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Liang ZJ, Chang S, Gao Y, Cao W, Kuo LR, Pomeroy MJ, Li LC, Abbasi AF, Bandovic J, Reiter MJ, Pickhardt PJ. Leveraging prior knowledge in machine intelligence to improve lesion diagnosis for early cancer detection. Med Phys 2025. [PMID: 40268724 DOI: 10.1002/mp.17841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 03/09/2025] [Accepted: 04/04/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND Experts' interpretations of medical images for lesion diagnosis may not always align with the underlying in vivo tissue pathology and, therefore, cannot be considered the definitive truth regarding malignancy or benignity. While current machine learning (ML) models in medical imaging can replicate expert interpretations, their results may also diverge from the actual ground truth. PURPOSE This study investigates various factors contributing to these discrepancies and proposes solutions. METHODS The central idea of the proposed solution is to integrate prior knowledge into ML models to enhance the characterization of in vivo tissues. The incorporation of prior knowledge into decision-making is task-specific, tailored to the data acquired for that task. This central idea was tested on the diagnosis of lesions using low dose computed tomography (LdCT) for early cancer detection, particularly focusing on more challenging, ambiguous or indeterminate lesions (IDLs) as classified by experts. One key piece of prior knowledge involves CT x-ray energy spectrum, where different energies interact with in vivo tissues within a lesion, producing variable but reproducible image contrasts that encapsulate biological information. Typically, CT imaging devices use only the high-energy portion of this spectrum for data acquisition; however, this study considers the full spectrum for lesion diagnostics. Another critical aspect of prior knowledge includes the functional or dynamic properties of in vivo tissues, such as elasticity, which can indicate pathological conditions. Instead of relying solely on abstract image features as current ML models do, this study extracts these tissue pathological characteristics from the image contrast variations. RESULTS The method was tested on LdCT images of four sets of IDLs, including pulmonary nodules and colorectal polyps, with pathological reports serving as the ground truth for malignancy or benignity. The method achieved an area under the receiver operating characteristic curve (AUC) of 0.98 ± 0.03, demonstrating a significant improvement over existing state-of-the-art ML models, which typically have AUCs in the 0.70 range. CONCLUSION Leveraging prior knowledge in machine intelligence can enhance lesion diagnosis, resolve the ambiguity of IDLs interpreted by experts, and improve the effectiveness of LdCT screening for early-stage cancers.
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Affiliation(s)
- Zhengrong J Liang
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Shaojie Chang
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Yongfeng Gao
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
| | - Weiguo Cao
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Licheng R Kuo
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Marc J Pomeroy
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA
| | - Lihong C Li
- Department of Engineering & Environment Science, City University of New York/CSI, Staten Island, New York, USA
| | - Almas F Abbasi
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
| | - Jela Bandovic
- Department of Pathology, Stony Brook University, Stony Brook, New York, USA
| | - Michael J Reiter
- Department of Radiology, Stony Brook University, Stony Brook, New York, USA
| | - Perry J Pickhardt
- Department of Radiology, School of Medicine & Public Health, University of Wisconsin, Madison, Wisconsin, USA
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Wang J, Cai J, Tang W, Dudurych I, van Tuinen M, Vliegenthart R, van Ooijen P. A comparison of an integrated and image-only deep learning model for predicting the disappearance of indeterminate pulmonary nodules. Comput Med Imaging Graph 2025; 123:102553. [PMID: 40239430 DOI: 10.1016/j.compmedimag.2025.102553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Revised: 03/18/2025] [Accepted: 04/03/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND Indeterminate pulmonary nodules (IPNs) require follow-up CT to assess potential growth; however, benign nodules may disappear. Accurately predicting whether IPNs will resolve is a challenge for radiologists. Therefore, we aim to utilize deep-learning (DL) methods to predict the disappearance of IPNs. MATERIAL AND METHODS This retrospective study utilized data from the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON) and Imaging in Lifelines (ImaLife) cohort. Participants underwent follow-up CT to determine the evolution of baseline IPNs. The NELSON data was used for model training. External validation was performed in ImaLife. We developed integrated DL-based models that incorporated CT images and demographic data (age, sex, smoking status, and pack years). We compared the performance of integrated methods with those limited to CT images only and calculated sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). From a clinical perspective, ensuring high specificity is critical, as it minimizes false predictions of non-resolving nodules that should be monitored for evolution on follow-up CTs. Feature importance was calculated using SHapley Additive exPlanations (SHAP) values. RESULTS The training dataset included 840 IPNs (134 resolving) in 672 participants. The external validation dataset included 111 IPNs (46 resolving) in 65 participants. On the external validation set, the performance of the integrated model (sensitivity, 0.50; 95 % CI, 0.35-0.65; specificity, 0.91; 95 % CI, 0.80-0.96; AUC, 0.82; 95 % CI, 0.74-0.90) was comparable to that solely trained on CT image (sensitivity, 0.41; 95 % CI, 0.27-0.57; specificity, 0.89; 95 % CI, 0.78-0.95; AUC, 0.78; 95 % CI, 0.69-0.86; P = 0.39). The top 10 most important features were all image related. CONCLUSION Deep learning-based models can predict the disappearance of IPNs with high specificity. Integrated models using CT scans and clinical data had comparable performance to those using only CT images.
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Affiliation(s)
- Jingxuan Wang
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands; Data Science in Health (DASH), University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Jiali Cai
- Department of Epidemiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Wei Tang
- Department of Neurology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands; Data Science in Health (DASH), University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Ivan Dudurych
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Marcel van Tuinen
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands; Data Science in Health (DASH), University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands
| | - Peter van Ooijen
- Department of Radiation Oncology, University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands; Data Science in Health (DASH), University of Groningen, University Medical Center of Groningen, Groningen, the Netherlands.
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Zhao M, Xue G, He B, Deng J, Wang T, Zhong Y, Li S, Wang Y, He Y, Chen T, Zhang J, Yan Z, Hu X, Guo L, Qu W, Song Y, Yang M, Zhao G, Yu B, Ma M, Liu L, Sun X, Zhao D, Xie D, Chen C, She Y. A multiomics dataset of paired CT image and plasma cell-free DNA end motif for patients with pulmonary nodules. Sci Data 2025; 12:545. [PMID: 40169596 PMCID: PMC11961589 DOI: 10.1038/s41597-025-04912-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 03/26/2025] [Indexed: 04/03/2025] Open
Abstract
Diagnosing lung cancer at a curable stage offers the opportunity for a favorable prognosis. The emerging epigenomics analysis on plasma cell-free DNA (cfDNA), including 5-methylcytosine (5mC) and 5-hydroxymethylcytosine (5hmC) modifications, has acted as a promising approach facilitating the identification of lung cancer. And, integrating 5mC biomarker with chest computed tomography (CT) image features could optimize the diagnosis of lung cancer, exceeding the performance of models built on single feature. However, the clinical applicability of integrated markers might be limited by the potential risk of overfitting due to small sample size. Hence, we prospectively collected peripheral blood sample and the paired chest CT images of 2032 patients with indeterminate pulmonary nodules across 5 centers, and constructed a large-scale, multi-institutional, multiomics database that encompass CT imaging data and plasma cfDNA fragmentomic in 5mC-, 5hmC-enriched regions. To our best knowledge, this dataset is the first radio-epigenomic dataset with the largest sample size, and provides multi-dimensional insights for early diagnosis of lung cancer, facilitating the individuated management for lung cancer.
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Affiliation(s)
- Mengmeng Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gang Xue
- Laboratory of Omics Technology and Bioinformatics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Bingxi He
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China
- Key Laboratory of Big Data-Based Precision Medicine, Beihang University, Ministry of Industry and Information Technology, Beijing, China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tingting Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shenghui Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yiming He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jun Zhang
- Tailai Inc., Chengdu, Sichuan, China
| | - Ziyue Yan
- Tailai Inc., Chengdu, Sichuan, China
| | - Xinlei Hu
- Laboratory of Omics Technology and Bioinformatics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Liuning Guo
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China
| | - Wendong Qu
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China
| | - Yongxiang Song
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China
| | - Minglei Yang
- Department of Thoracic Surgery, Ningbo No.2 Hospital, Zhejiang, China
| | - Guofang Zhao
- Department of Thoracic Surgery, Ningbo No.2 Hospital, Zhejiang, China
| | - Bentong Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Minjie Ma
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China
| | - Lunxu Liu
- Institute of Thoracic Oncology and Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Dan Xie
- Laboratory of Omics Technology and Bioinformatics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Taylor JL, Adams SJ, Dennie C, Lim R, McInnis M, Manos D. CAR/CSTR Practice Guideline on CT Screening for Lung Cancer. Can Assoc Radiol J 2025:8465371251317179. [PMID: 40016863 DOI: 10.1177/08465371251317179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2025] Open
Abstract
Lung cancer is the second-most diagnosed cancer and the leading cause of cancer-related death in Canada. The updated CAR/CSTR Practice Guideline on CT Screening for Lung Cancer reflects advancements in evidence since the 2016 guideline, including findings from the NELSON trial and preliminary data from multiple provincial lung cancer screening programs, and aims to support Canadian diagnostic imaging departments in implementing organized lung cancer screening programs. The guideline emphasizes screening with the use of low-dose CT (LDCT) to reduce lung cancer mortality in appropriately selected individuals with increased risk of lung cancer, using eligibility criteria based on risk prediction models such as the PLCOm2012. It outlines training requirements for radiologists, standardized CT and reporting protocols, quality assurance measures, and the integration of AI tools for nodule risk stratification. The document also highlights emerging areas for investigation, including the potential for biennial screening and equitable access to programs across Canada.
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Affiliation(s)
- Jana Lyn Taylor
- Department of Diagnostic Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Scott J Adams
- Department of Medical Imaging, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada
| | - Carole Dennie
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert Lim
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Micheal McInnis
- Joint Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Daria Manos
- Department of Diagnostic Radiology, Dalhousie University, Halifax, NS, Canada
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Hwang EJ, Goo JM, Park CM. AI Applications for Thoracic Imaging: Considerations for Best Practice. Radiology 2025; 314:e240650. [PMID: 39998373 DOI: 10.1148/radiol.240650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2025]
Abstract
Artificial intelligence (AI) technology is rapidly being introduced into thoracic radiology practice. Current representative use cases for AI in thoracic imaging show cumulative evidence of effectiveness. These include AI assistance for reading chest radiographs and low-dose (1.5-mSv) chest CT scans for lung cancer screening and triaging pulmonary embolism on chest CT scans. Other potential use cases are also under investigation, including filtering out normal chest radiographs, monitoring reading errors, and automated opportunistic screening of nontarget diseases. However, implementing AI tools in daily practice requires establishing practical strategies. Practical AI implementation will require objective on-site performance evaluation, institutional information technology infrastructure integration, and postdeployment monitoring. Meanwhile, the remaining challenges of adopting AI technology need to be addressed. These challenges include educating radiologists and radiology trainees, alleviating liability risk, and addressing potential disparities due to the uneven distribution of data and AI technology. Finally, next-generation AI technology represented by large language models (LLMs), including multimodal models, which can interpret both text and images, is expected to innovate the current landscape of AI in thoracic radiology practice. These LLMs offer opportunities ranging from generating text reports from images to explaining examination results to patients. However, these models require more research into their feasibility and efficacy.
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Affiliation(s)
- Eui Jin Hwang
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
| | - Chang Min Park
- Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
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Afridi WA, Picos SH, Bark JM, Stamoudis DAF, Vasani S, Irwin D, Fielding D, Punyadeera C. Minimally invasive biomarkers for triaging lung nodules-challenges and future perspectives. Cancer Metastasis Rev 2025; 44:29. [PMID: 39888565 PMCID: PMC11785609 DOI: 10.1007/s10555-025-10247-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2024] [Accepted: 01/23/2025] [Indexed: 02/01/2025]
Abstract
CT chest scans are commonly performed worldwide, either in routine clinical practice for a wide range of indications or as part of lung cancer screening programs. Many of these scans detect lung nodules, which are small, rounded opacities measuring 8-30 mm. While the concern about nodules is that they may represent early lung cancer, in screening programs, only 1% of such nodules turn out to be cancer. This leads to a series of complex decisions and, at times, unnecessary biopsies for nodules that are ultimately determined to be benign. Additionally, patients may be anxious about the status of detected lung nodules. The high rate of false positive lung nodule detections has driven advancements in biomarker-based research aimed at triaging lung nodules (benign versus malignant) to identify truly malignant nodules better. Biomarkers found in biofluids and breath hold promise owing to their minimally invasive sampling methods, ease of use, and cost-effectiveness. Although several biomarkers have demonstrated clinical utility, their sensitivity and specificity are still relatively low. Combining multiple biomarkers could enhance the characterisation of small pulmonary nodules by addressing the limitations of individual biomarkers. This approach may help reduce unnecessary invasive procedures and accelerate diagnosis in the future. This review offers a thorough overview of emerging minimally invasive biomarkers for triaging lung nodules, emphasising key challenges and proposing potential solutions for biomarker-based nodule differentiation. It focuses on diagnosis rather than screening, analysing research published primarily in the past five years with some exceptions. The incorporation of biomarkers into clinical practice will facilitate the early detection of malignant nodules, leading to timely interventions and improved outcomes. Further efforts are needed to increase the cost-effectiveness and practicality of many of these applications in clinical settings. However, the range of technologies is advancing rapidly, and they may soon be implemented in clinics in the near future.
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Affiliation(s)
- Waqar Ahmed Afridi
- Saliva and Liquid Biopsy Translational Laboratory, Institute for Biomedicine and Glycomics (IBG), Griffith University, Brisbane, 4111, Australia
- Virtual University of Pakistan, Islamabad, 44000, Pakistan
| | - Samandra Hernandez Picos
- Saliva and Liquid Biopsy Translational Laboratory, Institute for Biomedicine and Glycomics (IBG), Griffith University, Brisbane, 4111, Australia
| | - Juliana Muller Bark
- Saliva and Liquid Biopsy Translational Laboratory, Institute for Biomedicine and Glycomics (IBG), Griffith University, Brisbane, 4111, Australia
| | - Danyelle Assis Ferreira Stamoudis
- Saliva and Liquid Biopsy Translational Laboratory, Institute for Biomedicine and Glycomics (IBG), Griffith University, Brisbane, 4111, Australia
| | - Sarju Vasani
- Department of Otolaryngology, Royal Brisbane and Women's Hospital, Herston, 4006, Australia
| | - Darryl Irwin
- The Agena Biosciences, Bowen Hills, Brisbane, 4006, Australia
| | - David Fielding
- The Royal Brisbane and Women's Hospital, Herston, Brisbane, 4006, Australia
| | - Chamindie Punyadeera
- Saliva and Liquid Biopsy Translational Laboratory, Institute for Biomedicine and Glycomics (IBG), Griffith University, Brisbane, 4111, Australia.
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7
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Zhao M, Xue G, He B, Deng J, Wang T, Zhong Y, Li S, Wang Y, He Y, Chen T, Zhang J, Yan Z, Hu X, Guo L, Qu W, Song Y, Yang M, Zhao G, Yu B, Ma M, Liu L, Sun X, She Y, Xie D, Zhao D, Chen C. Integrated multiomics signatures to optimize the accurate diagnosis of lung cancer. Nat Commun 2025; 16:84. [PMID: 39747216 PMCID: PMC11695815 DOI: 10.1038/s41467-024-55594-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 12/14/2024] [Indexed: 01/04/2025] Open
Abstract
Diagnosing lung cancer from indeterminate pulmonary nodules (IPLs) remains challenging. In this multi-institutional study involving 2032 participants with IPLs, we integrate the clinical, radiomic with circulating cell-free DNA fragmentomic features in 5-methylcytosine (5mC)-enriched regions to establish a multiomics model (clinic-RadmC) for predicting the malignancy risk of IPLs. The clinic-RadmC yields an area-under-the-curve (AUC) of 0.923 on the external test set, outperforming the single-omics models, and models that only combine clinical features with radiomic, or fragmentomic features in 5mC-enriched regions (p < 0.050 for all). The superiority of the clinic-RadmC maintains well even after adjusting for clinic-radiological variables. Furthermore, the clinic-RadmC-guided strategy could reduce the unnecessary invasive procedures for benign IPLs by 10.9% ~ 35%, and avoid the delayed treatment for lung cancer by 3.1% ~ 38.8%. In summary, our study indicates that the clinic-RadmC provides a more effective and noninvasive tool for optimizing lung cancer diagnoses, thus facilitating the precision interventions.
