A novel framework for esophageal cancer grading: combining CT imaging, radiomics, reproducibility, and deep learning insights.

objectiveThis study aims to create a reliable framework for grading esophageal cancer. The framework combines feature extraction, deep learning with attention mechanisms, and radiomics to ensure accuracy, interpretability, and practical use in tumor analysis. MATERIALS AND

methodsThis retrospective study used data from 2,560 esophageal cancer patients across multiple clinical centers, collected from 2018 to 2023. The dataset included CT scan images and clinical information, representing a variety of cancer grades and types. Standardized CT imaging protocols were followed, and experienced radiologists manually segmented the tumor regions. Only high-quality data were used in the study. A total of 215 radiomic features were extracted using the SERA platform. The study used two deep learning models-DenseNet121 and EfficientNet-B0-enhanced with attention mechanisms to improve accuracy. A combined classification approach used both radiomic and deep learning features, and machine learning models like Random Forest, XGBoost, and CatBoost were applied. These models were validated with strict training and testing procedures to ensure effective cancer grading.

resultsThis study analyzed the reliability and performance of radiomic and deep learning features for grading esophageal cancer. Radiomic features were classified into four reliability levels based on their ICC (Intraclass Correlation) values. Most of the features had excellent (ICC > 0.90) or good (0.75 < ICC ≤ 0.90) reliability. Deep learning features extracted from DenseNet121 and EfficientNet-B0 were also categorized, and some of them showed poor reliability. The machine learning models, including XGBoost and CatBoost, were tested for their ability to grade cancer. XGBoost with Recursive Feature Elimination (RFE) gave the best results for radiomic features, with an AUC (Area Under the Curve) of 91.36%. For deep learning features, XGBoost with Principal Component Analysis (PCA) gave the best results using DenseNet121, while CatBoost with RFE performed best with EfficientNet-B0, achieving an AUC of 94.20%. Combining radiomic and deep features led to significant improvements, with XGBoost achieving the highest AUC of 96.70%, accuracy of 96.71%, and sensitivity of 95.44%. The combination of both DenseNet121 and EfficientNet-B0 models in ensemble models achieved the best overall performance, with an AUC of 95.14% and accuracy of 94.88%.

conclusionsThis study improves esophageal cancer grading by combining radiomics and deep learning. It enhances diagnostic accuracy, reproducibility, and interpretability, while also helping in personalized treatment planning through better tumor characterization. CLINICAL TRIAL NUMBER: Not applicable.