ArticleBMC medical imaging2026
Differentiating sub-centimeter lung metastases in colorectal cancer by deep learning: a multicenter retrospective study.
Article in BMC medical imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEarly diagnosis of sub-centimeter lung metastases is critical for timely decision-making and improved prognosis in patients with colorectal cancer. The diagnostic evaluation of indeterminate sub-centimeter lung nodules in colorectal cancer patients remains a crucial challenge. We aim to develop and validate a deep learning model for differentiating sub-centimeter lung metastases noninvasively.
methodsOur retrospective study included 1335 colorectal cancer patients with pretreated sub-centimeter lung metastases from 3 centers and 1335 benign lung nodules from one center. The primary cohort comprised 1194 patients, who were randomly assigned (8:2) to training and internal validation cohorts. Two external validation cohorts (EVC) consisted of 101 (EVC1) and 40 (EVC2) patients. The deep learning framework employed a fully automated VNet-based segmentation model for non-contrast computed tomography (CT) scans, integrated with a ResNet18 classifier for discriminating whether sub-centimeter lung nodules are benign or metastatic. Moreover, stepwise validation of subgroups was performed according to the maximum diameter of the nodules (10, 9, 8, 7, 6, 5, ≤ 4 mm).
resultsThe automatic segmentation model achieved a dice coefficient of 0.825. In primary cohort, the accuracy by radiologists was 0.705. The AUC in deep learning model showed 0.953 (95%CI: 0.937-0.967), 0.906 (95%CI: 0.874-0.926), and 0.951 (95%CI: 0.938-0.965) in internal and two external validation cohorts. Furthermore, the stepwise validation demonstrated that the diagnostic performance remain stable as the nodule maximum diameter shrinks when size≥5 mm.
conclusionThe deep learning model can accurately and non-invasively distinguish between benign and metastatic sub-centimeter lung nodules in patients with colorectal cancer.
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