Objectives: To develop a radiomic model based on low-dose CT (LDCT) to distinguish invasive adenocarcinomas (IAs) from adenocarcinoma in situ/minimally invasive adenocarcinomas (AIS/MIAs) manifesting as pure ground-glass nodules (pGGNs) and compare its performance with conventional quantitative and semantic features of LDCT, radiomic model of standard-dose CT, and intraoperative frozen section (FS). Methods: A total of 147 consecutive pathologically confirmed pGGNs were divided into primary cohort (43 IAs and 60 AIS/MIAs) and validation cohort (19 IAs and 25 AIS/MIAs). Logistic regression models were built using conventional quantitative and semantic features, selected radiomic features of LDCT and standard-dose CT, and intraoperative FS diagnosis, respectively. The diagnostic performance was assessed by area under curve (AUC) of receiver operating characteristic curve, sensitivity, and specificity. Results: The AUCs of quantitative-semantic model, radiomic model of LDCT, radiomic model of standard-dose CT, and FS model were 0.879 (95% CI, 0.801–0.935), 0.929 (95% CI, 0.862–0.971), 0.941 (95% CI, 0.876–0.978), and 0.884 (95% CI, 0.805–0.938) in the primary cohort and 0.897 (95% CI, 0.768–0.968), 0.933 (95% CI, 0.815–0.986), 0.901 (95% CI, 0.773–0.970), and 0.828 (95% CI, 0.685–0.925) in the validation cohort. No significant difference of the AUCs was found among these models in both the primary and validation cohorts (all p > 0.05). Conclusions: The LDCT-based quantitative-semantic score and radiomic signature, with good predictive performance, can be preoperative and non-invasive biomarkers for assessing the invasive risk of pGGNs in lung cancer screening. Advances in knowledge: The LDCT-based quantitative-semantic score and radiomic signature, with the equivalent performance to the radiomic model of standard-dose CT, can be preoperative predictors for assessing the invasiveness of pGGNs in lung cancer screening and reducing excess examination and treatment.
The Impact of Extended Delayed Surgery for Indolent Lung Cancer or Part-solid Ground Glass Nodules
