Skip to Main Content

An official website of the United States government

Government Funding Lapse

Because of a lapse in government funding, the information on this website may not be up to date, transactions submitted via the website may not be processed, and the agency may not be able to respond to inquiries until appropriations are enacted. The NIH Clinical Center (the research hospital of NIH) is open. For more details about its operating status, please visit  cc.nih.gov. Updates regarding government operating status and resumption of normal operations can be found at OPM.gov.

About this Publication
Title
Deep Learning Using Chest Radiographs to Identify High-Risk Smokers for Lung Cancer Screening Computed Tomography: Development and Validation of a Prediction Model.
Pubmed ID
32866413 (View this publication on the PubMed website)
Digital Object Identifier
Publication
Ann. Intern. Med. 2020 Sep 1
Authors
Lu MT, Raghu VK, Mayrhofer T, Aerts HJWL, Hoffmann U
Affiliations
  • Massachusetts General Hospital Cardiovascular Imaging Research Center, Brigham and Women's Hospital Program for Artificial Intelligence in Medicine, and Harvard Medical School, Boston, Massachusetts (M.T.L., V.K.R., U.H.).
  • Harvard Medical School, Boston, Massachusetts,and Stralsund University of Applied Sciences, Stralsund, Germany (T.M.).
  • Brigham and Women's Hospital Program for Artificial Intelligence in Medicine, Massachusetts General Hospital Cardiovascular Imaging Research Center, and Harvard Medical School, Boston, Massachusetts (H.J.A.).
Abstract

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 (n = 41 856). The final CXR-LC model was validated in additional PLCO smokers (n = 5615, 12-year follow-up) and NLST (National Lung Screening Trial) heavy smokers (n = 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; P < 0.001). The CXR-LC model's performance was similar to that of PLCOM2012, a state-of-the-art risk score with 11 inputs, in both the PLCO data set (CXR-LC AUC of 0.755 vs. PLCOM2012 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%; P = 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 PLCOM2012.

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.

Related CDAS Studies
Related CDAS Projects