Development and Validation of a Risk Stratification Model of Pulmonary Ground-Glass Nodules Based on Complementary Lung-RADS 1.1 and Deep Learning Scores

PurposeTo assess the value of novel deep learning (DL) scores combined with complementary lung imaging reporting and data system 1.1 (cLung-RADS 1.1) in managing the risk stratification of ground-glass nodules (GGNs) and therefore improving the efficiency of lung cancer (LC) screening in China. Materials and MethodsOverall, 506 patients with 561 GGNs on routine computed tomography images, obtained between January 2017 and March 2021, were enrolled in this single-center, retrospective Chinese study. Moreover, the cLung-RADS 1.1 was previously validated, and the DL algorithms were based on a multi-stage, three-dimensional DL-based convolutional neural network. Therefore, the DL-based cLung-RADS 1.1 model was created using a combination of the risk scores of DL and category of cLung-RADS 1.1. The recall rate, precision, accuracy, per-class F1 score, weighted average F1 score (F1(weighted)), Matthews correlation coefficient (MCC), and area under the curve (AUC) were used to evaluate the performance of DL-based cLung-RADS 1.1. ResultsThe percentage of neoplastic lesions appeared as GGNs in our study was 95.72% (537/561) after long-period follow-up.Compared to cLung-RADS 1.1 model or DL model, The DL-based cLung-RADS 1.1 model achieved the excellent performance with F1 scores of 95.96% and 95.58%, F1(weighted) values of 97.49 and 96.62%, accuracies of 92.38 and 91.77%, and MCCs of 32.43 and 37.15% in the training and validation tests, respectively. The combined model achieved the best AUCs of 0.753 (0.526-0.980) and 0.734 (0.585-0.884) for the training and validation tests, respectively. ConclusionThe DL-based cLung-RADS 1.1 model shows the best performance in risk stratification management of GGNs, which demonstrates substantial promise for developing a more effective personalized lung neoplasm management paradigm for LC screening in China.