Artificial Intelligence in Lung Cancer Imaging: Unfolding the Future

Lung cancer is one of the malignancies with higher morbidity and mortality. Imaging plays an essential role in each phase of lung cancer management, from detection to assessment of response to treatment. The development of imaging-based artificial intelligence (AI) models has the potential to play a key role in early detection and customized treatment planning. Computer-aided detection of lung nodules in screening programs has revolutionized the early detection of the disease. Moreover, the possibility to use AI approaches to identify patients at risk of developing lung cancer during their life can help a more targeted screening program. The combination of imaging features and clinical and laboratory data through AI models is giving promising results in the prediction of patients’ outcomes, response to specific therapies, and risk for toxic reaction development. In this review, we provide an overview of the main imaging AI-based tools in lung cancer imaging, including automated lesion detection, characterization, segmentation, prediction of outcome, and treatment response to provide radiologists and clinicians with the foundation for these applications in a clinical scenario.

Performance Analysis of State-of-the-Art CNN Architectures for LUNA16

The convolutional neural network (CNN) has become a powerful tool in machine learning (ML) that is used to solve complex problems such as image recognition, natural language processing, and video analysis. Notably, the idea of exploring convolutional neural network architecture has gained substantial attention as well as popularity. This study focuses on the intrinsic various CNN architectures: LeNet, AlexNet, VGG16, ResNet-50, and Inception-V1, which have been scrutinized and compared with each other for the detection of lung cancer using publicly available LUNA16 datasets. Furthermore, multiple performance optimizers: root mean square propagation (RMSProp), adaptive moment estimation (Adam), and stochastic gradient descent (SGD), were applied for this comparative study. The performances of the three CNN architectures were measured for accuracy, specificity, sensitivity, positive predictive value, false omission rate, negative predictive value, and F1 score. The experimental results showed that the CNN AlexNet architecture with the SGD optimizer achieved the highest validation accuracy for CT lung cancer with an accuracy of 97.42%, misclassification rate of 2.58%, 97.58% sensitivity, 97.25% specificity, 97.58% positive predictive value, 97.25% negative predictive value, false omission rate of 2.75%, and F1 score of 97.58%. AlexNet with the SGD optimizer was the best and outperformed compared to the other state-of-the-art CNN architectures.

The Influence of a Coherent Annotation and Synthetic Addition of Lung Nodules for Lung Segmentation in CT Scans

Lung cancer is a highly prevalent pathology and a leading cause of cancer-related deaths. Most patients are diagnosed when the disease has manifested itself, which usually is a sign of lung cancer in an advanced stage and, as a consequence, the 5-year survival rates are low. To increase the chances of survival, improving the cancer early detection capacity is crucial, for which computed tomography (CT) scans represent a key role. The manual evaluation of the CTs is a time-consuming task and computer-aided diagnosis (CAD) systems can help relieve that burden. The segmentation of the lung is one of the first steps in these systems, yet it is very challenging given the heterogeneity of lung diseases usually present and associated with cancer development. In our previous work, a segmentation model based on a ResNet34 and U-Net combination was developed on a cross-cohort dataset that yielded good segmentation masks for multiple pathological conditions but misclassified some of the lung nodules. The multiple datasets used for the model development were originated from different annotation protocols, which generated inconsistencies for the learning process, and the annotations are usually not adequate for lung cancer studies since they did not comprise lung nodules. In addition, the initial datasets used for training presented a reduced number of nodules, which was showed not to be enough to allow the segmentation model to learn to include them as a lung part. In this work, an objective protocol for the lung mask’s segmentation was defined and the previous annotations were carefully reviewed and corrected to create consistent and adequate ground-truth masks for the development of the segmentation model. Data augmentation with domain knowledge was used to create lung nodules in the cases used to train the model. The model developed achieved a Dice similarity coefficient (DSC) above 0.9350 for all test datasets and it showed an ability to cope, not only with a variety of lung patterns, but also with the presence of lung nodules as well. This study shows the importance of using consistent annotations for the supervised learning process, which is a very time-consuming task, but that has great importance to healthcare applications. Due to the lack of massive datasets in the medical field, which consequently brings a lack of wide representativity, data augmentation with domain knowledge could represent a promising help to overcome this limitation for learning models development.