Overall Staging Prediction for Non-Small Cell Lung Cancer (NSCLC): A Local Pilot Study with Artificial Neural Network Approach

Abstract

Background: Non-small cell lung cancer (NSCLC) has been the most common cancer globally in the recent decade. CT is the most common imaging modality for the initial diagnosis of NSCLC. The gold standard for definitive diagnosis is the histological evaluation of a biopsy or surgical sample, which usually requires a long processing time for the confirmation of diagnosis. This study aims to develop artificial intelligence models to predict overall staging based on patient demographics and radiomics retrieved from the initial CT images, so as to prioritize later-stage patients for histology evaluation to facilitate cancer diagnosis. Method: Two cohorts of NSCLC patient datasets were utilized for this study. The NSCLC-radiomics dataset from The Cancer Imaging Archive (TCIA) was divided into 70% for the training group and 30% for the internal testing group. Another cohort from a local hospital was collected for the an external testing group. Patient demographics and 107 radiomic features were retrieved from the gross tumor volume delineated by clinical oncologists on CT images. Artificial neural networks were used to build models for NSCLC overall staging (stage I, II, or III) prediction. Four traditional classifiers were also adopted to build models for comparison. Result: The proposed feed-forward neural network (FFNN) model showed good performance in predicting overall staging with an accuracy of 88.84%, 76.67%, and 74.52% in overall accuracies in validation, internal cohort testing, and external cohort testing, respectively. The sensitivity and specificity are balanced in all the stages, with average precision and F1 score in each of the stages. Conclusion: The FFNN demonstrated good performance in overall staging prediction for NSCLC patients. It has the benefit of predicting multiple overall stages in a single model. The software required and the proposed model are simple. It can be operated on a general-purpose computer in the radiology department. The application will eventually be used as a prediction tool to prioritize the biopsy or surgery sample for histological analysis and molecular investigation, thus shortening the time for diagnosis by pathologists, which supports the triage of patients for further testing.