A CT-based deep learning model for preoperative prediction of spread through air spaces in clinical stage I lung adenocarcinoma.

Objective: To develop and validate a deep learning signature for noninvasive prediction of spread through air spaces (STAS) in clinical stage I lung adenocarcinoma and compare its predictive performance with conventional clinical-semantic model. Methods: A total of 513 patients with pathologically-confirmed stage I lung adenocarcinoma were retrospectively enrolled and were divided into training cohort (n = 386) and independent validation cohort (n = 127) according to different center. Clinicopathological data were collected and CT semantic features were evaluated. Multivariate logistic regression analyses were conducted to construct a clinical-semantic model predictive of STAS. The Swin Transformer architecture was adopted to develop a deep learning signature predictive of STAS. Model performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive value, and calibration curve. AUC comparisons were performed by the DeLong test. Results: The proposed deep learning signature achieved an AUC of 0.869 (95% CI: 0.831, 0.901) in training cohort and 0.837 (95% CI: 0.831, 0.901) in validation cohort, surpassing clinical-semantic model both in training and validation cohort (all Conclusions: The proposed deep learning signature based on Swin Transformer achieved a promising performance in predicting STAS in clinical stage I lung adenocarcinoma, thereby offering information in directing surgical strategy and facilitating adjuvant therapeutic scheduling.