A bi-directional deep learning architecture for lung nodule semantic segmentation

Diagnostic accuracy of deep learning for the invasiveness assessment of ground-glass nodules with fine segmentation: a systematic review and meta-analysis

Background

Accurate recognition of invasive lung adenocarcinoma (IAC) presenting as ground-glass nodules (GGNs) is crucial for guiding clinical decision-making and timely surgical intervention. This study aimed to systematically evaluate the diagnostic accuracy of deep learning (DL) models via fine nodule segmentation in assessing the invasiveness of lung adenocarcinoma.

Methods

Literature from the inception of the PubMed, Embase, Cochrane Library, and Web of Science databases was searched. Studies related to DL and nodule segmentation in diagnosing IAC were evaluated and included. Titles and abstracts were screened, and the Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess the quality of the selected studies. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) criteria of diagnostic tests were used to assess the certainty of evidence.

Results

Eight studies involving 5,281 nodules and 4,676 patients were included and analyzed. Meta-analysis showed that the combined sensitivity of DL for the diagnosis of IAC was 0.81 [95% confidence interval (CI): 0.73-0.87], while the specificity was 0.86 (95% CI: 0.80-0.90). The area under the summary receiver operating characteristic (SROC) curve was 0.90 (95% CI: 0.88-0.93), but the overall quality of the evidence was suboptimal.

Conclusions

DL and nodule segmentation demonstrated high accuracy in assessing lung adenocarcinoma invasiveness, but the certainty of the associated evidence was low. More large-scale, multicenter, high-quality diagnostic accuracy studies are needed to validate the performance and usefulness of DL in the assessment of lung adenocarcinoma invasiveness.

Landscape of 2D Deep Learning Segmentation Networks Applied to CT Scan from Lung Cancer Patients: A Systematic Review

BACKGROUND

The increasing rates of lung cancer emphasize the need for early detection through computed tomography (CT) scans, enhanced by deep learning (DL) to improve diagnosis, treatment, and patient survival. This review examines current and prospective applications of 2D- DL networks in lung cancer CT segmentation, summarizing research, highlighting essential concepts and gaps; Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, a systematic search of peer-reviewed studies from 01/2020 to 12/2024 on data-driven population segmentation using structured data was conducted across databases like Google Scholar, PubMed, Science Direct, IEEE (Institute of Electrical and Electronics Engineers) and ACM (Association for Computing Machinery) library. 124 studies met the inclusion criteria and were analyzed.

RESULTS

The LIDC-LIDR dataset was the most frequently used; The finding particularly relies on supervised learning with labeled data. The UNet model and its variants were the most frequently used models in medical image segmentation, achieving Dice Similarity Coefficients (DSC) of up to 0.9999. The reviewed studies primarily exhibit significant gaps in addressing class imbalances (67%), underuse of cross-validation (21%), and poor model stability evaluations (3%). Additionally, 88% failed to address the missing data, and generalizability concerns were only discussed in 34% of cases.

CONCLUSIONS

The review emphasizes the importance of Convolutional Neural Networks, particularly UNet, in lung CT analysis and advocates for a combined 2D/3D modeling approach. It also highlights the need for larger, diverse datasets and the exploration of semi-supervised and unsupervised learning to enhance automated lung cancer diagnosis and early detection.

Improved lung nodule segmentation with a squeeze excitation dilated attention based residual UNet

The diverse types and sizes, proximity to non-nodule structures, identical shape characteristics, and varying sizes of nodules make them challenging for segmentation methods. Although many efforts have been made in automatic lung nodule segmentation, most of them have not sufficiently addressed the challenges related to the type and size of nodules, such as juxta-pleural and juxta-vascular nodules. The current research introduces a Squeeze-Excitation Dilated Attention-based Residual U-Net (SEDARU-Net) with a robust intensity normalization technique to address the challenges related to different types and sizes of lung nodules and to achieve an improved lung nodule segmentation. After preprocessing the images with the intensity normalization method and extracting the Regions of Interest by YOLOv3, they are fed into the SEDARU-Net with dilated convolutions in the encoder part. Then, the extracted features are given to the decoder part, which involves transposed convolutions, Squeeze-Excitation Dilated Residual blocks, and skip connections equipped with an Attention Gate, to decode the feature maps and construct the segmentation mask. The proposed model was evaluated using the publicly available Lung Nodule Analysis 2016 (LUNA16) dataset, achieving a Dice Similarity Coefficient of 97.86%, IoU of 96.40%, sensitivity of 96.54%, and precision of 98.84%. Finally, it was shown that each added component to the U-Net's structure and the intensity normalization technique increased the Dice Similarity Coefficient by more than 2%. The proposed method suggests a potential clinical tool to address challenges related to the segmentation of lung nodules with different types located in the proximity of non-nodule structures.

