Abstract
OBJECTIVES: The International Association for the Study of Lung Cancer (IASLC) grading system for invasive non-mucinous adenocarcinoma (ADC) incorporates high-grade patterns (HGP) and predominant subtypes (PS). Following the system, this study aimed to explore the feasibility of predicting HGP and PS for IASLC grading. MATERIALS AND METHODS: A total of 529 ADCs from patients who underwent radical surgical resection were randomly divided into training and validation datasets in a 7:3 ratio. A two-step model consisting of two submodels was developed for IASLC grading. One submodel assessed whether the HGP exceeded 20% for ADCs, whereas the other distinguished between lepidic and acinar/papillary PS. The predictions from both submodels determined the final IASLC grades. Two variants of this model using either radiomic or clinical-semantic features were created. Additionally, one-step models that directly assessed IASLC grades using clinical-semantic or radiomic features were developed for comparison. The area under the curve (AUC) was used for model evaluation. RESULTS: The two-step radiomic model achieved the highest AUC values of 0.95, 0.85, 0.96 for grades 1, 2, 3 among models. The two-step models outperformed the one-step models in predicting grades 2 and 3, with AUCs of 0.89 and 0.96 vs. 0.53 and 0.81 for radiomics, and 0.68 and 0.77 vs. 0.44 and 0.63 for clinical-semantics (p < 0.001). Radiomics models showed better AUCs than clinical-semantic models for grade 3 regardless of model steps. CONCLUSIONS: Predicting HGP and PS using radiomics can achieve accurate IASLC grading in ADCs. Such a two-step radiomics model may provide precise preoperative diagnosis, thereby supporting treatment planning.