Abstract
OBJECTIVES: The aim of this study was to determine the status of tertiary lymphoid structures (TLSs) using radiomic features in patients with invasive pulmonary adenocarcinoma (IA). METHODS: In this retrospective study, patients with IA from November 2015 to March 2024 were recruited from two independent centers (center 1, training and internal test data set; center 2, external test data set). TLS was divided into two groups according to hematoxylin-eosin staining. Radiomic features were extracted, and support vector machine (SVM) were implemented to predict the status of TLSs. Receiver operating characteristic (ROC) curves were used to analyze diagnostic performance. Furthermore, visual assessments of the test set were also conducted by two thoracic radiologists and compared with the radiomics results. RESULTS: A total of 456 patients were included (training data set, n = 278; internal test data set, n = 115; external test data set, n = 63). The area under the curve (AUC) of the radiomics model on the validation set, the internal test set, and the external test set were 0.781 (95% confidence interval (CI): 0.659-0.905;), 0.804 (95% CI: 0.723-0.884;) and 0.747 (95% CI: 0.621-0.874;), respectively. In the visual assessments, the mean CT value and air bronchogram were important indicators of TLS, the AUC was 0.683. In the external test set, the AUC of the clinical model was 0.632. CONCLUSIONS: The radiomics model has a higher AUC than the clinical model and effectively discriminates TLSs in patients with IA. CRITICAL RELEVANCE STATEMENT: This study demonstrates that the radiomics-based model can differentiate TLSs in patients with IA. As a non-invasive biomarker, it enhances our understanding of tumor prognosis and management. KEY POINTS: TLSs are closely related to favorable clinical outcomes in non-small cell lung cancer. Radiomics from Chest CT predicted TLSs in patients with IA. This study supports individualized clinical decision-making for patients with IA.