Abstract
OBJECT: To evaluate the difference between multiple primary lung adenocarcinoma (MPLA) and solitary primary lung adenocarcinoma (SPLA) by delta-radiomics based machine learning algorithms in CT images. METHODS: A total of 1094 patients containing 268 MPLAs and 826 SPLAs were recruited for this retrospective study between 2014 to 2020. After the segmentation of volume of interest, the radiomic features were automatically calculated. The patients were categorized into the training set and testing set by a random proportion of 7:3. After feature selection, the relevant classifiers were constructed by the machine learning algorithms of Bayes, forest, k-nearest neighbor, logistic regression, support vector machine, and decision tree. The relative standard deviation (RSD) was calculated and the classification model with minimal RSD was chosen for delta-radiomics analysis to explore the variation of tumor during follow-up surveillance in the cohort of 225 MPLAs and 320 SPLAs. According to the different follow-up duration, it was divided into group A (3-12 months), group B (13-24 months), and group C (25-48 months). Then the corresponding delta-radiomics classifiers were developed to predict MPLAs. The area under the receiver operator characteristic curve (AUC) with 95% confidence interval (CI) was quantified to evaluate the efficiency of the model. RESULTS: To radiomics analysis, the forest classifier (FC-radio) with the minimal RSD showed the better stability with AUCs of 0.840 (95%CI, 0.810-0.867) and 0.670 (95%CI, 0.611-0.724) in the training and testing set. The AUCs of the forest classifier based on delta-radiomics (FC-delta) were higher than those of FC-radio. In addition, with the extension of follow-up duration, the performance of FC-delta in Group C were the best with AUCs of 0.998 (95%CI, 0.993-1.000) in the training set and 0.853 (95%CI, 0.752-0.940) in the testing set. CONCLUSIONS: The machine-learning approach based on radiomics and delta-radiomics helped to differentiate SPLAs from MPLAs. The FC-delta with a longer follow-up duration could better distinguish between SPLAs and MPLAs.