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Clinical Studies

Radiomics-based decision support tool assists radiologists in small lung nodule classification and improves lung cancer early diagnosis

British Journal of Cancer volume 129, pages 1949–1955 (2023)Cite this article

Subjects

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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Fig. 1: Recruitment diagram and segmentation labels.
Fig. 2: Decision-support tool scenarios.

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Data availability

The radiomics data generated in this study are deposited into the Mendeley database under the accession code https://doi.org/10.17632/rxn95mp24d.1. The R scripts for model development are provided in notebook format at: https://github.com/dr-benjamin-hunter/Small-nodule-radiomics.

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Funding

This manuscript represents independent research funded by: (1) the Royal Marsden Partners Cancer Alliance, (2) the Royal Marsden Cancer Charity, (3) the National Institute for Health Research (NIHR) Biomedical Research Centre at the Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, (4) the National Institute for Health Research (NIHR) Biomedical Research Centre at Imperial College, London, (5) Cancer Research UK (C309/A31316). (6) The European Regional Development Fund and Higher Education Funding Council for England.

Author information

Author notes

  1. These authors contributed equally: Benjamin Hunter, Christos Argyros.

Authors and Affiliations

  1. Imperial College London, Faculty of Medicine, Department of Surgery & Cancer, London, UK

    Benjamin Hunter, Christos Argyros, Marianna Inglese, Kristofer Linton-Reid, Toby Burn & Eric O. Aboagye

  2. Department of Biomedicine and Prevention, University of Rome, Tor Vergata, Italy

    Marianna Inglese

  3. The Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, Department of Radiology, London, UK

    Ilaria Pulzato, Cillian McNamara, Julia Hine, Anika Choraria, Simon Padley, Carole A. Ridge, Sujal Desai & Anand Devaraj

  4. The Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, Department of Histopathology, London, UK

    Andrew G. Nicholson

  5. Imperial College London, National Heart and Lung Institute, London, UK

    Andrew G. Nicholson, Pallav L. Shah, Prashanthi Ratnakumar, Susannah Bloch, Simon Padley, Carole A. Ridge, Sujal Desai, Richard W. Lee & Anand Devaraj

  6. Nottingham University Hospitals NHS Trust, Department of Respiratory Medicine, Nottingham, UK

    Samuel V. Kemp

  7. The Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, Department of Respiratory Medicine, London, UK

    Pallav L. Shah & Philip L. Molyneaux

  8. King’s College Hospital, Department of Radiology, London, UK

    Emily Guilhem & Hasti Robbie

  9. Hospital Britanico, Department of Radiology, Buenos Aires, Argentina

    Marcos Mestas Nuñez

  10. St Mary’s Hospital, Imperial College Healthcare Trust, Department of Respiratory Medicine, London, UK

    Prashanthi Ratnakumar & Susannah Bloch

  11. The Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’s NHS Foundation Trust, Department of Thoracic Surgery, London, UK

    Simon Jordan

  12. The Royal United Hospital, Bath, Department of Radiology, Bath, UK

    Graham Robinson

  13. Department of Radiology, Royal Free Hospital, London, UK

    Joseph Barnett

  14. Section of “Scienze Radiologiche”, Department of Medicine and Surgery, University of Parma, Parma, Italy

    Mario Silva

  15. Imperial College London, Margaret Turner-Warwick Centre for Fibrosing Lung Disease, London, UK

    Sujal Desai

  16. Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK

    Richard W. Lee

  17. Early Diagnosis and Detection, Institute of Cancer Research, 123 Old Brompton Road, London, SW7 3RP, UK

    Richard W. Lee

Authors
  1. Benjamin Hunter
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  2. Christos Argyros
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  3. Marianna Inglese
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  4. Kristofer Linton-Reid
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  5. Ilaria Pulzato
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  28. Anand Devaraj
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Contributions

BH: Data collection, analysis and interpretation, paper preparation and editing. CA: Data collection, analysis and interpretation, manuscript preparation and editing. MI: Data analysis and interpretation. KL-R: Data analysis. IP, AN, SK, PLS, PLM, CM, TB, EG, JH, AC, SJ, MM and SP: Data collection. HR, JB, CAR, GR, MS and SD: Radiology reads. EOA, RWL and AD: Study design, project supervision, paper feedback and editing.

Corresponding author

Correspondence to Anand Devaraj.

Ethics declarations

Competing interests

Professor Devaraj reports personal fees from Brainomix, Roche, and Boehringer Ingelheim and has stock options in Brainomix. Dr Lee is funded by the Royal Marsden NIHR BRC, Royal Marsden Cancer Charity and SBRI (including QURE.AI). RL’s institution receives compensation for time spent in a secondment role for the lung health check programme and as a National Specialty Lead for the National Institute of Health and Care Research. He has received research funding from CRUK, Innovate UK (co-funded by GE Healthcare, Roche and Optellum), SBRI, RM Partners Cancer Alliance and NIHR (co-applicant in grants with Optellum). He has received honoraria from CRUK. The remaining authors declare no competing interests.

Ethics Approval and consent to participate

Health Regulatory Authority (HRA) and Research Ethics Committee (REC) approvals were obtained for the presented study (18/HRA/0434). Informed consent was not required. The study was performed in accordance with the Declaration of Helsinki.

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Hunter, B., Argyros, C., Inglese, M. et al. Radiomics-based decision support tool assists radiologists in small lung nodule classification and improves lung cancer early diagnosis. Br J Cancer 129, 1949–1955 (2023). https://doi.org/10.1038/s41416-023-02480-y

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