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Affiliation(s)
- Mengmeng Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gang Xue
- Laboratory of Omics Technology and Bioinformatics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Bingxi He
- Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Engineering Medicine, Beihang University, Beijing, China
- Key Laboratory of Big Data-Based Precision Medicine, Beihang University, Ministry of Industry and Information Technology, Beijing, China
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, China
| | - Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Tingting Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yifan Zhong
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shenghui Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yiming He
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | | | | | - Xinlei Hu
- Laboratory of Omics Technology and Bioinformatics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Liuning Guo
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China
| | - Wendong Qu
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China
| | - Yongxiang Song
- Department of Thoracic Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Medical College, Guizhou, China
| | - Minglei Yang
- Department of Thoracic Surgery, Hwa Mei Hospital, Chinese Academy of Sciences, Zhejiang, China
| | - Guofang Zhao
- Department of Thoracic Surgery, Hwa Mei Hospital, Chinese Academy of Sciences, Zhejiang, China
| | - Bentong Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Minjie Ma
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Gansu, China
| | - Lunxu Liu
- Institute of Thoracic Oncology and Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiwen Sun
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Dan Xie
- Laboratory of Omics Technology and Bioinformatics, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
- State Key Laboratory of Biotherapy, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Deping Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Piskorski L, Debic M, von Stackelberg O, Schlamp K, Welzel L, Weinheimer O, Peters AA, Wielpütz MO, Frauenfelder T, Kauczor HU, Heußel CP, Kroschke J. Malignancy risk stratification for pulmonary nodules: comparing a deep learning approach to multiparametric statistical models in different disease groups. Eur Radiol 2025:10.1007/s00330-024-11256-8. [PMID: 39747589 DOI: 10.1007/s00330-024-11256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 10/14/2024] [Accepted: 10/30/2024] [Indexed: 01/04/2025]
Abstract
OBJECTIVES Incidentally detected pulmonary nodules present a challenge in clinical routine with demand for reliable support systems for risk classification. We aimed to evaluate the performance of the lung-cancer-prediction-convolutional-neural-network (LCP-CNN), a deep learning-based approach, in comparison to multiparametric statistical methods (Brock model and Lung-RADS®) for risk classification of nodules in cohorts with different risk profiles and underlying pulmonary diseases. MATERIALS AND METHODS Retrospective analysis was conducted on non-contrast and contrast-enhanced CT scans containing pulmonary nodules measuring 5-30 mm. Ground truth was defined by histology or follow-up stability. The final analysis was performed on 297 patients with 422 eligible nodules, of which 105 nodules were malignant. Classification performance of the LCP-CNN, Brock model, and Lung-RADS® was evaluated in terms of diagnostic accuracy measurements including ROC-analysis for different subcohorts (total, screening, emphysema, and interstitial lung disease). RESULTS LCP-CNN demonstrated superior performance compared to the Brock model in total and screening cohorts (AUC 0.92 (95% CI: 0.89-0.94) and 0.93 (95% CI: 0.89-0.96)). Superior sensitivity of LCP-CNN was demonstrated compared to the Brock model and Lung-RADS® in total, screening, and emphysema cohorts for a risk threshold of 5%. Superior sensitivity of LCP-CNN was also shown across all disease groups compared to the Brock model at a threshold of 65%, compared to Lung-RADS® sensitivity was better or equal. No significant differences in the performance of LCP-CNN were found between subcohorts. CONCLUSION This study offers further evidence of the potential to integrate deep learning-based decision support systems into pulmonary nodule classification workflows, irrespective of the individual patient risk profile and underlying pulmonary disease. KEY POINTS Question Is a deep-learning approach (LCP-CNN) superior to multiparametric models (Brock model, Lung-RADS®) in classifying pulmonary nodule risk across varied patient profiles? Findings LCP-CNN shows superior performance in risk classification of pulmonary nodules compared to multiparametric models with no significant impact on risk profiles and structural pulmonary diseases. Clinical relevance LCP-CNN offers efficiency and accuracy, addressing limitations of traditional models, such as variations in manual measurements or lack of patient data, while producing robust results. Such approaches may therefore impact clinical work by complementing or even replacing current approaches.
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Affiliation(s)
- Lars Piskorski
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Manuel Debic
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Oyunbileg von Stackelberg
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Kai Schlamp
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Linn Welzel
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Oliver Weinheimer
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Alan Arthur Peters
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Department for Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mark Oliver Wielpütz
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Thomas Frauenfelder
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Claus Peter Heußel
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
- Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonas Kroschke
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Heidelberg, Germany.
- Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
- Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland.
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9
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Kudo Y, Saito A, Horiuchi T, Murakami K, Kobayashi M, Matsubayashi J, Nagao T, Ohira T, Kuroda M, Ikeda N. Preoperative evaluation of visceral pleural invasion in peripheral lung cancer utilizing deep learning technology. Surg Today 2025; 55:18-28. [PMID: 38782767 DOI: 10.1007/s00595-024-02869-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE This study aimed to assess the efficiency of artificial intelligence (AI) in the detection of visceral pleural invasion (VPI) of lung cancer using high-resolution computed tomography (HRCT) images, which is challenging for experts because of its significance in T-classification and lymph node metastasis prediction. METHODS This retrospective analysis was conducted on preoperative HRCT images of 472 patients with stage I non-small cell lung cancer (NSCLC), focusing on lesions adjacent to the pleura to predict VPI. YOLOv4.0 was utilized for tumor localization, and EfficientNetv2 was applied for VPI prediction with HRCT images meticulously annotated for AI model training and validation. RESULTS Of the 472 lung cancer cases (500 CT images) studied, the AI algorithm successfully identified tumors, with YOLOv4.0 accurately localizing tumors in 98% of the test images. In the EfficientNet v2-M analysis, the receiver operating characteristic curve exhibited an area under the curve of 0.78. It demonstrated powerful diagnostic performance with a sensitivity, specificity, and precision of 76.4% in VPI prediction. CONCLUSION AI is a promising tool for improving the diagnostic accuracy of VPI for NSCLC. Furthermore, incorporating AI into the diagnostic workflow is advocated because of its potential to improve the accuracy of preoperative diagnosis and patient outcomes in NSCLC.
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Affiliation(s)
- Yujin Kudo
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, Japan.
| | - Akira Saito
- Department of AI Applied Quantitative Clinical Science, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, Japan
| | | | - Kotaro Murakami
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, Japan
| | | | - Jun Matsubayashi
- Department of Anatomic Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, Japan
| | - Tatsuo Ohira
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, Japan
| | - Masahiko Kuroda
- Department of Molecular Pathology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, Japan
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10
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Baum P, Schlamp K, Klotz LV, Eichhorn ME, Herth F, Winter H. Incidental Pulmonary Nodules: Differential Diagnosis and Clinical Management. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:853-860. [PMID: 39316015 DOI: 10.3238/arztebl.m2024.0177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 08/21/2024] [Accepted: 08/21/2024] [Indexed: 09/25/2024]
Abstract
BACKGROUND According to data from the USA, the incidence of incidentally discovered pulmonary nodules is 5.8 per 100 000 person- years for women and 5.2 per 100 000 person-years for men. Their management as recommended in the pertinent guidelines can substantially improve clinical outcomes. More than 95% of all pulmonary nodules revealed by computerized tomography (CT) are benign, but many cases are not managed in conformity with the guidelines. In this article, we summarize the appropriate clinical approach and provide an overview of the pertinent diagnostic studies and when they should be performed. METHODS This review is based on relevant publications retrieved by a selective search in PubMed. The authors examined Englishlanguage recommendations issued since 2010 for the management of pulmonary nodules, supplemented by comments from the German lung cancer guideline. RESULTS In general, the risk that an incidentally discovered pulmonary nodule is malignant is low but rises markedly with increasing size and the presence of risk factors. When such a nodule is detected, the further recommendation, depending on size, is either for follow-up examinations with chest CT or else for an extended evaluation with positron emission tomography-CT and biopsy for histology. The diagnostic evaluation should include consideration of any earlier imaging studies that may be available as an indication of possible growth over time. Single nodules measuring less than 6 mm, in patients with few or no risk factors, do not require any follow-up. Lung cancer is diagnosed in just under 10% of patients with a nodule measuring more than 8 mm. CONCLUSION The recommendations of the guidelines for the management of incidentally discovered pulmonary nodules are intended to prevent both overand undertreatment. If a tumor is suspected, further care should be provided by an interdisciplinary team.
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Affiliation(s)
- Philip Baum
- Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Medical Center, Heidelberg, Germany; Depatrment of Diagnostic and Interventional Radiology, Thoraxklinik at Heidelberg University Medical Center, Heidelberg, Germany; Thoraxklinik-Heidelberg gGmbH, Department of Pneumology and Respiratory Medicine, Heidelberg University Medical Center
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11
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Dao TTP, Huynh TL, Pham MK, Le TN, Nguyen TC, Nguyen QT, Tran BA, Van BN, Ha CC, Tran MT. Improving Laryngoscopy Image Analysis Through Integration of Global Information and Local Features in VoFoCD Dataset. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:2794-2809. [PMID: 38809338 PMCID: PMC11612113 DOI: 10.1007/s10278-024-01068-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/24/2024] [Accepted: 02/26/2024] [Indexed: 05/30/2024]
Abstract
The diagnosis and treatment of vocal fold disorders heavily rely on the use of laryngoscopy. A comprehensive vocal fold diagnosis requires accurate identification of crucial anatomical structures and potential lesions during laryngoscopy observation. However, existing approaches have yet to explore the joint optimization of the decision-making process, including object detection and image classification tasks simultaneously. In this study, we provide a new dataset, VoFoCD, with 1724 laryngology images designed explicitly for object detection and image classification in laryngoscopy images. Images in the VoFoCD dataset are categorized into four classes and comprise six glottic object types. Moreover, we propose a novel Multitask Efficient trAnsformer network for Laryngoscopy (MEAL) to classify vocal fold images and detect glottic landmarks and lesions. To further facilitate interpretability for clinicians, MEAL provides attention maps to visualize important learned regions for explainable artificial intelligence results toward supporting clinical decision-making. We also analyze our model's effectiveness in simulated clinical scenarios where shaking of the laryngoscopy process occurs. The proposed model demonstrates outstanding performance on our VoFoCD dataset. The accuracy for image classification and mean average precision at an intersection over a union threshold of 0.5 (mAP50) for object detection are 0.951 and 0.874, respectively. Our MEAL method integrates global knowledge, encompassing general laryngoscopy image classification, into local features, which refer to distinct anatomical regions of the vocal fold, particularly abnormal regions, including benign and malignant lesions. Our contribution can effectively aid laryngologists in identifying benign or malignant lesions of vocal folds and classifying images in the laryngeal endoscopy process visually.
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Affiliation(s)
- Thao Thi Phuong Dao
- University of Science, Ho Chi Minh City, Vietnam
- John von Neumann Institute, Ho Chi Minh City, Vietnam
- Vietnam National University, Ho Chi Minh City, Vietnam
- Department of Otolaryngology, Thong Nhat Hospital, Tan Binh District, Ho Chi Minh City, Vietnam
| | - Tuan-Luc Huynh
- University of Science, Ho Chi Minh City, Vietnam
- Vietnam National University, Ho Chi Minh City, Vietnam
| | | | - Trung-Nghia Le
- University of Science, Ho Chi Minh City, Vietnam
- Vietnam National University, Ho Chi Minh City, Vietnam
| | - Tan-Cong Nguyen
- University of Science, Ho Chi Minh City, Vietnam
- Vietnam National University, Ho Chi Minh City, Vietnam
- University of Social Sciences and Humanities, Ho Chi Minh City, Vietnam
| | - Quang-Thuc Nguyen
- University of Science, Ho Chi Minh City, Vietnam
- John von Neumann Institute, Ho Chi Minh City, Vietnam
- Vietnam National University, Ho Chi Minh City, Vietnam
| | - Bich Anh Tran
- Otorhinolaryngology Department, Cho Ray Hospital, District 5, Ho Chi Minh City, Vietnam
| | - Boi Ngoc Van
- Department of Otolaryngology, Vinmec Central Park International Hospital, Binh Thanh District, Ho Chi Minh City, Vietnam
| | - Chanh Cong Ha
- Department of Otolaryngology, District 7 Hospital, District 7, Ho Chi Minh City, Vietnam
| | - Minh-Triet Tran
- University of Science, Ho Chi Minh City, Vietnam.
- John von Neumann Institute, Ho Chi Minh City, Vietnam.
- Vietnam National University, Ho Chi Minh City, Vietnam.
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12
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Hillyer GC, Milano N, Bulman WA. Pulmonary nodules and the psychological harm they can cause: A scoping review. Respir Med Res 2024; 86:101121. [PMID: 38964266 DOI: 10.1016/j.resmer.2024.101121] [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: 01/04/2024] [Revised: 05/21/2024] [Accepted: 06/13/2024] [Indexed: 07/06/2024]
Abstract
More than 1.6 million pulmonary nodules are diagnosed in the United States each year. Although the majority of nodules are found to be benign, nodule detection and the process of ruling out malignancy can cause patients psychological harm to varying degrees. The present study undertakes a scoping review of the literature investigating pulmonary nodule-related psychological harm as a primary or secondary outcome. Online databases were systematically searched to identify papers published through June 30, 2023, from which 19 publications were reviewed. We examined prevalence by type, measurement, associated factors, and behavioral or clinical consequences. Of the 19 studies reviewed, 11 studies investigated distress, anxiety (n = 6), and anxiety and depression (n = 4). Prevalence of distress was 24.0 %-56.7 %; anxiety 9.9 %-42.1 %, and 14.6 %-27.0 % for depression. A wide range of demographic and social characteristics and clinical factors were associated with nodule-related psychological harm. Outcomes of nodule-related harms included experiencing conflict when deciding about treatment or surveillance, decreased adherence to surveillance, adoption of more aggressive treatment, and lower health-related quality of life. Our scoping review demonstrates that nodule-related psychological harm is common. Findings provide evidence that nodule-related psychological harm can influence clinical decisions and adherence to treatment recommendations. Future research should focus on discerning between nodule-related distress and anxiety; identifying patients at risk; ascertaining the extent of psychological harm on patient behavior and clinical decisions; and developing interventions to assist patients in managing psychological harm for better health-related quality of life and treatment outcomes.
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Affiliation(s)
- Grace C Hillyer
- Mailman School of Public Health at Columbia University, New York, NY, USA; Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY USA.
| | - Nicole Milano
- School of Social Work, Rutgers University, New Brunswick, NJ, USA
| | - William A Bulman
- Veracyte Inc., South San Francisco, CA, USA; Columbia University Irving Medical Center, New York, NY, USA
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13
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Wang C, Shao J, He Y, Wu J, Liu X, Yang L, Wei Y, Zhou XS, Zhan Y, Shi F, Shen D, Li W. Data-driven risk stratification and precision management of pulmonary nodules detected on chest computed tomography. Nat Med 2024; 30:3184-3195. [PMID: 39289570 PMCID: PMC11564084 DOI: 10.1038/s41591-024-03211-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 07/22/2024] [Indexed: 09/19/2024]
Abstract
The widespread implementation of low-dose computed tomography (LDCT) in lung cancer screening has led to the increasing detection of pulmonary nodules. However, precisely evaluating the malignancy risk of pulmonary nodules remains a formidable challenge. Here we propose a triage-driven Chinese Lung Nodules Reporting and Data System (C-Lung-RADS) utilizing a medical checkup cohort of 45,064 cases. The system was operated in a stepwise fashion, initially distinguishing low-, mid-, high- and extremely high-risk nodules based on their size and density. Subsequently, it progressively integrated imaging information, demographic characteristics and follow-up data to pinpoint suspicious malignant nodules and refine the risk scale. The multidimensional system achieved a state-of-the-art performance with an area under the curve (AUC) of 0.918 (95% confidence interval (CI) 0.918-0.919) on the internal testing dataset, outperforming the single-dimensional approach (AUC of 0.881, 95% CI 0.880-0.882). Moreover, C-Lung-RADS exhibited a superior sensitivity compared with Lung-RADS v2022 (87.1% versus 63.3%) in an independent cohort, which was screened using mobile computed tomography scanners to broaden screening accessibility in resource-constrained settings. With its foundation in precise risk stratification and tailored management, this system has minimized unnecessary invasive procedures for low-risk cases and recommended prompt intervention for extremely high-risk nodules to avert diagnostic delays. This approach has the potential to enhance the decision-making paradigm and facilitate a more efficient diagnosis of lung cancer during routine checkups as well as screening scenarios.
