BACKGROUND

Lung cancer screening with chest computed tomography (CT) reduces lung cancer death. Centers for Medicare & Medicaid Services (CMS) eligibility criteria for lung cancer screening with CT require detailed smoking information and miss many incident lung cancers. An automated deep-learning approach based on chest radiograph images may identify more smokers at high risk for lung cancer who could benefit from screening with CT.

OBJECTIVE

To develop and validate a convolutional neural network (CXR-LC) that predicts long-term incident lung cancer using data commonly available in the electronic medical record (EMR) (chest radiograph, age, sex, and whether currently smoking).

DESIGN

Risk prediction study.

SETTING

U.S. lung cancer screening trials.

PARTICIPANTS

The CXR-LC model was developed in the PLCO (Prostate, Lung, Colorectal, and Ovarian) Cancer Screening Trial ( = 41 856). The final CXR-LC model was validated in additional PLCO smokers ( = 5615, 12-year follow-up) and NLST (National Lung Screening Trial) heavy smokers ( = 5493, 6-year follow-up). Results are reported for validation data sets only.

MEASUREMENTS

Up to 12-year lung cancer incidence predicted by CXR-LC.

RESULTS

The CXR-LC model had better discrimination (area under the receiver-operating characteristic curve [AUC]) for incident lung cancer than CMS eligibility (PLCO AUC, 0.755 vs. 0.634; < 0.001). The CXR-LC model's performance was similar to that of PLCO, a state-of-the-art risk score with 11 inputs, in both the PLCO data set (CXR-LC AUC of 0.755 vs. PLCO AUC of 0.751) and the NLST data set (0.659 vs. 0.650). When compared in equal-sized screening populations, CXR-LC was more sensitive than CMS eligibility in the PLCO data set (74.9% vs. 63.8%; = 0.012) and missed 30.7% fewer incident lung cancers. On decision curve analysis, CXR-LC had higher net benefit than CMS eligibility and similar benefit to PLCO.

LIMITATION

Validation in lung cancer screening trials and not a clinical setting.

CONCLUSION

The CXR-LC model identified smokers at high risk for incident lung cancer, beyond CMS eligibility and using information commonly available in the EMR.

PRIMARY FUNDING SOURCE

None.