Lung cancer's high mortality rate can be mitigated by early detection, increasingly reliant on AI for diagnostic imaging. However, AI model performance depends on training and validation datasets. This study develops and validates AI models for both nodule detection and cancer classification tasks. For detection, two models (DLCSD-mD and LUNA16-mD) were developed using the Duke Lung Cancer Screening Dataset (DLCSD), with over 2,000 CT scans from 1,613 patients and more than 3,000 annotations. These models were evaluated on internal (DLCSD) and external datasets, including LUNA16 (601 patients, 1186 nodules) and NLST (969 patients, 1192 nodules), using FROC analysis and AUC metrics. For classification, five models were developed and tested: a randomly initialized 3D ResNet50, Genesis, MedNet3D, an enhanced ResNet50 using Strategic Warm-Start++ (SWS++), and a linear classifier analyzing features from the Foundation Model for Cancer Biomarkers (FMCB). These models were trained to distinguish between benign and malignant nodules and evaluated using AUC analysis on internal (DLCSD) and external datasets, including LUNA16 (433 patients, 677 nodules) and NLST. The DLCSD-mD model achieved an AUC of 0.93 (95% CI: 0.91-0.94) on the internal DLCSD dataset. External validation results were 0.97 (95% CI: 0.96-0.98) on LUNA16 and 0.75 (95% CI: 0.73-0.76) on NLST. For classification, the ResNet50-SWS++ model recorded AUCs of 0.71 (95% CI: 0.61-0.81) on DLCSD, 0.90 (95% CI: 0.87-0.93) on LUNA16, and 0.81 (95% CI: 0.79-0.82) on NLST. Other models showed varying performance across datasets, underscoring the importance of diverse model approaches. This benchmarking establishes DLCSD as a reliable resource for lung cancer AI research.

Lung cancer is a significant cause of mortality worldwide, emphasizing the importance of early detection for improved survival rates. In this study, we propose a machine learning (ML) tool trained on data from the PLCO Cancer Screening Trial and validated on the NLST to estimate the likelihood of lung cancer occurrence within five years. The study utilized two datasets, the PLCO (n=55,161) and NLST (n=48,595), consisting of comprehensive information on risk factors, clinical measurements, and outcomes related to lung cancer. Data preprocessing involved removing patients who were not current or former smokers and those who had died of causes unrelated to lung cancer. Additionally, a focus was placed on mitigating bias caused by censored data. Feature selection, hyper-parameter optimization, and model calibration were performed using XGBoost, an ensemble learning algorithm that combines gradient boosting and decision trees. The ML model was trained on the pre-processed PLCO dataset and tested on the NLST dataset. The model incorporated features such as age, gender, smoking history, medical diagnoses, and family history of lung cancer. The model was well-calibrated (Brier score=0.044). ROC-AUC was 82% on the PLCO dataset and 70% on the NLST dataset. PR-AUC was 29% and 11% respectively. When compared to the USPSTF guidelines for lung cancer screening, our model provided the same recall with a precision of 13.1% vs. 9.3% on the PLCO dataset and 3.2% vs. 3.1% on the NLST dataset. The developed ML tool provides a freely available web application for estimating the likelihood of developing lung cancer within five years. By utilizing risk factors and clinical data, individuals can assess their risk and make informed decisions regarding lung cancer screening. This research contributes to the efforts in early detection and prevention strategies, aiming to reduce lung cancer-related mortality rates.

"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. To develop a model to estimate lung cancer risk using lung cancer screening CT and clinical data elements (CDE) without manual reading efforts. Two screening cohorts were retrospectively studied: the National Lung Screening Trial (NLST; 2002–2004) and an in-house Lung Screening Program (iLSP, 2015–2018).