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Affiliation(s)
- Chengdi Wang
- Department of Pulmonary and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China.
- Frontiers Medical Center, Tianfu Jincheng Laboratory, Chengdu, China.
| | - Jun Shao
- Department of Pulmonary and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Yichu He
- Department of Research and Development, United Imaging Intelligence, Shanghai, China
| | - Jiaojiao Wu
- Department of Research and Development, United Imaging Intelligence, Shanghai, China
| | - Xingting Liu
- Department of Pulmonary and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Liuqing Yang
- Department of Pulmonary and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China
| | - Ying Wei
- Department of Research and Development, United Imaging Intelligence, Shanghai, China
| | - Xiang Sean Zhou
- School of Biomedical Engineering and State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China
| | - Yiqiang Zhan
- School of Biomedical Engineering and State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China
| | - Feng Shi
- Department of Research and Development, United Imaging Intelligence, Shanghai, China.
| | - Dinggang Shen
- School of Biomedical Engineering and State Key Laboratory of Advanced Medical Materials and Devices, ShanghaiTech University, Shanghai, China.
- Shanghai Clinical Research and Trial Center, Shanghai, China.
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, Targeted Tracer Research and Development Laboratory, Frontiers Science Center for Disease-Related Molecular Network, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, China.
- Frontiers Medical Center, Tianfu Jincheng Laboratory, Chengdu, China.
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14
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Wulaningsih W, Villamaria C, Akram A, Benemile J, Croce F, Watkins J. Deep Learning Models for Predicting Malignancy Risk in CT-Detected Pulmonary Nodules: A Systematic Review and Meta-analysis. Lung 2024; 202:625-636. [PMID: 38782779 PMCID: PMC11427562 DOI: 10.1007/s00408-024-00706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/12/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND There has been growing interest in using artificial intelligence/deep learning (DL) to help diagnose prevalent diseases earlier. In this study we sought to survey the landscape of externally validated DL-based computer-aided diagnostic (CADx) models, and assess their diagnostic performance for predicting the risk of malignancy in computed tomography (CT)-detected pulmonary nodules. METHODS An electronic search was performed in four databases (from inception to 10 August 2023). Studies were eligible if they were peer-reviewed experimental or observational articles comparing the diagnostic performance of externally validated DL-based CADx models with models widely used in clinical practice to predict the risk of malignancy. A bivariate random-effect approach for the meta-analysis on the included studies was used. RESULTS Seventeen studies were included, comprising 8553 participants and 9884 nodules. Pooled analyses showed DL-based CADx models were 11.6% more sensitive than physician judgement alone, and 14.5% more than clinical risk models alone. They had a similar pooled specificity to physician judgement alone [0.77 (95% CI 0.68-0.84) v 0.81 (95% CI 0.71-0.88)], and were 7.4% more specific than clinical risk models alone. They had superior pooled areas under the receiver operating curve (AUC), with relative pooled AUCs of 1.03 (95% CI 1.00-1.07) and 1.10 (95% CI 1.07-1.13) versus physician judgement and clinical risk models alone, respectively. CONCLUSION DL-based models are already used in clinical practice in certain settings for nodule management. Our results show their diagnostic performance potentially justifies wider, more routine deployment alongside experienced physician readers to help inform multidisciplinary team decision-making.
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Affiliation(s)
- Wahyu Wulaningsih
- The Royal Marsden, London, UK.
- Faculty of Life Sciences & Medicine, King's College London, London, UK.
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15
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Kim RY, Yee C, Zeb S, Steltz J, Vickers AJ, Rendle KA, Mitra N, Pickup LC, DiBardino DM, Vachani A. Clinical utility of an artificial intelligence radiomics-based tool for risk stratification of pulmonary nodules. JNCI Cancer Spectr 2024; 8:pkae086. [PMID: 39292567 PMCID: PMC11521375 DOI: 10.1093/jncics/pkae086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/10/2024] [Accepted: 08/31/2024] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND Clinical utility data on pulmonary nodule (PN) risk stratification biomarkers are lacking. We aimed to determine the incremental predictive value and clinical utility of using an artificial intelligence (AI) radiomics-based computer-aided diagnosis (CAD) tool in addition to routine clinical information to risk stratify PNs among real-world patients. METHODS We performed a retrospective cohort study of patients with PNs who underwent lung biopsy. We collected clinical data and used a commercially available AI radiomics-based CAD tool to calculate a Lung Cancer Prediction (LCP) score. We developed logistic regression models to evaluate a well-validated clinical risk prediction model (the Mayo Clinic model) with and without the LCP score (Mayo vs Mayo + LCP) using area under the curve (AUC), risk stratification table, and standardized net benefit analyses. RESULTS Among the 134 patients undergoing PN biopsy, cancer prevalence was 61%. Addition of the radiomics-based LCP score to the Mayo model was associated with increased predictive accuracy (likelihood ratio test, P = .012). The AUCs for the Mayo and Mayo + LCP models were 0.58 (95% CI = 0.48 to 0.69) and 0.65 (95% CI = 0.56 to 0.75), respectively. At the 65% risk threshold, the Mayo + LCP model was associated with increased sensitivity (56% vs 38%; P = .019), similar false positive rate (33% vs 35%; P = .8), and increased standardized net benefit (18% vs -3.3%) compared with the Mayo model. CONCLUSIONS Use of a commercially available AI radiomics-based CAD tool as a supplement to clinical information improved PN cancer risk prediction and may result in clinically meaningful changes in risk stratification.
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Affiliation(s)
- Roger Y Kim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sana Zeb
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer Steltz
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Katharine A Rendle
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, USA
| | | | - David M DiBardino
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anil Vachani
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Moghaddam SJ, Savai R, Salehi-Rad R, Sengupta S, Kammer MN, Massion P, Beane JE, Ostrin EJ, Priolo C, Tennis MA, Stabile LP, Bauer AK, Sears CR, Szabo E, Rivera MP, Powell CA, Kadara H, Jenkins BJ, Dubinett SM, Houghton AM, Kim CF, Keith RL. Premalignant Progression in the Lung: Knowledge Gaps and Novel Opportunities for Interception of Non-Small Cell Lung Cancer. An Official American Thoracic Society Research Statement. Am J Respir Crit Care Med 2024; 210:548-571. [PMID: 39115548 PMCID: PMC11389570 DOI: 10.1164/rccm.202406-1168st] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Indexed: 08/13/2024] Open
Abstract
Rationale: Despite significant advances in precision treatments and immunotherapy, lung cancer is the most common cause of cancer death worldwide. To reduce incidence and improve survival rates, a deeper understanding of lung premalignancy and the multistep process of tumorigenesis is essential, allowing timely and effective intervention before cancer development. Objectives: To summarize existing information, identify knowledge gaps, formulate research questions, prioritize potential research topics, and propose strategies for future investigations into the premalignant progression in the lung. Methods: An international multidisciplinary team of basic, translational, and clinical scientists reviewed available data to develop and refine research questions pertaining to the transformation of premalignant lung lesions to advanced lung cancer. Results: This research statement identifies significant gaps in knowledge and proposes potential research questions aimed at expanding our understanding of the mechanisms underlying the progression of premalignant lung lesions to lung cancer in an effort to explore potential innovative modalities to intercept lung cancer at its nascent stages. Conclusions: The identified gaps in knowledge about the biological mechanisms of premalignant progression in the lung, together with ongoing challenges in screening, detection, and early intervention, highlight the critical need to prioritize research in this domain. Such focused investigations are essential to devise effective preventive strategies that may ultimately decrease lung cancer incidence and improve patient outcomes.
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Xiao D, Kammer MN, Chen H, Woodhouse P, Sandler KL, Baron AE, Wilson DO, Billatos E, Pu J, Maldonado F, Deppen SA, Grogan EL. Assessing the transportability of radiomic models for lung cancer diagnosis: commercial vs. open-source feature extractors. Transl Lung Cancer Res 2024; 13:1907-1917. [PMID: 39263016 PMCID: PMC11384473 DOI: 10.21037/tlcr-24-281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 07/10/2024] [Indexed: 09/13/2024]
Abstract
Background Radiomics has shown promise in improving malignancy risk stratification of indeterminate pulmonary nodules (IPNs) with many platforms available, but with no head-to-head comparisons. This study aimed to evaluate transportability of radiomic models across platforms by comparing performances of a commercial radiomic feature extractor (HealthMyne) with an open-source extractor (PyRadiomics) on diagnosis of lung cancer in IPNs. Methods A commercial radiomic feature extractor was used to segment IPNs from computed tomography (CT) scans, and a previously validated radiomic model based on commercial features was used as baseline (ComRad). Using same segmentation masks, PyRadiomics, an open-source feature extractor was used to build three open-source radiomic models (OpenRad) using different methods: de novo open-source model derived using least absolute shrinkage and selection operator (LASSO) for feature selection, selecting open-source features matched to ComRad features based upon Imaging Biomarker Standardization Initiative (IBSI) nomenclature, and selecting open-source features most highly correlated to ComRad features. Radiomic models were trained on an internal cohort (n=161) and externally validated on 3 cohorts (n=278). We added Mayo clinical risk score to OpenRad and ComRad models, creating integrated clinical radiomic (ClinRad) models. All models were compared using area under the curve (AUC) and evaluated for clinical improvement using bias-corrected clinical net reclassification indices (cNRIs). Results ComRad AUC was 0.76 [95% confidence interval (CI): 0.71-0.82], and OpenRad AUC was 0.75 (95% CI: 0.69-0.81) for LASSO model, 0.74 (95% CI: 0.68-0.79) for Spearman's correlation, and 0.71 (95% CI: 0.65-0.77) for IBSI. Mayo scores were added to OpenRad LASSO model, which performed best, forming open-source ClinRad model with AUC of 0.80 (95% CI: 0.74-0.86), identical to commercial ClinRad's AUC. Both ClinRad models showed clinical improvement compared to Mayo alone, with commercial ClinRad achieving cNRI of 0.09 (95% CI: 0.02-0.15) for benign and 0.07 (95% CI: 0.00-0.13) for malignant, and open-source ClinRad achieving cNRI of 0.09 (95% CI: 0.02-0.15) for benign and 0.06 (95% CI: 0.00-0.12) for malignant. Conclusions Transportability of radiomic models across platforms directly does not conserve performance, but radiomic platforms can provide equivalent results when building de novo models allowing for flexibility in feature selection to maximize prediction accuracy.
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Affiliation(s)
- David Xiao
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael N. Kammer
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Palina Woodhouse
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kim L. Sandler
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Anna E. Baron
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - David O. Wilson
- Department of Radiology and Bioengineering, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ehab Billatos
- Section of Pulmonary and Critical Care, Department of Medicine, Boston University, Boston, MA, USA
- Section of Computational Biomedicine, Department of Medicine, Boston University, Boston, MA, USA
| | - Jiantao Pu
- Department of Radiology and Bioengineering, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen A. Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Section of Thoracic Surgery, VA Tennessee Valley Healthcare System Nashville Campus, Nashville, TN, USA
| | - Eric L. Grogan
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Section of Thoracic Surgery, VA Tennessee Valley Healthcare System Nashville Campus, Nashville, TN, USA
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18
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Chen J, Ming M, Huang S, Wei X, Wu J, Zhou S, Ling Z. AI-enhanced diagnostic model for pulmonary nodule classification. Front Oncol 2024; 14:1417753. [PMID: 39281372 PMCID: PMC11393475 DOI: 10.3389/fonc.2024.1417753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/29/2024] [Indexed: 09/18/2024] Open
Abstract
Background The identification of benign and malignant pulmonary nodules (BPN and MPN) can significantly reduce mortality. However, a reliable and validated diagnostic model for clinical decision-making is still lacking. Methods Enzyme-linked immunosorbent assay and electro chemiluminescent immunoassay were utilized to determine the serum concentrations of 7AABs (p53, GAGE7, PGP9.5, CAGE, MAGEA1, SOX2, GBU4-5), and 4TTMs (CYFR21, CEA, NSE and SCC) in 260 participants (72 BPNs and 188 early-stage MPNs), respectively. The malignancy probability was calculated using Artificial intelligence pulmonary nodule auxiliary diagnosis system, or Mayo model. Along with age, sex, smoking history and nodule size, 18 variables were enrolled for model development. Baseline comparison, univariate ROC analysis, variable correlation analysis, lasso regression, univariate and stepwise logistic regression, and decision curve analysis (DCA) was used to reduce and screen variables. A nomogram and DCA were built for model construction and clinical use. Training (60%) and validation (40%) cohorts were used to for model validation. Results Age, CYFRA21_1, AI, PGP9.5, GAGE7, and GBU4_5 was screened out from 18 variables and utilized to establish the regression model for identifying BPN and early-stage MPN, as well as nomogram and DCA for clinical practical use. The AUC of the nomogram in the training and validation cohorts were 0.884 and 0.820, respectively. Moreover, the calibration curve showed high coherence between the predicted and actual probability. Conclusion This diagnostic model and DCA could provide evidence for upgrading or maintaining the current clinical decision based on malignancy probability stratification. It enables low and moderate risk or ambiguous patients to benefit from more precise clinical decision stratification, more timely detection of malignant nodules, and early treatment.
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Affiliation(s)
- Jifei Chen
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Guangxi Medical University, Key Laboratory of Biological Molecular Medicine Research (Guangxi Medical University), Education Department of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Moyu Ming
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Shuangping Huang
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Xuan Wei
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Jinyan Wu
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Sufang Zhou
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Guangxi Medical University, Key Laboratory of Biological Molecular Medicine Research (Guangxi Medical University), Education Department of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Zhougui Ling
- Department of Pulmonary and Critical Care Medicine, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
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19
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Reid MM, Amja JJ, Riestra Guiance IT, Andani RR, Vierkant RA, Goyal A, Reisenauer JS. A Retrospective External Validation of the Cleveland Clinic Malignancy Probability Prediction Model for Indeterminate Pulmonary Nodules. Mayo Clin Proc Innov Qual Outcomes 2024; 8:375-383. [PMID: 39069970 PMCID: PMC11283066 DOI: 10.1016/j.mayocpiqo.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Objective To perform a retrospective, multicenter, external validation of the Cleveland Clinic malignancy probability prediction model for incidental pulmonary nodules. Patients and Methods From July 1, 2022, to May 31, 2023, we identified 296 patients who underwent tissue acquisition at Mayo Clinic (MC) (n=198) and Loyola University Medical Center (n=98) with histopathology indicating malignant (n=195) or benign (n=101). Data was collected at initial radiographic identification (point 1) and at the time of intervention (point 2). Point 3 represented the most recent data. The areas under the receiver operating characteristics were calculated for each model per time point. Calibration was evaluated by comparing the predicted and observed rates of malignancy. Results The areas under the receiver operating characteristics at time points 1, 2, and 3 for the MC model were 0.67 (95% CI, 0.61-0.74), 0.67 (95% CI, 0.58-0.77), and 0.70 (95% CI, 0.63-0.76), respectively. The Cleveland Clinic model (CCM) was 0.68 (95% CI, 0.61-0.74), 0.75 (95% CI, 0.65-0.84), and 0.72 (95% CI, 0.66-0.78), respectively. The mean ± SD estimated probability for malignant pulmonary nodules (PNs) at time points 1, 2, and 3 for the CCM was 64.2±25.9, 65.8±24.0, and 64.7±24.4, which resembled the overall proportion of malignant PNs (66%). The mean estimated probability of malignancy for the MC model at each time point was 38.3±27.4, 36.2±24.4, and 42.1±27.3, substantially lower than the observed proportion of malignancies. Conclusion The CCM found discrimination similar to its internal validation and good calibration. The CCM can be used to augment clinical and shared decision-making when evaluating high-risk PNs.
