Differentiation of predominant subtypes of lung adenocarcinoma using a quantitative radiomics approach on CT.

objectivesTo develop a model for differentiating the predominant subtype-based prognostic groups of lung adenocarcinoma using CT radiomic features, and to validate its performance in comparison with radiologists' assessments.

methodsA total of 993 patients presenting with invasive lung adenocarcinoma between March 2010 and June 2016 were identified. Predominant histologic subtypes were categorized into three groups according to their prognosis (group 0: lepidic; group 1: acinar/papillary; group 2: solid/micropapillary). Seven hundred eighteen radiomic features were extracted from segmented lung cancers on contrast-enhanced CT. A model-development set was formed from the images of 893 patients, while 100 image sets were reserved for testing. A least absolute shrinkage and selection operator method was used for feature selection. Performance of the radiomic model was evaluated using receiver operating characteristic curve analysis, and accuracy on the test set was compared with that of three radiologists with varying experiences (6, 7, and 19 years in chest CT).

resultsOur model differentiated the three groups with areas under the curve (AUCs) of 0.892 and 0.895 on the development and test sets, respectively. In pairwise discrimination, the AUC was highest for group 0 vs. 2 (0.984). The accuracy of the model on the test set was higher than the averaged accuracy of the three radiologists without statistical significance (73.0% vs. 61.7%, p = 0.059). For group 2, the model achieved higher PPV than the observers (85.7% vs. 35.0-48.4%).

conclusionsPredominant subtype-based prognostic groups of lung adenocarcinoma were classified by a CT-based radiomic model with comparable performance to radiologists. KEY POINTS: • A CT-based radiomic model differentiated three prognosis-based subtype groups of lung adenocarcinoma with areas under the curve (AUCs) of 0.892 and 0.895 on development and test sets, respectively. • The CT-based radiomic model showed near perfect discrimination between group 0 and group 2 (AUCs, 0.984-1.000). • The accuracy of the CT-based radiomic model was comparable to the averaged accuracy of the three radiologists with 6, 7, and 19 years of clinical experience in chest CT (73.0% vs. 61.7%, p = 0.059), achieving a higher positive predictive value for group 2 than the observers (85.7% vs. 35.0-48.4%).