Advances in artificial intelligence applications in the field of lung cancer

Lung cancer remains a leading cause of cancer-related deaths globally, with its incidence steadily rising each year, representing a significant threat to human health. Early detection, diagnosis, and timely treatment play a crucial role in improving survival rates and reducing mortality. In recent years, significant and rapid advancements in artificial intelligence (AI) technology have found successful applications in various clinical areas, especially in the diagnosis and treatment of lung cancer. AI not only improves the efficiency and accuracy of physician diagnosis but also aids in patient treatment and management. This comprehensive review presents an overview of fundamental AI-related algorithms and highlights their clinical applications in lung nodule detection, lung cancer pathology classification, gene mutation prediction, treatment strategies, and prognosis. Additionally, the rapidly advancing field of AI-based three-dimensional (3D) reconstruction in lung cancer surgical resection is discussed. Lastly, the limitations of AI and future prospects are addressed.

Systematic review and meta-analysis of deep learning applications in computed tomography lung cancer segmentation

BACKGROUND

Accurate segmentation of lung tumors on chest computed tomography (CT) scans is crucial for effective diagnosis and treatment planning. Deep Learning (DL) has emerged as a promising tool in medical imaging, particularly for lung cancer segmentation. However, its efficacy across different clinical settings and tumor stages remains variable.

METHODS

We conducted a comprehensive search of PubMed, Embase, and Web of Science until November 7, 2023. We assessed the quality of these studies by using the Checklist for Artificial Intelligence in Medical Imaging and the Quality Assessment of Diagnostic Accuracy Studies-2 tools. This analysis included data from various clinical settings and stages of lung cancer. Key performance metrics, such as the Dice similarity coefficient, were pooled, and factors affecting algorithm performance, such as clinical setting, algorithm type, and image processing techniques, were examined.

RESULTS

Our analysis of 37 studies revealed a pooled Dice score of 79 % (95 % CI: 76 %-83 %), indicating moderate accuracy. Radiotherapy studies had a slightly lower score of 78 % (95 % CI: 74 %-82 %). A temporal increase was noted, with recent studies (post-2022) showing improvement from 75 % (95 % CI: 70 %-81 %). to 82 % (95 % CI: 81 %-84 %). Key factors affecting performance included algorithm type, resolution adjustment, and image cropping. QUADAS-2 assessments identified ambiguous risks in 78 % of studies due to data interval omissions and concerns about generalizability in 8 % due to nodule size exclusions, and CLAIM criteria highlighted areas for improvement, with an average score of 27.24 out of 42.

CONCLUSION

This meta-analysis demonstrates DL algorithms' promising but varied efficacy in lung cancer segmentation, particularly higher efficacy noted in early stages. The results highlight the critical need for continued development of tailored DL models to improve segmentation accuracy across diverse clinical settings, especially in advanced cancer stages with greater challenges. As recent studies demonstrate, ongoing advancements in algorithmic approaches are crucial for future applications.

Overcoming the Challenge of Accurate Segmentation of Lung Nodules: A Multi-crop CNN Approach

Lung nodules are generated based on the growth of small and round- or oval-shaped cells in the lung, which are either cancerous or non-cancerous. Accurate segmentation of these nodules is crucial for early detection and diagnosis of lung cancer. However, lung nodules can have various shapes, sizes, and densities, making their accurate segmentation a difficult task. Moreover, they can be easily confused with other structures in the lung, including blood vessels and airways, further complicating the segmentation process. To address this challenge, this paper proposes a novel multi-crop convolutional neural network (multi-crop CNN) model that utilizes different sized cropped regions of CT scan images for accurate segmentation of lung nodules. The model consists of three modules, namely the feature representation module, boundary refinement module, and segmentation module. The feature representation module captures features from the lung CT scan image using cropped regions of different sizes, while the boundary refinement module combines the boundary maps and feature maps to generate a final feature map for the segmentation process. The segmentation module produces a high-resolution segmentation map that shows improved accuracy in segmenting cancerous lung nodules. The proposed multi-crop CNN model is evaluated on two segmentation datasets namely LUNA 16 and LIDC-IDRI with an accuracy of 98.3% and 98.5%, respectively. The performances are measured in terms of accuracy, recall, precision, dice coefficient, specificity, AUC/ROC, Hausdorff distance, Jaccard index, and average Hausdorff. Overall, the proposed multi-crop CNN model demonstrates the potential to enhance the lung nodule segmentation accuracy, which could lead to earlier detection and diagnosis of lung cancer and ultimately reduce mortality rates associated with the disease.