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Affiliation(s)
- Michal M. Reid
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Jack J. Amja
- Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, IL
- Division of Pulmonary, Critical Care, and Sleep Medicine, Hartford Healthcare Medical Group, Hartford, CT
| | | | - Rupesh R. Andani
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Robert A. Vierkant
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
| | - Amit Goyal
- Division of Pulmonary and Critical Care Medicine, Loyola University Medical Center, Maywood, IL
| | - Janani S. Reisenauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
- Division of Thoracic Surgery, Mayo Clinic, Rochester, MN
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20
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Liang DD, Liang DD, Pomeroy MJ, Gao Y, Kuo LR, Li LC. Examining feature extraction and classification modules in machine learning for diagnosis of low-dose computed tomographic screening-detected in vivo lesions. J Med Imaging (Bellingham) 2024; 11:044501. [PMID: 38993628 PMCID: PMC11234229 DOI: 10.1117/1.jmi.11.4.044501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/27/2024] [Accepted: 06/03/2024] [Indexed: 07/13/2024] Open
Abstract
Purpose Medical imaging-based machine learning (ML) for computer-aided diagnosis of in vivo lesions consists of two basic components or modules of (i) feature extraction from non-invasively acquired medical images and (ii) feature classification for prediction of malignancy of lesions detected or localized in the medical images. This study investigates their individual performances for diagnosis of low-dose computed tomography (CT) screening-detected lesions of pulmonary nodules and colorectal polyps. Approach Three feature extraction methods were investigated. One uses the mathematical descriptor of gray-level co-occurrence image texture measure to extract the Haralick image texture features (HFs). One uses the convolutional neural network (CNN) architecture to extract deep learning (DL) image abstractive features (DFs). The third one uses the interactions between lesion tissues and X-ray energy of CT to extract tissue-energy specific characteristic features (TFs). All the above three categories of extracted features were classified by the random forest (RF) classifier with comparison to the DL-CNN method, which reads the images, extracts the DFs, and classifies the DFs in an end-to-end manner. The ML diagnosis of lesions or prediction of lesion malignancy was measured by the area under the receiver operating characteristic curve (AUC). Three lesion image datasets were used. The lesions' tissue pathological reports were used as the learning labels. Results Experiments on the three datasets produced AUC values of 0.724 to 0.878 for the HFs, 0.652 to 0.965 for the DFs, and 0.985 to 0.996 for the TFs, compared to the DL-CNN of 0.694 to 0.964. These experimental outcomes indicate that the RF classifier performed comparably to the DL-CNN classification module and the extraction of tissue-energy specific characteristic features dramatically improved AUC value. Conclusions The feature extraction module is more important than the feature classification module. Extraction of tissue-energy specific characteristic features is more important than extraction of image abstractive and characteristic features.
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Affiliation(s)
- Daniel D Liang
- Ward Melville High School, East Setauket, New York, United States
| | - David D Liang
- University of Chicago, Department of Computer Science, Chicago, Illinois, United States
| | - Marc J Pomeroy
- State University of New York, Department of Biomedical Engineering, Stony Brook, New York, United States
- State University of New York, Department of Radiology, Stony Brook, New York, United States
| | - Yongfeng Gao
- State University of New York, Department of Radiology, Stony Brook, New York, United States
| | - Licheng R Kuo
- State University of New York, Department of Biomedical Engineering, Stony Brook, New York, United States
- State University of New York, Department of Radiology, Stony Brook, New York, United States
| | - Lihong C Li
- City University of New York/CSI, Department of Engineering and Environment Science, Staten Island, New York, United States
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21
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Peters AA, Solomon JB, von Stackelberg O, Samei E, Alsaihati N, Valenzuela W, Debic M, Heidt C, Huber AT, Christe A, Heverhagen JT, Kauczor HU, Heussel CP, Ebner L, Wielpütz MO. Influence of CT dose reduction on AI-driven malignancy estimation of incidental pulmonary nodules. Eur Radiol 2024; 34:3444-3452. [PMID: 37870625 PMCID: PMC11126495 DOI: 10.1007/s00330-023-10348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/10/2023] [Accepted: 09/03/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the influence of dose reduction on a commercially available lung cancer prediction convolutional neuronal network (LCP-CNN). METHODS CT scans from a cohort provided by the local lung cancer center (n = 218) with confirmed pulmonary malignancies and their corresponding reduced dose simulations (25% and 5% dose) were subjected to the LCP-CNN. The resulting LCP scores (scale 1-10, increasing malignancy risk) and the proportion of correctly classified nodules were compared. The cohort was divided into a low-, medium-, and high-risk group based on the respective LCP scores; shifts between the groups were studied to evaluate the potential impact on nodule management. Two different malignancy risk score thresholds were analyzed: a higher threshold of ≥ 9 ("rule-in" approach) and a lower threshold of > 4 ("rule-out" approach). RESULTS In total, 169 patients with 196 nodules could be included (mean age ± SD, 64.5 ± 9.2 year; 49% females). Mean LCP scores for original, 25% and 5% dose levels were 8.5 ± 1.7, 8.4 ± 1.7 (p > 0.05 vs. original dose) and 8.2 ± 1.9 (p < 0.05 vs. original dose), respectively. The proportion of correctly classified nodules with the "rule-in" approach decreased with simulated dose reduction from 58.2 to 56.1% (p = 0.34) and to 52.0% for the respective dose levels (p = 0.01). For the "rule-out" approach the respective values were 95.9%, 96.4%, and 94.4% (p = 0.12). When reducing the original dose to 25%/5%, eight/twenty-two nodules shifted to a lower, five/seven nodules to a higher malignancy risk group. CONCLUSION CT dose reduction may affect the analyzed LCP-CNN regarding the classification of pulmonary malignancies and potentially alter pulmonary nodule management. CLINICAL RELEVANCE STATEMENT Utilization of a "rule-out" approach with a lower malignancy risk threshold prevents underestimation of the nodule malignancy risk for the analyzed software, especially in high-risk cohorts. KEY POINTS • LCP-CNN may be affected by CT image parameters such as noise resulting from low-dose CT acquisitions. • CT dose reduction can alter pulmonary nodule management recommendations by affecting the outcome of the LCP-CNN. • Utilization of a lower malignancy risk threshold prevents underestimation of pulmonary malignancies in high-risk cohorts.
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Affiliation(s)
- Alan A Peters
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany.
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany.
| | - Justin B Solomon
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Oyunbileg von Stackelberg
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Ehsan Samei
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Njood Alsaihati
- Carl E. Ravin Advanced Imaging Laboratories, Medical Physics Graduate Program, Clinical Imaging Physics Group, Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Waldo Valenzuela
- University Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Manuel Debic
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Christian Heidt
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Adrian T Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Andreas Christe
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Johannes T Heverhagen
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
- Department of BioMedical Research, Experimental Radiology, University of Bern, Bern, Switzerland
- Department of Radiology, The Ohio State University, Columbus, OH, USA
| | - Hans-Ulrich Kauczor
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Claus P Heussel
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Mark O Wielpütz
- Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
- Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Im Neuenheimer Feld 156, 69120, Heidelberg, Germany
- Department of Diagnostic and Interventional Radiology With Nuclear Medicine, Thoraxklinik at University of Heidelberg, Röntgenstraße 1, 69126, Heidelberg, Germany
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22
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Kiraly AP, Cunningham CA, Najafi R, Nabulsi Z, Yang J, Lau C, Ledsam JR, Ye W, Ardila D, McKinney SM, Pilgrim R, Liu Y, Saito H, Shimamura Y, Etemadi M, Melnick D, Jansen S, Corrado GS, Peng L, Tse D, Shetty S, Prabhakara S, Nadich DP, Beladia N, Eswaran K. Assistive AI in Lung Cancer Screening: A Retrospective Multinational Study in the United States and Japan. Radiol Artif Intell 2024; 6:e230079. [PMID: 38477661 PMCID: PMC11140517 DOI: 10.1148/ryai.230079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 01/07/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024]
Abstract
Purpose To evaluate the impact of an artificial intelligence (AI) assistant for lung cancer screening on multinational clinical workflows. Materials and Methods An AI assistant for lung cancer screening was evaluated on two retrospective randomized multireader multicase studies where 627 (141 cancer-positive cases) low-dose chest CT cases were each read twice (with and without AI assistance) by experienced thoracic radiologists (six U.S.-based or six Japan-based radiologists), resulting in a total of 7524 interpretations. Positive cases were defined as those within 2 years before a pathology-confirmed lung cancer diagnosis. Negative cases were defined as those without any subsequent cancer diagnosis for at least 2 years and were enriched for a spectrum of diverse nodules. The studies measured the readers' level of suspicion (on a 0-100 scale), country-specific screening system scoring categories, and management recommendations. Evaluation metrics included the area under the receiver operating characteristic curve (AUC) for level of suspicion and sensitivity and specificity of recall recommendations. Results With AI assistance, the radiologists' AUC increased by 0.023 (0.70 to 0.72; P = .02) for the U.S. study and by 0.023 (0.93 to 0.96; P = .18) for the Japan study. Scoring system specificity for actionable findings increased 5.5% (57% to 63%; P < .001) for the U.S. study and 6.7% (23% to 30%; P < .001) for the Japan study. There was no evidence of a difference in corresponding sensitivity between unassisted and AI-assisted reads for the U.S. (67.3% to 67.5%; P = .88) and Japan (98% to 100%; P > .99) studies. Corresponding stand-alone AI AUC system performance was 0.75 (95% CI: 0.70, 0.81) and 0.88 (95% CI: 0.78, 0.97) for the U.S.- and Japan-based datasets, respectively. Conclusion The concurrent AI interface improved lung cancer screening specificity in both U.S.- and Japan-based reader studies, meriting further study in additional international screening environments. Keywords: Assistive Artificial Intelligence, Lung Cancer Screening, CT Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Atilla P. Kiraly
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Corbin A. Cunningham
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Ryan Najafi
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Zaid Nabulsi
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Jie Yang
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Charles Lau
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Joseph R. Ledsam
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Wenxing Ye
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Diego Ardila
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Scott M. McKinney
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Rory Pilgrim
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Yun Liu
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Hiroaki Saito
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Yasuteru Shimamura
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Mozziyar Etemadi
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - David Melnick
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Sunny Jansen
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Greg S. Corrado
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Lily Peng
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Daniel Tse
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Shravya Shetty
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Shruthi Prabhakara
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - David P. Nadich
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Neeral Beladia
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
| | - Krish Eswaran
- From Google Health Research, 1600 Amphitheatre Pkwy, Mountain View,
CA 94043 (A.P.K., C.A.C., R.N., Z.N., C.L., J.R.L., D.A., S.M.M., R.P., Y.L.,
S.J., G.S.C., L.P., D.T., S.S., S.P., K.E.); Waymo, Mountain View, Calif (J.Y.,
N.B.), David Geffen School of Medicine at UCLA, Los Angeles, Calif (C.L.);
Google, Mountain View, Calif (W.Y.); Department of Gastroenterology, Sendai
Kousei Hospital, Sendai, Japan (H.S.); MNES Inc, Hiroshima, Japan (Y.S.);
Department of Telemedicine, Northwestern University Feinberg School of Medicine,
Chicago, Ill (M.E., D.M.); and Center for Biological Imaging, New York
University–Langone Medical Center, New York, NY (D.P.N.)
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23
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Flory MN, Napel S, Tsai EB. Artificial Intelligence in Radiology: Opportunities and Challenges. Semin Ultrasound CT MR 2024; 45:152-160. [PMID: 38403128 DOI: 10.1053/j.sult.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Artificial intelligence's (AI) emergence in radiology elicits both excitement and uncertainty. AI holds promise for improving radiology with regards to clinical practice, education, and research opportunities. Yet, AI systems are trained on select datasets that can contain bias and inaccuracies. Radiologists must understand these limitations and engage with AI developers at every step of the process - from algorithm initiation and design to development and implementation - to maximize benefit and minimize harm that can be enabled by this technology.
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Affiliation(s)
- Marta N Flory
- Department of Radiology, Stanford University School of Medicine, Center for Academic Medicine, Palo Alto, CA
| | - Sandy Napel
- Department of Radiology, Stanford University School of Medicine, Center for Academic Medicine, Palo Alto, CA
| | - Emily B Tsai
- Department of Radiology, Stanford University School of Medicine, Center for Academic Medicine, Palo Alto, CA.
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24
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Caglayan A, Slusarczyk W, Rabbani RD, Ghose A, Papadopoulos V, Boussios S. Large Language Models in Oncology: Revolution or Cause for Concern? Curr Oncol 2024; 31:1817-1830. [PMID: 38668040 PMCID: PMC11049602 DOI: 10.3390/curroncol31040137] [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: 01/29/2024] [Revised: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
The technological capability of artificial intelligence (AI) continues to advance with great strength. Recently, the release of large language models has taken the world by storm with concurrent excitement and concern. As a consequence of their impressive ability and versatility, their provide a potential opportunity for implementation in oncology. Areas of possible application include supporting clinical decision making, education, and contributing to cancer research. Despite the promises that these novel systems can offer, several limitations and barriers challenge their implementation. It is imperative that concerns, such as accountability, data inaccuracy, and data protection, are addressed prior to their integration in oncology. As the progression of artificial intelligence systems continues, new ethical and practical dilemmas will also be approached; thus, the evaluation of these limitations and concerns will be dynamic in nature. This review offers a comprehensive overview of the potential application of large language models in oncology, as well as concerns surrounding their implementation in cancer care.
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Affiliation(s)
- Aydin Caglayan
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; (A.C.); (R.D.R.); (A.G.)
| | | | - Rukhshana Dina Rabbani
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; (A.C.); (R.D.R.); (A.G.)
| | - Aruni Ghose
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; (A.C.); (R.D.R.); (A.G.)
- Department of Medical Oncology, Barts Cancer Centre, St Bartholomew’s Hospital, Barts Heath NHS Trust, London EC1A 7BE, UK
- Department of Medical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire Trust, London HA6 2RN, UK
- Health Systems and Treatment Optimisation Network, European Cancer Organisation, 1040 Brussels, Belgium
- Oncology Council, Royal Society of Medicine, London W1G 0AE, UK
| | | | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham ME7 5NY, UK; (A.C.); (R.D.R.); (A.G.)
- Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, UK;
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, Strand Campus, London WC2R 2LS, UK
- Faculty of Medicine, Health, and Social Care, Canterbury Christ Church University, Canterbury CT2 7PB, UK
- AELIA Organization, 9th Km Thessaloniki—Thermi, 57001 Thessaloniki, Greece
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25
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Warkentin MT, Al-Sawaihey H, Lam S, Liu G, Diergaarde B, Yuan JM, Wilson DO, Atkar-Khattra S, Grant B, Brhane Y, Khodayari-Moez E, Murison KR, Tammemagi MC, Campbell KR, Hung RJ. Radiomics analysis to predict pulmonary nodule malignancy using machine learning approaches. Thorax 2024; 79:307-315. [PMID: 38195644 PMCID: PMC10947877 DOI: 10.1136/thorax-2023-220226] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 12/04/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Low-dose CT screening can reduce lung cancer-related mortality. However, most screen-detected pulmonary abnormalities do not develop into cancer and it often remains challenging to identify malignant nodules, particularly among indeterminate nodules. We aimed to develop and assess prediction models based on radiological features to discriminate between benign and malignant pulmonary lesions detected on a baseline screen. METHODS Using four international lung cancer screening studies, we extracted 2060 radiomic features for each of 16 797 nodules (513 malignant) among 6865 participants. After filtering out low-quality radiomic features, 642 radiomic and 9 epidemiological features remained for model development. We used cross-validation and grid search to assess three machine learning (ML) models (eXtreme Gradient Boosted Trees, random forest, least absolute shrinkage and selection operator (LASSO)) for their ability to accurately predict risk of malignancy for pulmonary nodules. We report model performance based on the area under the curve (AUC) and calibration metrics in the held-out test set. RESULTS The LASSO model yielded the best predictive performance in cross-validation and was fit in the full training set based on optimised hyperparameters. Our radiomics model had a test-set AUC of 0.93 (95% CI 0.90 to 0.96) and outperformed the established Pan-Canadian Early Detection of Lung Cancer model (AUC 0.87, 95% CI 0.85 to 0.89) for nodule assessment. Our model performed well among both solid (AUC 0.93, 95% CI 0.89 to 0.97) and subsolid nodules (AUC 0.91, 95% CI 0.85 to 0.95). CONCLUSIONS We developed highly accurate ML models based on radiomic and epidemiological features from four international lung cancer screening studies that may be suitable for assessing indeterminate screen-detected pulmonary nodules for risk of malignancy.
