Development of a CT-Based comprehensive model combining clinical, radiomics with deep learning for differentiating pulmonary metastases from noncalcified pulmonary hamartomas, a retrospective cohort study

Abstract

Background: Clinical differentiation between pulmonary metastases and noncalcified pulmonary hamartomas (NCPH) often presents challenges, leading to potential misdiagnosis. However, the efficacy of a comprehensive model that integrates clinical features, radiomics, and deep learning (CRDL) for differential diagnosis of these two diseases remains uncertain.

Objective: This study evaluated the diagnostic efficacy of a Clinical Features, Radiomics, and Deep Learning (CRDL) model in differentiating pulmonary metastases from noncalcified pulmonary hamartomas (NCPH).

Methods: We retrospectively analyzed the clinical and imaging data of 256 patients from Hospital A and 85 patients from Hospital B, who were pathologically confirmed pulmonary hamartomas or pulmonary metastases after thoracic surgery. Employing Python 3.7 software suites, we extracted radiomic features and deep learning attributes from patient datasets. The cohort was divided into training set, internal validation set, and external validation set. The diagnostic performance of the constructed models was evaluated using receiver operating characteristic (ROC) curve analysis to determine their effectiveness in differentiating between pulmonary metastases and NCPH.

Results: Clinical features such as white blood cell count (WBC), platelet count (PLT), history of cancer, carcinoembryonic antigen (CEA) level, tumor marker status, lesion margin characteristics (smooth or blurred) and maximum diameter were found to have diagnostic value in differentiating between the two diseases. In the domains of radiomics and deep learning. Of the 1,130 radiomics features and 512 deep learning features, 24 and 7, respectively, were selected for model development. The area under the ROC curve (AUC) values for the four groups were 0.980, 0.979, 0.999, and 0.985 in the training set, 0.947, 0.816, 0.934, and 0.952 in the internal validation set, and 0.890, 0.904, 0.923, and 0.938 in the external validation set. This demonstrated that the CRDL model showed the greatest efficacy.

Conclusions: The comprehensive model incorporating clinical features, radiomics, and deep learning shows promise for aiding in the differentiation between pulmonary metastases and hamartomas.