CT-based radiomics predictive model for spread through air space of IA stage lung adenocarcinoma.

Background: Spread through air spaces (STAS) in lung adenocarcinoma means different treatment and worse prognosis.

Purpose: To construct a radiomics model based on CT scans to predict the presence of STAS in stage IA lung adenocarcinoma, compared with the traditional clinical model.

Material and methods: The study included 317 patients (median age = 57.21 years; age range = 45.84-68.61 years) with pathologically confirmed stage IA lung adenocarcinoma. In total, 122 (38.5%) patients were diagnosed with STAS by pathology after the operation. Two experienced radiologists independently segmented the lesions using MITK software and extracted 1791 radiomics features using Python. Single-factor t-test or Mann-Whitney U-test and LASSO were used to screen for radiomics signatures related to STAS. This study constructed a radiomics model, a clinical model, and a combined model, combining radiomics and clinical features. Model performance was evaluated using the area under the curve (AUC).

Results: By single-factor analysis, four clinical features and 13 radiomics features were significantly associated with STAS. The three models (the clinical, radiomics, and combine models) achieved predictive efficacy, with an AUC of 0.849, 0.867, and 0.939, respectively, in the training set and 0.808, 0.848, and 0.876, respectively, in the testing set.

Conclusion: The combined model based on the radiomics and clinical features of preoperative chest CT could be used to preoperatively diagnose the presence of STAS in stage IA lung adenocarcinoma and has an excellent diagnostic performance.