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Affiliation(s)
- Matthew T Warkentin
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hamad Al-Sawaihey
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Stephen Lam
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Geoffrey Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Brenda Diergaarde
- Department of Human Genetics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
- Cancer Epidemiology and Prevention Program, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
| | - Jian-Min Yuan
- Cancer Epidemiology and Prevention Program, UPMC Hillman Cancer Center, Pittsburgh, Pennsylvania, USA
- Department of Epidemiology, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania, USA
| | - David O Wilson
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sukhinder Atkar-Khattra
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Benjamin Grant
- Department of Medical Oncology and Hematology, Princess Margaret Hospital Cancer Centre, Toronto, Ontario, Canada
| | - Yonathan Brhane
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Elham Khodayari-Moez
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Kiera R Murison
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
| | - Martin C Tammemagi
- Cancer Control and Evidence Integration, Cancer Care Ontario, Toronto, Ontario, Canada
| | - Kieran R Campbell
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Rayjean J Hung
- Prosserman Centre for Population Health Research, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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26
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Lobig F, Graham J, Damania A, Sattin B, Reis J, Bharadwaj P. Enhancing patient outcomes: the role of clinical utility in guiding healthcare providers in curating radiology AI applications. Front Digit Health 2024; 6:1359383. [PMID: 38515551 PMCID: PMC10955074 DOI: 10.3389/fdgth.2024.1359383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
With advancements in artificial intelligence (AI) dominating the headlines, diagnostic imaging radiology is no exception to the accelerating role that AI is playing in today's technology landscape. The number of AI-driven radiology diagnostic imaging applications (digital diagnostics) that are both commercially available and in-development is rapidly expanding as are the potential benefits these tools can deliver for patients and providers alike. Healthcare providers seeking to harness the potential benefits of digital diagnostics may consider evaluating these tools and their corresponding use cases in a systematic and structured manner to ensure optimal capital deployment, resource utilization, and, ultimately, patient outcomes-or clinical utility. We propose several guiding themes when using clinical utility to curate digital diagnostics.
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Affiliation(s)
- Franziska Lobig
- Digital & Commercial Innovation, Pharmaceuticals, MACS Radiology, Bayer AG, Berlin, Germany
| | - Jacob Graham
- Life Sciences, Guidehouse Inc, New York, NY, United States
| | | | - Brian Sattin
- Life Sciences, Guidehouse Inc, New York, NY, United States
| | - Joana Reis
- Digital & Commercial Innovation, Pharmaceuticals, MACS Radiology, Bayer AG, Berlin, Germany
| | - Prateek Bharadwaj
- Digital & Commercial Innovation, Pharmaceuticals, MACS Radiology, Bayer AG, Berlin, Germany
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27
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Yang X, Chu XP, Huang S, Xiao Y, Li D, Su X, Qi YF, Qiu ZB, Wang Y, Tang WF, Wu YL, Zhu Q, Liang H, Zhong WZ. A novel image deep learning-based sub-centimeter pulmonary nodule management algorithm to expedite resection of the malignant and avoid over-diagnosis of the benign. Eur Radiol 2024; 34:2048-2061. [PMID: 37658883 DOI: 10.1007/s00330-023-10026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/08/2023] [Accepted: 06/26/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVES With the popularization of chest computed tomography (CT) screening, there are more sub-centimeter (≤ 1 cm) pulmonary nodules (SCPNs) requiring further diagnostic workup. This area represents an important opportunity to optimize the SCPN management algorithm avoiding "one-size fits all" approach. One critical problem is how to learn the discriminative multi-view characteristics and the unique context of each SCPN. METHODS Here, we propose a multi-view coupled self-attention module (MVCS) to capture the global spatial context of the CT image through modeling the association order of space and dimension. Compared with existing self-attention methods, MVCS uses less memory consumption and computational complexity, unearths dimension correlations that previous methods have not found, and is easy to integrate with other frameworks. RESULTS In total, a public dataset LUNA16 from LIDC-IDRI, 1319 SCPNs from 1069 patients presenting to a major referral center, and 160 SCPNs from 137 patients from three other major centers were analyzed to pre-train, train, and validate the model. Experimental results showed that performance outperforms the state-of-the-art models in terms of accuracy and stability and is comparable to that of human experts in classifying precancerous lesions and invasive adenocarcinoma. We also provide a fusion MVCS network (MVCSN) by combining the CT image with the clinical characteristics and radiographic features of patients. CONCLUSION This tool may ultimately aid in expediting resection of the malignant SCPNs and avoid over-diagnosis of the benign ones, resulting in improved management outcomes. CLINICAL RELEVANCE STATEMENT In the diagnosis of sub-centimeter lung adenocarcinoma, fusion MVCSN can help doctors improve work efficiency and guide their treatment decisions to a certain extent. KEY POINTS • Advances in computed tomography (CT) not only increase the number of nodules detected, but also the nodules that are identified are smaller, such as sub-centimeter pulmonary nodules (SCPNs). • We propose a multi-view coupled self-attention module (MVCS), which could model spatial and dimensional correlations sequentially for learning global spatial contexts, which is better than other attention mechanisms. • MVCS uses fewer huge memory consumption and computational complexity than the existing self-attention methods when dealing with 3D medical image data. Additionally, it reaches promising accuracy for SCPNs' malignancy evaluation and has lower training cost than other models.
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Affiliation(s)
- Xiongwen Yang
- School of Medicine, South China University of Technology, Guangzhou, China
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Rd, Guangzhou, 510080, China
| | - Xiang-Peng Chu
- School of Medicine, South China University of Technology, Guangzhou, China
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Rd, Guangzhou, 510080, China
| | - Shaohong Huang
- Department of Cardio-Thoracic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yi Xiao
- Department of Cardio-Thoracic Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Dantong Li
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, 510080, China
| | - Xiaoyang Su
- Department of Thoracic Surgery, Maoming City People's Hospital, Maoming, China
| | - Yi-Fan Qi
- School of Medicine, South China University of Technology, Guangzhou, China
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Rd, Guangzhou, 510080, China
| | - Zhen-Bin Qiu
- School of Medicine, South China University of Technology, Guangzhou, China
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Rd, Guangzhou, 510080, China
| | - Yanqing Wang
- Department of Gynecology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Wen-Fang Tang
- Department of Cardio-Thoracic Surgery, Zhongshan City People's Hospital, Zhongshan, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Rd, Guangzhou, 510080, China
| | - Qikui Zhu
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, 44106, USA.
| | - Huiying Liang
- Medical Big Data Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
- Guangdong Cardiovascular Institute, Guangzhou, Guangdong, China.
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, 510080, China.
| | - Wen-Zhao Zhong
- School of Medicine, South China University of Technology, Guangzhou, China.
- Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, 106 Zhongshan Er Rd, Guangzhou, 510080, China.
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28
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Kim RY. Radiomics and artificial intelligence for risk stratification of pulmonary nodules: Ready for primetime? Cancer Biomark 2024:CBM230360. [PMID: 38427470 PMCID: PMC11300708 DOI: 10.3233/cbm-230360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
Pulmonary nodules are ubiquitously found on computed tomography (CT) imaging either incidentally or via lung cancer screening and require careful diagnostic evaluation and management to both diagnose malignancy when present and avoid unnecessary biopsy of benign lesions. To engage in this complex decision-making, clinicians must first risk stratify pulmonary nodules to determine what the best course of action should be. Recent developments in imaging technology, computer processing power, and artificial intelligence algorithms have yielded radiomics-based computer-aided diagnosis tools that use CT imaging data including features invisible to the naked human eye to predict pulmonary nodule malignancy risk and are designed to be used as a supplement to routine clinical risk assessment. These tools vary widely in their algorithm construction, internal and external validation populations, intended-use populations, and commercial availability. While several clinical validation studies have been published, robust clinical utility and clinical effectiveness data are not yet currently available. However, there is reason for optimism as ongoing and future studies aim to target this knowledge gap, in the hopes of improving the diagnostic process for patients with pulmonary nodules.
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Affiliation(s)
- Roger Y Kim
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Tel.: +1 215 662 3677; E-mail:
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29
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Godwin RC, Tridandapani S. Beyond the AJR: Applying Screening Algorithms (Artificially) Intelligently. AJR Am J Roentgenol 2024; 222:e2329663. [PMID: 37315013 DOI: 10.2214/ajr.23.29663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- Ryan C Godwin
- Department of Radiology, University of Alabama, Birmingham, 619 19th St S, JT N455E, Birmingham, AL 35249
| | - Srini Tridandapani
- Department of Radiology, University of Alabama, Birmingham, 619 19th St S, JT N455E, Birmingham, AL 35249
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30
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Su L, Liu S, Long Y, Chen C, Chen K, Chen M, Chen Y, Cheng Y, Cui Y, Ding Q, Ding R, Duan M, Gao T, Gu X, He H, He J, Hu B, Hu C, Huang R, Huang X, Jiang H, Jiang J, Lan Y, Li J, Li L, Li L, Li W, Li Y, Lin J, Luo X, Lyu F, Mao Z, Miao H, Shang X, Shang X, Shang Y, Shen Y, Shi Y, Sun Q, Sun W, Tang Z, Wang B, Wang H, Wang H, Wang L, Wang L, Wang S, Wang Z, Wang Z, Wei D, Wu J, Wu Q, Xing X, Yang J, Yang X, Yu J, Yu W, Yu Y, Yuan H, Zhai Q, Zhang H, Zhang L, Zhang M, Zhang Z, Zhao C, Zheng R, Zhong L, Zhou F, Zhu W. Chinese experts' consensus on the application of intensive care big data. Front Med (Lausanne) 2024; 10:1174429. [PMID: 38264049 PMCID: PMC10804886 DOI: 10.3389/fmed.2023.1174429] [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: 02/26/2023] [Accepted: 11/09/2023] [Indexed: 01/25/2024] Open
Abstract
The development of intensive care medicine is inseparable from the diversified monitoring data. Intensive care medicine has been closely integrated with data since its birth. Critical care research requires an integrative approach that embraces the complexity of critical illness and the computational technology and algorithms that can make it possible. Considering the need of standardization of application of big data in intensive care, Intensive Care Medicine Branch of China Health Information and Health Care Big Data Society, Standard Committee has convened expert group, secretary group and the external audit expert group to formulate Chinese Experts' Consensus on the Application of Intensive Care Big Data (2022). This consensus makes 29 recommendations on the following five parts: Concept of intensive care big data, Important scientific issues, Standards and principles of database, Methodology in solving big data problems, Clinical application and safety consideration of intensive care big data. The consensus group believes this consensus is the starting step of application big data in the field of intensive care. More explorations and big data based retrospective research should be carried out in order to enhance safety and reliability of big data based models of critical care field.
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Affiliation(s)
- Longxiang Su
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengjun Liu
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yun Long
- Department of Critical Care Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chaodong Chen
- Department of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Kai Chen
- Department of Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, Fujian, China
| | - Ming Chen
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Yisong Cheng
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Yating Cui
- Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qi Ding
- Department of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Renyu Ding
- Department of Intensive Care Unit, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Meili Duan
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Tao Gao
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiaohua Gu
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital; Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hongli He
- Intensive Care Unit, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine of University of Electronic Science and Technology, Chengdu, China
| | - Jiawei He
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Chang Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Rui Huang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xiaobo Huang
- Intensive Care Unit, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine of University of Electronic Science and Technology, Chengdu, China
| | - Huizhen Jiang
- Department of Information Center, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Jiang
- Department of Critical Care Medicine, Chongqing General Hospital, Chongqing, China
| | - Yunping Lan
- Intensive Care Unit, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine of University of Electronic Science and Technology, Chengdu, China
| | - Jun Li
- Department of Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, Fujian, China
| | - Linfeng Li
- Medical Data Research Institute, Chongqing Medical University, Chongqing, China
| | - Lu Li
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wenxiong Li
- Department of Surgical Intensive Critical Unit, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yongzai Li
- Information Network Center, QiLu Hospital, ShanDong University, Jinan, China
| | - Jin Lin
- Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xufei Luo
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Feng Lyu
- Department of Computer Science and Engineering, Central South University, Changsha, China
| | - Zhi Mao
- Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - He Miao
- Department of Intensive Care Unit, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Xiaopu Shang
- Department of Information Management, Beijing Jiaotong University, Beijing, China
| | - Xiuling Shang
- Department of Critical Care Medicine, Fujian Provincial Key Laboratory of Critical Care Medicine, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, Fujian, China
| | - You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuwen Shen
- Intensive Care Unit of Cardiovascular Surgery Department, Qilu Hospital of Shandong University, Jinan, China
| | - Yinghuan Shi
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Qihang Sun
- British Chinese Society of Health Informatics, Beijing, China
| | - Weijun Sun
- Faculty of Automation, Guangdong University of Technology, Guangzhou, China
| | - Zhiyun Tang
- Department of Intensive Care Unit, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Emergency and Intensive Care Unit Center, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Bo Wang
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Haijun Wang
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongliang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Li Wang
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences; School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Luhao Wang
- Department of Critical Care Medicine, Sun Yat-Sen University First Affiliated Hospital, Guangzhou, China
| | - Sicong Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhanwen Wang
- Intensive Care Unit, XiangYa Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiang Ya Hospital, Central South University, Changsha, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiang Ya Hospital, Central South University, Changsha, China
| | - Zhong Wang
- Department of Intensive Care Unit, The First Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dong Wei
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Jianfeng Wu
- Intensive Care Unit, XiangYa Hospital, Central South University, Changsha, China
| | - Qin Wu
- Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Xuezhong Xing
- Department of Epidemiology and Biostatistics, Institute of Basic Medical Sciences Chinese Academy of Medical Sciences; School of Basic Medicine Peking Union Medical College, Beijing, China
| | - Jin Yang
- Department of Critical Care Medicine, Chongqing General Hospital, Chongqing, China
| | - Xianghong Yang
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiangquan Yu
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital; Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Wenkui Yu
- Department of Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yuan Yu
- Intensive Care Unit of Cardiovascular Surgery Department, Qilu Hospital of Shandong University, Jinan, China
| | - Hao Yuan
- Department of Critical Care Medicine, Sun Yat-Sen University First Affiliated Hospital, Guangzhou, China
| | - Qian Zhai
- National Institute of Healthcare Data Science, Nanjing University, Nanjing, China
| | - Hao Zhang
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lina Zhang
- Intensive Care Unit, XiangYa Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiang Ya Hospital, Central South University, Changsha, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiang Ya Hospital, Central South University, Changsha, China
| | - Meng Zhang
- Department of Critical Care Medicine, Chongqing General Hospital, Chongqing, China
| | - Zhongheng Zhang
- Department of Emergency Medicine, Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunguang Zhao
- Intensive Care Unit, XiangYa Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiang Ya Hospital, Central South University, Changsha, China
- Hunan Provincial Clinical Research Center for Critical Care Medicine, Xiang Ya Hospital, Central South University, Changsha, China
| | - Ruiqiang Zheng
- Department of Critical Care Medicine, Northern Jiangsu People’s Hospital; Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Lei Zhong
- Department of Intensive Care Unit, National Cancer Center/National Clinical Research Center, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feihu Zhou
- Department of Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Weiguo Zhu
- Department of General Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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O'Dowd E, Berovic M, Callister M, Chalitsios CV, Chopra D, Das I, Draper A, Garner JL, Gleeson F, Janes S, Kennedy M, Lee R, Mauri F, McKeever TM, McNulty W, Murray J, Nair A, Park J, Rawlinson J, Sagoo GS, Scarsbrook A, Shah P, Sudhir R, Talwar A, Thakrar R, Watkins J, Baldwin DR. Determining the impact of an artificial intelligence tool on the management of pulmonary nodules detected incidentally on CT (DOLCE) study protocol: a prospective, non-interventional multicentre UK study. BMJ Open 2024; 14:e077747. [PMID: 38176863 PMCID: PMC10773382 DOI: 10.1136/bmjopen-2023-077747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/28/2023] [Indexed: 01/06/2024] Open
Abstract
INTRODUCTION In a small percentage of patients, pulmonary nodules found on CT scans are early lung cancers. Lung cancer detected at an early stage has a much better prognosis. The British Thoracic Society guideline on managing pulmonary nodules recommends using multivariable malignancy risk prediction models to assist in management. While these guidelines seem to be effective in clinical practice, recent data suggest that artificial intelligence (AI)-based malignant-nodule prediction solutions might outperform existing models. METHODS AND ANALYSIS This study is a prospective, observational multicentre study to assess the clinical utility of an AI-assisted CT-based lung cancer prediction tool (LCP) for managing incidental solid and part solid pulmonary nodule patients vs standard care. Two thousand patients will be recruited from 12 different UK hospitals. The primary outcome is the difference between standard care and LCP-guided care in terms of the rate of benign nodules and patients with cancer discharged straight after the assessment of the baseline CT scan. Secondary outcomes investigate adherence to clinical guidelines, other measures of changes to clinical management, patient outcomes and cost-effectiveness. ETHICS AND DISSEMINATION This study has been reviewed and given a favourable opinion by the South Central-Oxford C Research Ethics Committee in UK (REC reference number: 22/SC/0142).Study results will be available publicly following peer-reviewed publication in open-access journals. A patient and public involvement group workshop is planned before the study results are available to discuss best methods to disseminate the results. Study results will also be fed back to participating organisations to inform training and procurement activities. TRIAL REGISTRATION NUMBER NCT05389774.
