Abstract
OBJECTIVE: To construct a nomogram incorporating clinical-radiological and radiomics features from computed tomography (CT) for distinguishing invasive adenocarcinoma (IAC) from adenocarcinoma in situ (AIS) and minimally invasive adenocarcinoma (MIA) in ground-glass nodules (GGNs). METHODS: This retrospective study included 473 GGN patients with postoperative pathological confirmation of AIS, MIA, or IAC. The training set comprised 257 patients from Yantaishan Hospital, while the test set, used for external validation, included 216 patients from the Affiliated Hospital of Binzhou Medical College. Radiomics features were selected, and a radiomics model was constructed using least absolute shrinkage and selection operator (LASSO) and minimum redundancy maximum relevance (mRMR) methods. A clinical-radiological model was developed using univariate and multivariate logistic regression. The nomogram was generated by combining the two models. Its performance was evaluated via receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA). RESULTS: The radiomics model included 11 features, while the clinical-radiological model incorporated lobulation, age, and long diameter. The nomogram outperformed both individual models in terms of accuracy and area under the curve (AUC) in both the training and test sets. Calibration curve analysis confirmed good consistency between actual and predicted outcomes, and DCA indicated the nomogram's clinical utility. CONCLUSION: The nomogram is a non-invasive, accurate tool for preoperative differentiation of GGN types, providing valuable guidance for clinicians in treatment planning.