Deep Learning to Optimize Candidate Selection for Lung Cancer CT Screening: Advancing the 2021 USPSTF Recommendations

Jong Hyuk Lee, Dongheon Lee, Michael T. Lu, Vineet K. Raghu, Chang Min Park, Jin Mo Goo, Seung Ho Choi, Hyungjin Kim

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: A deep learning (DL) model to identify lung cancer screening candidates based on their chest radiographs requires external validation with a recent real-world non–U.S. sample. Purpose: To validate the DL model and identify added benefits to the 2021 U.S. Preventive Services Task Force (USPSTF) recommendations in a health check-up sample. Materials and Methods: This single-center retrospective study included consecutive current and former smokers aged 50–80 years who underwent chest radiography during a health check-up between January 2004 and June 2018. Discrimination performance, including receiver operating characteristic curve analysis and area under the receiver operating characteristic curve (AUC) calculation, of the model for incident lung cancers was evaluated. The added value of the model to the 2021 USPSTF recommendations was investigated for lung cancer inclusion rate, proportion of selected CT screening candidates, and positive predictive value (PPV). Results: For model validation, a total of 19 488 individuals (mean age, 58 years 6 6 [SD]; 18 467 [95%] men) and the subset of USPSTF-eligible individuals (n = 7835; mean age, 57 years 6 6; 7699 [98%] men) were assessed, and the AUCs for incident lung cancers were 0.68 (95% CI: 0.62, 0.73) and 0.75 (95% CI: 0.68, 0.81), respectively. In individuals with pack-year information (n = 17 390), when excluding low- and indeterminate-risk categories from the USPSTF-eligible sample, the proportion of selected CT screening candidates was reduced to 35.8% (6233 of 17 390) from 45.1% (7835 of 17 390, P , .001), with three missed lung cancers (0.2%). The cancer inclusion rate (0.3% [53 of 17 390] vs 0.3% [56 of 17 390], P = .85) and PPV (0.9% [53 of 6233] vs 0.7% [56 of 7835], P = .42) remained unaffected. Conclusion: An externally validated deep learning model showed the added value to the 2021 U.S. Preventive Services Task Force recommendations for low-dose CT lung cancer screening in reducing the number of screening candidates while maintaining the inclusion rate and positive predictive value for incident lung cancer.

Original languageEnglish
Pages (from-to)209-218
Number of pages10
JournalRadiology
Volume305
Issue number1
DOIs
StatePublished - Oct 2022

Fingerprint

Dive into the research topics of 'Deep Learning to Optimize Candidate Selection for Lung Cancer CT Screening: Advancing the 2021 USPSTF Recommendations'. Together they form a unique fingerprint.

Cite this