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Affiliation(s)
- Emma O'Dowd
- Nottingham University Hospitals NHS Trust, Nottingham, UK emma.o'
| | - Marko Berovic
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | | | - Indrajeet Das
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adrian Draper
- Respiratory Medicine, St George's Hospital, London, UK
| | | | - Fergus Gleeson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sam Janes
- University College London, London, UK
| | | | - Richard Lee
- Royal Marsden Hospital NHS Trust, London, UK
| | | | | | | | - James Murray
- Royal Free London NHS Foundation Trust, London, UK
| | | | - John Park
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Janette Rawlinson
- Consumer Forum, NCRI CSG (lung) Subgroup, BTOG Steering Committee, NHSE CEG, National Cancer Research Institute, London, UK
| | - Gurdeep Singh Sagoo
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
| | | | - Pallav Shah
- Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Rajini Sudhir
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Ambika Talwar
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ricky Thakrar
- University College London Hospitals NHS Foundation Trust, London, UK
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Lam S, Bai C, Baldwin DR, Chen Y, Connolly C, de Koning H, Heuvelmans MA, Hu P, Kazerooni EA, Lancaster HL, Langs G, McWilliams A, Osarogiagbon RU, Oudkerk M, Peters M, Robbins HA, Sahar L, Smith RA, Triphuridet N, Field J. Current and Future Perspectives on Computed Tomography Screening for Lung Cancer: A Roadmap From 2023 to 2027 From the International Association for the Study of Lung Cancer. J Thorac Oncol 2024; 19:36-51. [PMID: 37487906 PMCID: PMC11253723 DOI: 10.1016/j.jtho.2023.07.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 07/18/2023] [Indexed: 07/26/2023]
Abstract
Low-dose computed tomography (LDCT) screening for lung cancer substantially reduces mortality from lung cancer, as revealed in randomized controlled trials and meta-analyses. This review is based on the ninth CT screening symposium of the International Association for the Study of Lung Cancer, which focuses on the major themes pertinent to the successful global implementation of LDCT screening and develops a strategy to further the implementation of lung cancer screening globally. These recommendations provide a 5-year roadmap to advance the implementation of LDCT screening globally, including the following: (1) establish universal screening program quality indicators; (2) establish evidence-based criteria to identify individuals who have never smoked but are at high-risk of developing lung cancer; (3) develop recommendations for incidentally detected lung nodule tracking and management protocols to complement programmatic lung cancer screening; (4) Integrate artificial intelligence and biomarkers to increase the prediction of malignancy in suspicious CT screen-detected lesions; and (5) standardize high-quality performance artificial intelligence protocols that lead to substantial reductions in costs, resource utilization and radiologist reporting time; (6) personalize CT screening intervals on the basis of an individual's lung cancer risk; (7) develop evidence to support clinical management and cost-effectiveness of other identified abnormalities on a lung cancer screening CT; (8) develop publicly accessible, easy-to-use geospatial tools to plan and monitor equitable access to screening services; and (9) establish a global shared education resource for lung cancer screening CT to ensure high-quality reading and reporting.
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Affiliation(s)
- Stephen Lam
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Chunxue Bai
- Shanghai Respiratory Research Institute and Chinese Alliance Against Cancer, Shanghai, People's Republic of China
| | - David R Baldwin
- Nottingham University Hospitals National Health Services (NHS) Trust, Nottingham, United Kingdom
| | - Yan Chen
- Digital Screening, Faculty of Medicine & Health Sciences, University of Nottingham Medical School, Nottingham, United Kingdom
| | - Casey Connolly
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Harry de Koning
- Department of Public Health, Erasmus MC University Medical Centre Rotterdam, The Netherlands
| | - Marjolein A Heuvelmans
- University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands; The Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Ping Hu
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Ella A Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan Medical School, Ann Arbor, Michigan; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Harriet L Lancaster
- University of Groningen, Groningen, The Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands; The Institute for Diagnostic Accuracy, Groningen, The Netherlands
| | - Georg Langs
- Computational Imaging Research Laboratory, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Annette McWilliams
- Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Australia University of Western Australia, Nedlands, Western Australia
| | | | - Matthijs Oudkerk
- Center for Medical Imaging and The Institute for Diagnostic Accuracy, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Matthew Peters
- Woolcock Institute of Respiratory Medicine, Macquarie University, Sydney, New South Wales, Australia
| | - Hilary A Robbins
- Genomic Epidemiology Branch, International Agency for Research on Cancer, Lyon, France
| | - Liora Sahar
- Data Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia
| | | | - John Field
- Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool, United Kingdom
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Burnazovic E, Yee A, Levy J, Gore G, Abbasgholizadeh Rahimi S. Application of Artificial intelligence in COVID-19-related geriatric care: A scoping review. Arch Gerontol Geriatr 2024; 116:105129. [PMID: 37542917 DOI: 10.1016/j.archger.2023.105129] [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: 12/20/2022] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Older adults have been disproportionately affected by the COVID-19 pandemic. This scoping review aimed to summarize the current evidence of artificial intelligence (AI) use in the screening/monitoring, diagnosis, and/or treatment of COVID-19 among older adults. METHOD The review followed the Joanna Briggs Institute and Arksey and O'Malley frameworks. An information specialist performed a comprehensive search from the date of inception until May 2021, in six bibliographic databases. The selected studies considered all populations, and all AI interventions that had been used in COVID-19-related geriatric care. We focused on patient, healthcare provider, and healthcare system-related outcomes. The studies were restricted to peer-reviewed English publications. Two authors independently screened the titles and abstracts of the identified records, read the selected full texts, and extracted data from the included studies using a validated data extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. RESULTS Six databases were searched , yielding 3,228 articles, of which 10 were included. The majority of articles used a single AI model to assess the association between patients' comorbidities and COVID-19 outcomes. Articles were mainly conducted in high-income countries, with limited representation of females in study participants, and insufficient reporting of participants' race and ethnicity. DISCUSSION This review highlighted how the COVID-19 pandemic has accelerated the application of AI to protect older populations, with most interventions in the pilot testing stage. Further work is required to measure effectiveness of these technologies in a larger scale, use more representative datasets for training of AI models, and expand AI applications to low-income countries.
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Affiliation(s)
- Emina Burnazovic
- Integrated Biomedical Engineering and Health Sciences, Department of Computing and Software, Faculty of Engineering, McMaster University, Hamilton, ON, Canada
| | - Amanda Yee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Joshua Levy
- Department of Pharmacology and Therapeutics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, QC, Canada
| | - Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada; Mila-Quebec Artificial Intelligence Institute, Montreal, QC, Canada; Faculty of Dental Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada.
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Liu D, Zhao Y, Liu B. The effectiveness of deep learning model in differentiating benign and malignant pulmonary nodules on spiral CT. Technol Health Care 2024; 32:5129-5140. [PMID: 39520159 PMCID: PMC11613059 DOI: 10.3233/thc-241079] [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: 05/13/2024] [Accepted: 07/04/2024] [Indexed: 11/16/2024]
Abstract
BACKGROUND Pulmonary nodule, one of the most common clinical phenomena, is an irregular circular lesion with a diameter of ⩽ 3 cm in the lungs, which can be classified as benign or malignant. Differentiating benign and malignant pulmonary nodules has an essential effect on clinical medical diagnosis. OBJECTIVE To explore the clinical value and diagnostic effects of the lung nodule classification and segmentation algorithm based on deep learning in differentiating benign and malignant pulmonary nodules. METHODS A deep learning model with a fine-grained classification manner for the discrimination of pulmonary models in Dr.Wise Lung Analyzer. This study retrospectively enrolled 120 patients with pulmonary nodules detected by chest spiral CT from March 2021 to September 2022 in the radiology department of Ninghai First Hospital. The DL-based method and physicians' accuracy, sensitivity, and specificity results were compared using the pathological results as the gold standard. The ROC curve of the deep learning model was plotted, and the AUCs were calculated. RESULTS On 120 CT images, pathologically diagnosed 81 malignant nodules and 122 benign modules. The AUCs of radiologists' diagnostic approach and DL-base method for differentiating patients were 0.62 and 0.81; radiologists' diagnostic approach and DL-base method achieved AUCs of 0.75 and 0.90 for benign and malignant pulmonary nodules differentiate. The accuracy, sensitivity, and specificity with the deep learning model were 73.33%, 78.75%, and 62.50%, respectively, while the accuracy, sensitivity, and specificity with the physician's diagnosis were 63.33%, 66.25%, and 57.500. CONCLUSION There was no significant difference between the diagnosis results of the proposed DL-based method and the radiologists' diagnostic approach in differentiating benign and malignant lung nodules on spiral CT (P< 0.05).
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Affiliation(s)
- Dongquan Liu
- Radiology Department, Ninghai First Hospital Medicare and Health Group, Ningbo, China
| | - Yonggang Zhao
- Radiology Department, Ninghai First Hospital Medicare and Health Group, Ningbo, China
| | - Bangquan Liu
- College of Digital Technology and Engineering, Ningbo University of Finance and Economics, Ningbo, China
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Hlouschek J, König B, Bos D, Santiago A, Zensen S, Haubold J, Pöttgen C, Herz A, Opitz M, Wetter A, Guberina M, Stuschke M, Zylka W, Kühl H, Guberina N. Experimental Examination of Conventional, Semi-Automatic, and Automatic Volumetry Tools for Segmentation of Pulmonary Nodules in a Phantom Study. Diagnostics (Basel) 2023; 14:28. [PMID: 38201337 PMCID: PMC10804383 DOI: 10.3390/diagnostics14010028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/10/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
The aim of this study is to examine the precision of semi-automatic, conventional and automatic volumetry tools for pulmonary nodules in chest CT with phantom N1 LUNGMAN. The phantom is a life-size anatomical chest model with pulmonary nodules representing solid and subsolid metastases. Gross tumor volumes (GTVis) were contoured using various approaches: manually (0); as a means of semi-automated, conventional contouring with (I) adaptive-brush function; (II) flood-fill function; and (III) image-thresholding function. Furthermore, a deep-learning algorithm for automatic contouring was applied (IV). An intermodality comparison of the above-mentioned strategies for contouring GTVis was performed. For the mean GTVref (standard deviation (SD)), the interquartile range (IQR)) was 0.68 mL (0.33; 0.34-1.1). GTV segmentation was distributed as follows: (I) 0.61 mL (0.27; 0.36-0.92); (II) 0.41 mL (0.28; 0.23-0.63); (III) 0.65 mL (0.35; 0.32-0.90); and (IV) 0.61 mL (0.29; 0.33-0.95). GTVref was found to be significantly correlated with GTVis (I) p < 0.001, r = 0.989 (III) p = 0.001, r = 0.916, and (IV) p < 0.001, r = 0.986, but not with (II) p = 0.091, r = 0.595. The Sørensen-Dice indices for the semi-automatic tools were 0.74 (I), 0.57 (II) and 0.71 (III). For the semi-automatic, conventional segmentation tools evaluated, the adaptive-brush function (I) performed closest to the reference standard (0). The automatic deep learning tool (IV) showed high performance for auto-segmentation and was close to the reference standard. For high precision radiation therapy, visual control, and, where necessary, manual correction, are mandatory for all evaluated tools.
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Affiliation(s)
- Julian Hlouschek
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Britta König
- Department of Radiology, University Hospital Muenster (UKM), Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Muenster, Germany
| | - Denise Bos
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Alina Santiago
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Sebastian Zensen
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Johannes Haubold
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Christoph Pöttgen
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Andreas Herz
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Marcel Opitz
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Axel Wetter
- Department of Diagnostic and Interventional Radiology, Neuroradiology, Asklepios Klinikum Harburg, Eißendorfer Pferdeweg 52, 21075 Hamburg, Germany
| | - Maja Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Waldemar Zylka
- Westphalian University, Campus Gelsenkirchen, Neidenburger Str. 43, 45897 Gelsenkirchen, Germany
| | - Hilmar Kühl
- Department of Radiology, St. Bernhard-Hospital Kamp-Lintfort, Bürgermeister-Schmelzing-Str. 90, 47475 Kamp-Lintfort, Germany
| | - Nika Guberina
- Department of Radiotherapy, West German Cancer Center, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
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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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Usuzaki T, Takahashi K, Takagi H, Ishikuro M, Obara T, Yamaura T, Kamimoto M, Majima K. Efficacy of exponentiation method with a convolutional neural network for classifying lung nodules on CT images by malignancy level. Eur Radiol 2023; 33:9309-9319. [PMID: 37477673 DOI: 10.1007/s00330-023-09946-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/24/2023] [Accepted: 05/19/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The aim of this study was to examine the performance of a convolutional neural network (CNN) combined with exponentiating each pixel value in classifying benign and malignant lung nodules on computed tomography (CT) images. MATERIALS AND METHODS Images in the Lung Image Database Consortium-Image Database Resource Initiative (LIDC-IDRI) were analyzed. Four CNN models were then constructed to classify the lung nodules by malignancy level (malignancy level 1 vs. 2, malignancy level 1 vs. 3, malignancy level 1 vs. 4, and malignancy level 1 vs. 5). The exponentiation method was applied for exponent values of 1.0 to 10.0 in increments of 0.5. Accuracy, sensitivity, specificity, and area under the curve of receiver operating characteristics (AUC-ROC) were calculated. These statistics were compared between an exponent value of 1.0 and all other exponent values in each model by the Mann-Whitney U-test. RESULTS In malignancy 1 vs. 4, maximum test accuracy (MTA; exponent value = 2.0, 3.0, 3.5, 4.5, 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, and 10.0) and specificity (6.5, 7.0, and 9.0) were improved by up to 0.012 and 0.037, respectively. In malignancy 1 vs. 5, MTA (6.5 and 7.0) and sensitivity (1.5) were improved by up to 0.030 and 0.0040, respectively. CONCLUSIONS The exponentiation method improved the performance of the CNN in the task of classifying lung nodules on CT images as benign or malignant. The exponentiation method demonstrated two advantages: improved accuracy, and the ability to adjust sensitivity and specificity by selecting an appropriate exponent value. CLINICAL RELEVANCE STATEMENT Adjustment of sensitivity and specificity by selecting an exponent value enables the construction of proper CNN models for screening, diagnosis, and treatment processes among patients with lung nodules. KEY POINTS • The exponentiation method improved the performance of the convolutional neural network. • Contrast accentuation by the exponentiation method may derive features of lung nodules. • Sensitivity and specificity can be adjusted by selecting an exponent value.
