Establishment and verification of a prediction model based on clinical characteristics and computed tomography radiomics parameters for distinguishing benign and malignant pulmonary nodules

Xiaohui Hou; Meng Wu; Jingjing Chen; Rui Zhang; Yan Wang; Shuwen Zhang; Zaixin Yuan; Jian Feng; Liqin Xu

doi:10.21037/jtd-23-1400

Establishment and verification of a prediction model based on clinical characteristics and computed tomography radiomics parameters for distinguishing benign and malignant pulmonary nodules

J Thorac Dis. 2024 Mar 29;16(3):1984-1995. doi: 10.21037/jtd-23-1400. Epub 2024 Mar 18.

Authors

Xiaohui Hou^{1

2}, Meng Wu³, Jingjing Chen¹, Rui Zhang¹, Yan Wang³, Shuwen Zhang¹, Zaixin Yuan^{1

4}, Jian Feng¹, Liqin Xu¹

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong, China.
² Department of Geriatric Medicine, Province Veterans Hospital, Wuxi, China.
³ Department of Pathology, Affiliated Hospital of Nantong University, Nantong, China.
⁴ Respiratory and Severe Disease, Nantong University, Nantong, China.

Abstract

Background: The radiographic classification of pulmonary nodules into benign versus malignant categories is a pivotal component of early lung cancer diagnosis. The present study aimed to investigate clinical and computed tomography (CT) clinical-radiomics nomogram for preoperative differentiation of benign and malignant pulmonary nodules.

Methods: This retrospective study included 342 patients with pulmonary nodules who underwent high-resolution CT (HRCT) examination. We assigned them to a training dataset (n=239) and a validation dataset (n=103). There are 1781 tumor characteristics quantified by extracted features from the lesion segmented from patients' CT images. The features with poor reproducibility and high redundancy were removed. Then a least absolute shrinkage and selection operator (LASSO) logistic regression model with 10-fold cross-validation was used to further select features and build radiomics signatures. The independent predictive factors were identified by multivariate logistic regression. A radiomics nomogram was developed to predict the malignant probability. The performance and clinical utility of the clinical-radiomics nomogram was evaluated by receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

Results: After dimension reduction by the LASSO algorithm and multivariate logistic regression, four radiomic features were selected, including original_shape_Sphericity, exponential_glcm_Maximum Probability, log_sigma_2_0_mm_3D_glcm_Maximum Probability, and ogarithm_firstorder_90Percentile. Multivariate logistic regression showed that carcinoembryonic antigen (CEA) [odds ratio (OR) 95% confidence interval (CI): 1.40 (1.09-1.88)], CT rad score [OR (95% CI): 2.74 (2.03-3.85)], and cytokeratin-19-fragment (CYFRA21-1) [OR (95% CI): 1.80 (1.14-2.94)] were independent influencing factors of malignant pulmonary nodule (all P<0.05). The clinical-radiomics nomogram combining CEA, CYFRA21-1 and radiomics features achieved an area of curve (AUC) of 0.85 and 0.76 in the training group and verification group for the prediction of malignant pulmonary nodules. The clinical-radiomics nomogram demonstrated excellent agreement and practicality, as evidenced by the calibration curve and DCA.

Conclusions: The clinical-radiomics nomogram combined of CT-based radiomics signature, along with CYFRA21-1 and CEA, demonstrated strong predictive ability, calibration, and clinical usefulness in distinguishing between benign and malignant pulmonary nodules. The use of CT-based radiomics has the potential to assist clinicians in making informed decisions prior to biopsy or surgery while avoiding unnecessary treatment for non-cancerous lesions.

Keywords: Radiomics nomogram; computed tomography (CT); least absolute shrinkage and selection operator (LASSO); logistics regression; malignant pulmonary nodule.