Development and validation of a deep learning signature for predicting lymph node metastasis in lung adenocarcinoma: comparison with radiomics signature and clinical-semantic model

Objective To develop and validate a deep learning (DL) signature for predicting lymph node (LN) metastasis in patients with lung adenocarcinoma. Methods A total of 612 patients with pathologically-confirmed lung adenocarcinoma were retrospectively enrolled and were randomly divided into training cohort (n = 489) and internal validation cohort (n = 123). Besides, 108 patients were enrolled and constituted an independent test cohort (n = 108). Patients' clinical characteristics and CT semantic features were collected. The radiomics features were derived from contrast-enhanced CT images. The clinical-semantic model and radiomics signature were built to predict LN metastasis. Furthermore, Swin Transformer was adopted to develop a DL signature predictive of LN metastasis. Model performance was evaluated by area under the receiver operating characteristic curve (AUC), sensitivity, specificity, calibration curve, and decision curve analysis. The comparisons of AUC were conducted by the DeLong test. Results The proposed DL signature yielded an AUC of 0.948-0.961 across all three cohorts, significantly superior to both clinical-semantic model and radiomics signature (all p < 0.05). The calibration curves show that DL signature predicted probabilities fit well the actual observed probabilities of LN metastasis. DL signature gained a higher net benefit than both clinical-semantic model and radiomics signature. The incorporation of radiomics signature or clinical-semantic risk predictors failed to reveal an incremental value over the DL signature. Conclusions The proposed DL signature based on Swin Transformer achieved a promising performance in predicting LN metastasis and could confer important information in noninvasive mediastinal LN staging and individualized therapeutic options.