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Affiliation(s)
- Takuma Usuzaki
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan.
| | - Kengo Takahashi
- Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidenobu Takagi
- Department of Diagnostic Radiology, Tohoku University Hospital, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan
- Department of Advanced MRI Collaborative Research, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Mami Ishikuro
- Division of Molecular Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
| | - Taku Obara
- Division of Molecular Epidemiology, Graduate School of Medicine, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Japan
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Hunter B, Argyros C, Inglese M, Linton-Reid K, Pulzato I, Nicholson AG, Kemp SV, L Shah P, Molyneaux PL, McNamara C, Burn T, Guilhem E, Mestas Nuñez M, Hine J, Choraria A, Ratnakumar P, Bloch S, Jordan S, Padley S, Ridge CA, Robinson G, Robbie H, Barnett J, Silva M, Desai S, Lee RW, Aboagye EO, Devaraj A. Radiomics-based decision support tool assists radiologists in small lung nodule classification and improves lung cancer early diagnosis. Br J Cancer 2023; 129:1949-1955. [PMID: 37932513 PMCID: PMC10703918 DOI: 10.1038/s41416-023-02480-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 09/21/2023] [Accepted: 10/23/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Methods to improve stratification of small (≤15 mm) lung nodules are needed. We aimed to develop a radiomics model to assist lung cancer diagnosis. METHODS Patients were retrospectively identified using health records from January 2007 to December 2018. The external test set was obtained from the national LIBRA study and a prospective Lung Cancer Screening programme. Radiomics features were extracted from multi-region CT segmentations using TexLab2.0. LASSO regression generated the 5-feature small nodule radiomics-predictive-vector (SN-RPV). K-means clustering was used to split patients into risk groups according to SN-RPV. Model performance was compared to 6 thoracic radiologists. SN-RPV and radiologist risk groups were combined to generate "Safety-Net" and "Early Diagnosis" decision-support tools. RESULTS In total, 810 patients with 990 nodules were included. The AUC for malignancy prediction was 0.85 (95% CI: 0.82-0.87), 0.78 (95% CI: 0.70-0.85) and 0.78 (95% CI: 0.59-0.92) for the training, test and external test datasets, respectively. The test set accuracy was 73% (95% CI: 65-81%) and resulted in 66.67% improvements in potentially missed [8/12] or delayed [6/9] cancers, compared to the radiologist with performance closest to the mean of six readers. CONCLUSIONS SN-RPV may provide net-benefit in terms of earlier cancer diagnosis.
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Affiliation(s)
- Benjamin Hunter
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Christos Argyros
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Marianna Inglese
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
- Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Italy
| | - Kristofer Linton-Reid
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Ilaria Pulzato
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Andrew G Nicholson
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Histopathology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
| | - Samuel V Kemp
- Nottingham University Hospitals NHS Trust, Department of Respiratory Medicine, Nottingham, UK
| | - Pallav L Shah
- Imperial College London, National Heart and Lung Institute, London, UK
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Respiratory Medicine, London, UK
| | - Philip L Molyneaux
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Respiratory Medicine, London, UK
| | - Cillian McNamara
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Toby Burn
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Emily Guilhem
- King's College Hospital, Department of Radiology, London, UK
| | | | - Julia Hine
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Anika Choraria
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
| | - Prashanthi Ratnakumar
- Imperial College London, National Heart and Lung Institute, London, UK
- St Mary's Hospital, Imperial College Healthcare Trust, Department of Respiratory Medicine, London, UK
| | - Susannah Bloch
- Imperial College London, National Heart and Lung Institute, London, UK
- St Mary's Hospital, Imperial College Healthcare Trust, Department of Respiratory Medicine, London, UK
| | - Simon Jordan
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Thoracic Surgery, London, UK
| | - Simon Padley
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
| | - Carole A Ridge
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
| | - Graham Robinson
- The Royal United Hospital, Bath, Department of Radiology, Bath, UK
| | - Hasti Robbie
- King's College Hospital, Department of Radiology, London, UK
| | - Joseph Barnett
- Department of Radiology, Royal Free Hospital, London, UK
| | - Mario Silva
- Section of "Scienze Radiologiche", Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Sujal Desai
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK
- Imperial College London, National Heart and Lung Institute, London, UK
- Imperial College London, Margaret Turner-Warwick Centre for Fibrosing Lung Disease, London, UK
| | - Richard W Lee
- Imperial College London, National Heart and Lung Institute, London, UK
- Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK
- Early Diagnosis and Detection, Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK
| | - Eric O Aboagye
- Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK
| | - Anand Devaraj
- The Royal Brompton and Harefield Hospitals, Guy's and St Thomas's NHS Foundation Trust, Department of Radiology, London, UK.
- Imperial College London, National Heart and Lung Institute, London, UK.
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Michelin B, Labani A, Bilbault P, Roy C, Ohana M. Potential added value of an AI software with prediction of malignancy for the management of incidental lung nodules. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2023; 8:100031. [PMID: 39076687 PMCID: PMC11265191 DOI: 10.1016/j.redii.2023.100031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/09/2023] [Indexed: 07/31/2024]
Abstract
Purpose To determine the impact of an artificial intelligence software predicting malignancy in the management of incidentally discovered lung nodules. Materials and methods In this retrospective study, all lung nodules ≥ 6 mm and ≤ 30 mm incidentally discovered on emergency CT scans performed between June 1, 2017 and December 31, 2017 were assessed. Artificial intelligence software using deep learning algorithms was applied to determine their likelihood of malignancy: most likely benign (AI score < 50%), undetermined (AI score 50-75%) or probably malignant (AI score > 75%). Predictions were compared to two-year follow-up and Brock's model. Results Ninety incidental pulmonary nodules in 83 patients were retrospectively included. 36 nodules were benign, 13 were malignant and 41 remained indeterminate at 2 years follow-up.AI analysis was possible for 81/90 nodules. The 34 benign nodules had an AI score between 0.02% and 96.73% (mean = 48.05 ± 37.32), while the 11 malignant nodules had an AI score between 82.89% and 100% (mean = 93.9 ± 2.3). The diagnostic performance of the AI software for positive diagnosis of malignant nodules using a 75% malignancy threshold was: sensitivity = 100% [95% CI 72%-100%]; specificity = 55.8% [38-73]; PPV = 42.3% [23-63]; NPV = 100% [82-100]. With its apparent high NPV, the addition of an AI score to the initial CT could have avoided a guidelines-recommended follow-up in 50% of the benign pulmonary nodules (6/12 nodules). Conclusion Artificial intelligence software using deep learning algorithms presents a strong NPV (100%, with a 95% CI 82-100), suggesting potential use for reducing the need for follow-up of nodules categorized as benign.
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Affiliation(s)
- Bastien Michelin
- Department of Diagnostic Imaging (Radio B), Hôpitaux universitaires de Strasbourg, Strasbourg 67000, France
| | - Aïssam Labani
- Department of Diagnostic Imaging (Radio B), Hôpitaux universitaires de Strasbourg, Strasbourg 67000, France
| | - Pascal Bilbault
- Emergency Department, Hpitaux universitaires de Strasbourg, Strasbourg 67000, France
| | - Catherine Roy
- Department of Diagnostic Imaging (Radio B), Hôpitaux universitaires de Strasbourg, Strasbourg 67000, France
| | - Mickaël Ohana
- Department of Diagnostic Imaging (Radio B), Hôpitaux universitaires de Strasbourg, Strasbourg 67000, France
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Simon J, Mikhael P, Tahir I, Graur A, Ringer S, Fata A, Jeffrey YCF, Shepard JA, Jacobson F, Barzilay R, Sequist LV, Pace LE, Fintelmann FJ. Role of sex in lung cancer risk prediction based on single low-dose chest computed tomography. Sci Rep 2023; 13:18611. [PMID: 37903855 PMCID: PMC10616081 DOI: 10.1038/s41598-023-45671-6] [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: 08/31/2023] [Accepted: 10/22/2023] [Indexed: 11/01/2023] Open
Abstract
A validated open-source deep-learning algorithm called Sybil can accurately predict long-term lung cancer risk from a single low-dose chest computed tomography (LDCT). However, Sybil was trained on a majority-male cohort. Use of artificial intelligence algorithms trained on imbalanced cohorts may lead to inequitable outcomes in real-world settings. We aimed to study whether Sybil predicts lung cancer risk equally regardless of sex. We analyzed 10,573 LDCTs from 6127 consecutive lung cancer screening participants across a health system between 2015 and 2021. Sybil achieved AUCs of 0.89 (95% CI: 0.85-0.93) for females and 0.89 (95% CI: 0.85-0.94) for males at 1 year, p = 0.92. At 6 years, the AUC was 0.87 (95% CI: 0.83-0.93) for females and 0.79 (95% CI: 0.72-0.86) for males, p = 0.01. In conclusion, Sybil can accurately predict future lung cancer risk in females and males in a real-world setting and performs better in females than in males for predicting 6-year lung cancer risk.
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Affiliation(s)
- Judit Simon
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Peter Mikhael
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Ismail Tahir
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Alexander Graur
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Stefan Ringer
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
| | - Amanda Fata
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Yang Chi-Fu Jeffrey
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Jo-Anne Shepard
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Francine Jacobson
- Harvard Medical School, Boston, MA, USA
- Division of Thoracic Imaging, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Regina Barzilay
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Lecia V Sequist
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lydia E Pace
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Florian J Fintelmann
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
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Prosper AE, Kammer MN, Maldonado F, Aberle DR, Hsu W. Expanding Role of Advanced Image Analysis in CT-detected Indeterminate Pulmonary Nodules and Early Lung Cancer Characterization. Radiology 2023; 309:e222904. [PMID: 37815447 PMCID: PMC10623199 DOI: 10.1148/radiol.222904] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 10/11/2023]
Abstract
The implementation of low-dose chest CT for lung screening presents a crucial opportunity to advance lung cancer care through early detection and interception. In addition, millions of pulmonary nodules are incidentally detected annually in the United States, increasing the opportunity for early lung cancer diagnosis. Yet, realization of the full potential of these opportunities is dependent on the ability to accurately analyze image data for purposes of nodule classification and early lung cancer characterization. This review presents an overview of traditional image analysis approaches in chest CT using semantic characterization as well as more recent advances in the technology and application of machine learning models using CT-derived radiomic features and deep learning architectures to characterize lung nodules and early cancers. Methodological challenges currently faced in translating these decision aids to clinical practice, as well as the technical obstacles of heterogeneous imaging parameters, optimal feature selection, choice of model, and the need for well-annotated image data sets for the purposes of training and validation, will be reviewed, with a view toward the ultimate incorporation of these potentially powerful decision aids into routine clinical practice.
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Affiliation(s)
- Ashley Elizabeth Prosper
- From the Department of Radiological Sciences, David Geffen School of
Medicine at UCLA, 924 Westwood Blvd, Suite 420, Los Angeles, CA 90024 (A.E.P.,
D.R.A., W.H.); Division of Allergy, Pulmonary and Critical Care Medicine,
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
(M.N.K., F.M.); and Department of Bioengineering, UCLA Samueli School of
Engineering, Los Angeles, Calif (D.R.A., W.H.)
| | - Michael N. Kammer
- From the Department of Radiological Sciences, David Geffen School of
Medicine at UCLA, 924 Westwood Blvd, Suite 420, Los Angeles, CA 90024 (A.E.P.,
D.R.A., W.H.); Division of Allergy, Pulmonary and Critical Care Medicine,
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
(M.N.K., F.M.); and Department of Bioengineering, UCLA Samueli School of
Engineering, Los Angeles, Calif (D.R.A., W.H.)
| | - Fabien Maldonado
- From the Department of Radiological Sciences, David Geffen School of
Medicine at UCLA, 924 Westwood Blvd, Suite 420, Los Angeles, CA 90024 (A.E.P.,
D.R.A., W.H.); Division of Allergy, Pulmonary and Critical Care Medicine,
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
(M.N.K., F.M.); and Department of Bioengineering, UCLA Samueli School of
Engineering, Los Angeles, Calif (D.R.A., W.H.)
| | - Denise R. Aberle
- From the Department of Radiological Sciences, David Geffen School of
Medicine at UCLA, 924 Westwood Blvd, Suite 420, Los Angeles, CA 90024 (A.E.P.,
D.R.A., W.H.); Division of Allergy, Pulmonary and Critical Care Medicine,
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
(M.N.K., F.M.); and Department of Bioengineering, UCLA Samueli School of
Engineering, Los Angeles, Calif (D.R.A., W.H.)
| | - William Hsu
- From the Department of Radiological Sciences, David Geffen School of
Medicine at UCLA, 924 Westwood Blvd, Suite 420, Los Angeles, CA 90024 (A.E.P.,
D.R.A., W.H.); Division of Allergy, Pulmonary and Critical Care Medicine,
Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
(M.N.K., F.M.); and Department of Bioengineering, UCLA Samueli School of
Engineering, Los Angeles, Calif (D.R.A., W.H.)
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Paez R, Kammer MN, Tanner NT, Shojaee S, Heideman BE, Peikert T, Balbach ML, Iams WT, Ning B, Lenburg ME, Mallow C, Yarmus L, Fong KM, Deppen S, Grogan EL, Maldonado F. Update on Biomarkers for the Stratification of Indeterminate Pulmonary Nodules. Chest 2023; 164:1028-1041. [PMID: 37244587 PMCID: PMC10645597 DOI: 10.1016/j.chest.2023.05.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 05/29/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths. Early detection and diagnosis are critical, as survival decreases with advanced stages. Approximately 1.6 million nodules are incidentally detected every year on chest CT scan images in the United States. This number of nodules identified is likely much larger after accounting for screening-detected nodules. Most of these nodules, whether incidentally or screening detected, are benign. Despite this, many patients undergo unnecessary invasive procedures to rule out cancer because our current stratification approaches are suboptimal, particularly for intermediate probability nodules. Thus, noninvasive strategies are urgently needed. Biomarkers have been developed to assist through the continuum of lung cancer care and include blood protein-based biomarkers, liquid biopsies, quantitative imaging analysis (radiomics), exhaled volatile organic compounds, and bronchial or nasal epithelium genomic classifiers, among others. Although many biomarkers have been developed, few have been integrated into clinical practice as they lack clinical utility studies showing improved patient-centered outcomes. Rapid technologic advances and large network collaborative efforts will continue to drive the discovery and validation of many novel biomarkers. Ultimately, however, randomized clinical utility studies showing improved patient outcomes will be required to bring biomarkers into clinical practice.
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Affiliation(s)
- Rafael Paez
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Michael N Kammer
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Nicole T Tanner
- Department of Medicine, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC
| | - Samira Shojaee
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Brent E Heideman
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Tobias Peikert
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Meridith L Balbach
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Wade T Iams
- Department of Medicine, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN
| | - Boting Ning
- Department of Medicine, Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA
| | - Marc E Lenburg
- Department of Medicine, Section of Computational Biomedicine, Boston University School of Medicine, Boston, MA
| | - Christopher Mallow
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, FL
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Kwun M Fong
- University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Stephen Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN; Tennessee Valley Healthcare System, Nashville, TN
| | - Eric L Grogan
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN; Vanderbilt-Ingram Cancer Center, Nashville, TN; Tennessee Valley Healthcare System, Nashville, TN
| | - Fabien Maldonado
- Department of Medicine, Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
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Malík M, Dzian A, Števík M, Vetešková Š, Al Hakim A, Hliboký M, Magyar J, Kolárik M, Bundzel M, Babič F. Lung Ultrasound Reduces Chest X-rays in Postoperative Care after Thoracic Surgery: Is There a Role for Artificial Intelligence?-Systematic Review. Diagnostics (Basel) 2023; 13:2995. [PMID: 37761362 PMCID: PMC10527627 DOI: 10.3390/diagnostics13182995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/16/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chest X-ray (CXR) remains the standard imaging modality in postoperative care after non-cardiac thoracic surgery. Lung ultrasound (LUS) showed promising results in CXR reduction. The aim of this review was to identify areas where the evaluation of LUS videos by artificial intelligence could improve the implementation of LUS in thoracic surgery. METHODS A literature review of the replacement of the CXR by LUS after thoracic surgery and the evaluation of LUS videos by artificial intelligence after thoracic surgery was conducted in Medline. RESULTS Here, eight out of 10 reviewed studies evaluating LUS in CXR reduction showed that LUS can reduce CXR without a negative impact on patient outcome after thoracic surgery. No studies on the evaluation of LUS signs by artificial intelligence after thoracic surgery were found. CONCLUSION LUS can reduce CXR after thoracic surgery. We presume that artificial intelligence could help increase the LUS accuracy, objectify the LUS findings, shorten the learning curve, and decrease the number of inconclusive results. To confirm this assumption, clinical trials are necessary. This research is funded by the Slovak Research and Development Agency, grant number APVV 20-0232.