Artificial Intelligence in Lung Cancer Imaging: From Data to Therapy

Lung cancer remains a global health challenge, leading to substantial morbidity and mortality. While prevention and early detection strategies have improved, the need for precise diagnosis, prognosis, and treatment remains crucial. In this comprehensive review article, we explore the role of artificial intelligence (AI) in reshaping the management of lung cancer. AI may have different potential applications in lung cancer characterization and outcome prediction. Manual segmentation is a time-consuming task, with high inter-observer variability, that can be replaced by AI-based approaches, including deep learning models such as U-Net, BCDU-Net, and others, to quantify lung nodules and cancers objectively and to extract radiomics features for the characterization of the tissue. AI models have also demonstrated their ability to predict treatment responses, such as immunotherapy and targeted therapy, by integrating radiomic features with clinical data. Additionally, AI-based prognostic models have been developed to identify patients at higher risk and personalize treatment strategies. In conclusion, this review article provides a comprehensive overview of the current state of AI applications in lung cancer management, spanning from segmentation and virtual biopsy to outcome prediction. The evolving role of AI in improving the precision and effectiveness of lung cancer diagnosis and treatment underscores its potential to significantly impact clinical practice and patient outcomes.

Factors influencing the outcome of volumetry tools for pulmonary nodule analysis: a systematic review and attempted meta-analysis

Health systems worldwide are implementing lung cancer screening programmes to identify early-stage lung cancer and maximise patient survival. Volumetry is recommended for follow-up of pulmonary nodules and outperforms other measurement methods. However, volumetry is known to be influenced by multiple factors. The objectives of this systematic review (PROSPERO CRD42022370233) are to summarise the current knowledge regarding factors that influence volumetry tools used in the analysis of pulmonary nodules, assess for significant clinical impact, identify gaps in current knowledge and suggest future research. Five databases (Medline, Scopus, Journals@Ovid, Embase and Emcare) were searched on the 21st of September, 2022, and 137 original research studies were included, explicitly testing the potential impact of influencing factors on the outcome of volumetry tools. The summary of these studies is tabulated, and a narrative review is provided. A subset of studies (n = 16) reporting clinical significance were selected, and their results were combined, if appropriate, using meta-analysis. Factors with clinical significance include the segmentation algorithm, quality of the segmentation, slice thickness, the level of inspiration for solid nodules, and the reconstruction algorithm and kernel in subsolid nodules. Although there is a large body of evidence in this field, it is unclear how to apply the results from these studies in clinical practice as most studies do not test for clinical relevance. The meta-analysis did not improve our understanding due to the small number and heterogeneity of studies testing for clinical significance. CRITICAL RELEVANCE STATEMENT: Many studies have investigated the influencing factors of pulmonary nodule volumetry, but only 11% of these questioned their clinical relevance in their management. The heterogeneity among these studies presents a challenge in consolidating results and clinical application of the evidence. KEY POINTS: • Factors influencing the volumetry of pulmonary nodules have been extensively investigated. • Just 11% of studies test clinical significance (wrongly diagnosing growth). • Nodule size interacts with most other influencing factors (especially for smaller nodules). • Heterogeneity among studies makes comparison and consolidation of results challenging. • Future research should focus on clinical applicability, screening, and updated technology.

A Deep Learning-Based Framework for Uncertainty Quantification in Medical Imaging Using the DropWeak Technique: An Empirical Study with Baresnet

Lung cancer is a leading cause of cancer-related deaths globally. Early detection is crucial for improving patient survival rates. Deep learning (DL) has shown promise in the medical field, but its accuracy must be evaluated, particularly in the context of lung cancer classification. In this study, we conducted uncertainty analysis on various frequently used DL architectures, including Baresnet, to assess the uncertainties in the classification results. This study focuses on the use of deep learning for the classification of lung cancer, which is a critical aspect of improving patient survival rates. The study evaluates the accuracy of various deep learning architectures, including Baresnet, and incorporates uncertainty quantification to assess the level of uncertainty in the classification results. The study presents a novel automatic tumor classification system for lung cancer based on CT images, which achieves a classification accuracy of 97.19% with an uncertainty quantification. The results demonstrate the potential of deep learning in lung cancer classification and highlight the importance of uncertainty quantification in improving the accuracy of classification results. This study's novelty lies in the incorporation of uncertainty quantification in deep learning for lung cancer classification, which can lead to more reliable and accurate diagnoses in clinical settings.

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.