A benchmark of deep learning approaches to predict lung cancer risk using national lung screening trial cohort.

Deep learning (DL) methods have demonstrated remarkable effectiveness in assisting with lung cancer risk prediction tasks using computed tomography (CT) scans. However, the lack of comprehensive comparison and validation of state-of-the-art (SOTA) models in practical settings limits their clinical application. This study aims to review and analyze current SOTA deep learning models for lung cancer risk prediction (malignant-benign classification). To evaluate our model's general performance, we selected 253 out of 467 patients from a subset of the National Lung Screening Trial (NLST) who had CT scans without contrast, which are the most commonly used, and divided them into training and test cohorts. The CT scans were preprocessed into 2D-image and 3D-volume formats according to their nodule annotations. We evaluated ten 3D and eleven 2D SOTA deep learning models, which were pretrained on large-scale general-purpose datasets (Kinetics and ImageNet) and radiological datasets (3DSeg-8, nnUnet and RadImageNet), for their lung cancer risk prediction performance. Our results showed that 3D-based deep learning models generally perform better than 2D models. On the test cohort, the best-performing 3D model achieved an AUROC of 0.86, while the best 2D model reached 0.79. The lowest AUROCs for the 3D and 2D models were 0.70 and 0.62, respectively. Furthermore, pretraining on large-scale radiological image datasets did not show the expected performance advantage over pretraining on general-purpose datasets. Both 2D and 3D deep learning models can handle lung cancer risk prediction tasks effectively, although 3D models generally have superior performance than their 2D competitors. Our findings highlight the importance of carefully selecting pretrained datasets and model architectures for lung cancer risk prediction. Overall, these results have important implications for the development and clinical integration of DL-based tools in lung cancer screening.