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Affiliation(s)
- Marek Malík
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Anton Dzian
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Martin Števík
- Radiology Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Štefánia Vetešková
- Radiology Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Abdulla Al Hakim
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Maroš Hliboký
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - Ján Magyar
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - Michal Kolárik
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - Marek Bundzel
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
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Marmor HN, Kammer MN, Deppen SA, Shipe M, Welty VF, Patel K, Godfrey C, Billatos E, Herman JG, Wilson DO, Kussrow AK, Bornhop DJ, Maldonado F, Chen H, Grogan EL. Improving lung cancer diagnosis with cancer, fungal, and imaging biomarkers. J Thorac Cardiovasc Surg 2023; 166:669-678.e4. [PMID: 36792410 PMCID: PMC10287834 DOI: 10.1016/j.jtcvs.2022.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/09/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Indeterminate pulmonary nodules (IPNs) represent a significant diagnostic burden in health care. We aimed to compare a combination clinical prediction model (Mayo Clinic model), fungal (histoplasmosis serology), imaging (computed tomography [CT] radiomics), and cancer (high-sensitivity cytokeratin fraction 21; hsCYFRA 21-1) biomarker approach to a validated prediction model in diagnosing lung cancer. METHODS A prospective specimen collection, retrospective blinded evaluation study was performed in 3 independent cohorts with 6- to 30-mm IPNs (n = 281). Serum histoplasmosis immunoglobulin G and immunoglobulin M antibodies and hsCYFRA 21-1 levels were measured and a validated CT radiomic score was calculated. Multivariable logistic regression models were estimated with Mayo Clinic model variables, histoplasmosis antibody levels, CT radiomic score, and hsCYFRA 21-1. Diagnostic performance of the combination model was compared with that of the Mayo Clinic model. Bias-corrected clinical net reclassification index (cNRI) was used to estimate the clinical utility of a combination biomarker approach. RESULTS A total of 281 patients were included (111 from a histoplasmosis-endemic region). The combination biomarker model including the Mayo Clinic model score, histoplasmosis antibody levels, radiomics, and hsCYFRA 21-1 level showed improved diagnostic accuracy for IPNs compared with the Mayo Clinic model alone with an area under the receiver operating characteristics curve of 0.80 (95% CI, 0.76-0.84) versus 0.72 (95% CI, 0.66-0.78). Use of this combination model correctly reclassified intermediate risk IPNs into low- or high-risk category (cNRI benign = 0.11 and cNRI malignant = 0.16). CONCLUSIONS The addition of cancer, fungal, and imaging biomarkers improves the diagnostic accuracy for IPNs. Integrating a combination biomarker approach into the diagnostic algorithm of IPNs might decrease unnecessary invasive testing of benign nodules and reduce time to diagnosis for cancer.
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Affiliation(s)
- Hannah N Marmor
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Michael N Kammer
- Department of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Stephen A Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Section of Thoracic Surgery, Tennessee Valley VA Healthcare System, Nashville, Tenn.
| | - Maren Shipe
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Valerie F Welty
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Khushbu Patel
- Department of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Caroline Godfrey
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn
| | - Ehab Billatos
- Section of Pulmonary and Critical Care Medicine, Boston Medical Center, Boston, Mass
| | - James G Herman
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - David O Wilson
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | | | | | - Fabien Maldonado
- Department of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Heidi Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tenn
| | - Eric L Grogan
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, Tenn; Section of Thoracic Surgery, Tennessee Valley VA Healthcare System, Nashville, Tenn
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Shao J, Feng J, Li J, Liang S, Li W, Wang C. Novel tools for early diagnosis and precision treatment based on artificial intelligence. CHINESE MEDICAL JOURNAL PULMONARY AND CRITICAL CARE MEDICINE 2023; 1:148-160. [PMID: 39171128 PMCID: PMC11332840 DOI: 10.1016/j.pccm.2023.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Indexed: 08/23/2024]
Abstract
Lung cancer has the highest mortality rate among all cancers in the world. Hence, early diagnosis and personalized treatment plans are crucial to improving its 5-year survival rate. Chest computed tomography (CT) serves as an essential tool for lung cancer screening, and pathology images are the gold standard for lung cancer diagnosis. However, medical image evaluation relies on manual labor and suffers from missed diagnosis or misdiagnosis, and physician heterogeneity. The rapid development of artificial intelligence (AI) has brought a whole novel opportunity for medical task processing, demonstrating the potential for clinical application in lung cancer diagnosis and treatment. AI technologies, including machine learning and deep learning, have been deployed extensively for lung nodule detection, benign and malignant classification, and subtype identification based on CT images. Furthermore, AI plays a role in the non-invasive prediction of genetic mutations and molecular status to provide the optimal treatment regimen, and applies to the assessment of therapeutic efficacy and prognosis of lung cancer patients, enabling precision medicine to become a reality. Meanwhile, histology-based AI models assist pathologists in typing, molecular characterization, and prognosis prediction to enhance the efficiency of diagnosis and treatment. However, the leap to extensive clinical application still faces various challenges, such as data sharing, standardized label acquisition, clinical application regulation, and multimodal integration. Nevertheless, AI holds promising potential in the field of lung cancer to improve cancer care.
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Affiliation(s)
- Jun Shao
- Department of Pulmonary and Critical Care Medicine, Med-X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jiaming Feng
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Jingwei Li
- Department of Pulmonary and Critical Care Medicine, Med-X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Shufan Liang
- Department of Pulmonary and Critical Care Medicine, Med-X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Weimin Li
- Department of Pulmonary and Critical Care Medicine, Med-X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Chengdi Wang
- Department of Pulmonary and Critical Care Medicine, Med-X Center for Manufacturing, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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Froń A, Semianiuk A, Lazuk U, Ptaszkowski K, Siennicka A, Lemiński A, Krajewski W, Szydełko T, Małkiewicz B. Artificial Intelligence in Urooncology: What We Have and What We Expect. Cancers (Basel) 2023; 15:4282. [PMID: 37686558 PMCID: PMC10486651 DOI: 10.3390/cancers15174282] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/15/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Artificial intelligence is transforming healthcare by driving innovation, automation, and optimization across various fields of medicine. The aim of this study was to determine whether artificial intelligence (AI) techniques can be used in the diagnosis, treatment planning, and monitoring of urological cancers. METHODOLOGY We conducted a thorough search for original and review articles published until 31 May 2022 in the PUBMED/Scopus database. Our search included several terms related to AI and urooncology. Articles were selected with the consensus of all authors. RESULTS Several types of AI can be used in the medical field. The most common forms of AI are machine learning (ML), deep learning (DL), neural networks (NNs), natural language processing (NLP) systems, and computer vision. AI can improve various domains related to the management of urologic cancers, such as imaging, grading, and nodal staging. AI can also help identify appropriate diagnoses, treatment options, and even biomarkers. In the majority of these instances, AI is as accurate as or sometimes even superior to medical doctors. CONCLUSIONS AI techniques have the potential to revolutionize the diagnosis, treatment, and monitoring of urologic cancers. The use of AI in urooncology care is expected to increase in the future, leading to improved patient outcomes and better overall management of these tumors.
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Affiliation(s)
- Anita Froń
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (U.L.); (W.K.); (T.S.)
| | - Alina Semianiuk
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (U.L.); (W.K.); (T.S.)
| | - Uladzimir Lazuk
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (U.L.); (W.K.); (T.S.)
| | - Kuba Ptaszkowski
- Department of Physiotherapy, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Agnieszka Siennicka
- Department of Physiology and Pathophysiology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Artur Lemiński
- Department of Urology and Urological Oncology, Pomeranian Medical University, 70-111 Szczecin, Poland;
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (U.L.); (W.K.); (T.S.)
| | - Tomasz Szydełko
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (U.L.); (W.K.); (T.S.)
| | - Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland; (A.S.); (U.L.); (W.K.); (T.S.)
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Ni YL, Zheng XC, Shi XJ, Xu YF, Li H. Deep convolutional neural network based on CT images of pulmonary nodules in the lungs of adolescent and young adult patients with osteosarcoma. Oncol Lett 2023; 26:344. [PMID: 37427350 PMCID: PMC10326807 DOI: 10.3892/ol.2023.13930] [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: 01/28/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
The aim of the present study was to explore the diagnostic value of a deep convolutional neural network (DCNN) model for the diagnosis of pulmonary nodules in adolescent and young adult patients with osteosarcoma. For the present study, 675 chest CT images were retrospectively collected from 109 patients with clinically confirmed osteosarcoma who underwent chest CT examination at Hangzhou Third People's Hospital (Hangzhou, China) from March 2011 to February 2022. CT images were then evaluated using the DCNN and manual models. Subsequently, pulmonary nodules of osteosarcoma were divided into calcified nodules, solid nodules, partially solid nodules and ground glass nodules using the DCNN model. Those patients with osteosarcoma who were diagnosed and treated were followed up to observe dynamic changes in the pulmonary nodules. A total of 3,087 nodules were detected, while 278 nodules were missed compared with those determined using the reference standard given by the consensus of three Experienced radiologists., which was analyzed by two diagnostic radiologists. In the manual model group, 2,442 nodules were detected, while 657 nodules were missed. The DCNN model showed significantly higher sensitivity and specificity compared with the manual model (sensitivity, 0.923 vs. 0.908; specificity, 0.552 vs. 0.351; P<0.05). In addition, the DCNN model yielded an area under the curve (AUC) value of 0.795 [95% confidence interval (CI), 0.743-0.846], outperforming that of the manual model (AUC, 0.687; 95% CI, 0.629-0.732; P<0.05). The film reading time of the DCNN model was also significantly shorter compared with that of the manual model [mean ± standard deviation (SD); 173.25±24.10 vs. 328.32±22.72 sec; P<0.05)]. The AUC of calcified nodules, solid nodules, partially solid nodules and ground glass nodules was calculated to be 0.766, 0.771, 0.761 and 0.796, respectively, using the DCNN model. Using this model, the majority of the pulmonary nodules were detected in patients with osteosarcoma at the initial diagnosis (69/109, 62.3%), and the majority of these were found with multiple pulmonary nodules instead of a single nodule (71/109, 65.1% vs. 38/109, 34.9%). These data suggest that, compared with the manual model, the DCNN model proved to be beneficial for the detection of pulmonary nodules in adolescent and young adult patients with osteosarcoma, which may reduce the time of artificial radiograph reading. In conclusion, the proposed DCNN model, developed using data from 675 chest CT images retrospectively collected from 109 patients with clinically confirmed osteosarcoma, may be used as an effective tool to evaluate pulmonary nodules in patients with osteosarcoma.
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Affiliation(s)
- Yun Long Ni
- Department of Radiology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang 310009, P.R. China
| | - Xin Cheng Zheng
- Department of Radiology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang 310009, P.R. China
| | - Xiao Jian Shi
- Department of Radiology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang 310009, P.R. China
| | - Ye Feng Xu
- Department of Oncology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang 310009, P.R. China
| | - Hua Li
- Department of Oncology, Hangzhou Third People's Hospital, Hangzhou, Zhejiang 310009, P.R. China
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Zhou J, Hu B, Feng W, Zhang Z, Fu X, Shao H, Wang H, Jin L, Ai S, Ji Y. An ensemble deep learning model for risk stratification of invasive lung adenocarcinoma using thin-slice CT. NPJ Digit Med 2023; 6:119. [PMID: 37407729 DOI: 10.1038/s41746-023-00866-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
Lung cancer screening using computed tomography (CT) has increased the detection rate of small pulmonary nodules and early-stage lung adenocarcinoma. It would be clinically meaningful to accurate assessment of the nodule histology by CT scans with advanced deep learning algorithms. However, recent studies mainly focus on predicting benign and malignant nodules, lacking of model for the risk stratification of invasive adenocarcinoma. We propose an ensemble multi-view 3D convolutional neural network (EMV-3D-CNN) model to study the risk stratification of lung adenocarcinoma. We include 1075 lung nodules (≤30 mm and ≥4 mm) with preoperative thin-section CT scans and definite pathology confirmed by surgery. Our model achieves a state-of-art performance of 91.3% and 92.9% AUC for diagnosis of benign/malignant and pre-invasive/invasive nodules, respectively. Importantly, our model outperforms senior doctors in risk stratification of invasive adenocarcinoma with 77.6% accuracy [i.e., Grades 1, 2, 3]). It provides detailed predictive histological information for the surgical management of pulmonary nodules. Finally, for user-friendly access, the proposed model is implemented as a web-based system ( https://seeyourlung.com.cn ).
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Affiliation(s)
- Jing Zhou
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, China
| | - Bin Hu
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wei Feng
- Department of Cardiothoracic Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhang Zhang
- Department of Thoracic Surgery, Changsha Central Hospital, Changsha, China
| | - Xiaotong Fu
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, China
| | - Handie Shao
- Center for Applied Statistics, School of Statistics, Renmin University of China, Beijing, China
| | - Hansheng Wang
- Guanghua School of Management, Peking University, Beijing, China
| | - Longyu Jin
- Department of Cardiothoracic Surgery, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Siyuan Ai
- Department of Thoracic Surgery, Beijing LIANGXIANG Hospital, Beijing, China
| | - Ying Ji
- Department of Thoracic Surgery, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Lobig F, Subramanian D, Blankenburg M, Sharma A, Variyar A, Butler O. To pay or not to pay for artificial intelligence applications in radiology. NPJ Digit Med 2023; 6:117. [PMID: 37353531 DOI: 10.1038/s41746-023-00861-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/09/2023] [Indexed: 06/25/2023] Open
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Lee JH, Hong H, Nam G, Hwang EJ, Park CM. Effect of Human-AI Interaction on Detection of Malignant Lung Nodules on Chest Radiographs. Radiology 2023; 307:e222976. [PMID: 37367443 DOI: 10.1148/radiol.222976] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Background The factors affecting radiologists' diagnostic determinations in artificial intelligence (AI)-assisted image reading remain underexplored. Purpose To assess how AI diagnostic performance and reader characteristics influence detection of malignant lung nodules during AI-assisted reading of chest radiographs. Materials and Methods This retrospective study consisted of two reading sessions from April 2021 to June 2021. Based on the first session without AI assistance, 30 readers were assigned into two groups with equivalent areas under the free-response receiver operating characteristic curve (AUFROCs). In the second session, each group reinterpreted radiographs assisted by either a high or low accuracy AI model (blinded to the fact that two different AI models were used). Reader performance for detecting lung cancer and reader susceptibility (changing the original reading following the AI suggestion) were compared. A generalized linear mixed model was used to identify the factors influencing AI-assisted detection performance, including readers' attitudes and experiences of AI and Grit score. Results Of the 120 chest radiographs assessed, 60 were obtained in patients with lung cancer (mean age, 67 years ± 12 [SD]; 32 male; 63 cancers) and 60 in controls (mean age, 67 years ± 12; 36 male). Readers included 20 thoracic radiologists (5-18 years of experience) and 10 radiology residents (2-3 years of experience). Use of the high accuracy AI model improved readers' detection performance to a greater extent than use of the low accuracy AI model (area under the receiver operating characteristic curve, 0.77 to 0.82 vs 0.75 to 0.75; AUFROC, 0.71 to 0.79 vs 0.7 to 0.72). Readers who used the high accuracy AI showed a higher susceptibility (67%, 224 of 334 cases) to changing their diagnosis based on the AI suggestions than those using the low accuracy AI (59%, 229 of 386 cases). Accurate readings at the first session, correct AI suggestions, high accuracy Al, and diagnostic difficulty were associated with accurate AI-assisted readings, but readers' characteristics were not. Conclusion An AI model with high diagnostic accuracy led to improved performance of radiologists in detecting lung cancer on chest radiographs and increased radiologists' susceptibility to AI suggestions. © RSNA, 2023 Supplemental material is available for this article.
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Affiliation(s)
- Jong Hyuk Lee
- From the Department of Radiology (J.H.L., E.J.H., C.M.P.) and Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Korea; Lunit, Seoul, Korea (G.N.); Institute of Medical and Biological Engineering and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (C.M.P.); and Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (C.M.P.)
| | - Hyunsook Hong
- From the Department of Radiology (J.H.L., E.J.H., C.M.P.) and Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Korea; Lunit, Seoul, Korea (G.N.); Institute of Medical and Biological Engineering and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (C.M.P.); and Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (C.M.P.)
| | - Gunhee Nam
- From the Department of Radiology (J.H.L., E.J.H., C.M.P.) and Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Korea; Lunit, Seoul, Korea (G.N.); Institute of Medical and Biological Engineering and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (C.M.P.); and Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (C.M.P.)
| | - Eui Jin Hwang
- From the Department of Radiology (J.H.L., E.J.H., C.M.P.) and Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Korea; Lunit, Seoul, Korea (G.N.); Institute of Medical and Biological Engineering and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (C.M.P.); and Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (C.M.P.)
| | - Chang Min Park
- From the Department of Radiology (J.H.L., E.J.H., C.M.P.) and Medical Research Collaborating Center (H.H.), Seoul National University Hospital, Seoul, Korea; Lunit, Seoul, Korea (G.N.); Institute of Medical and Biological Engineering and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea (C.M.P.); and Department of Radiology, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea (C.M.P.)
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