Abstract
OBJECTIVES: To investigate the feasibility and effectiveness of a deep learning (DL) super-resolution (SR) ultrasound image reconstruction model for predicting cervical lymph node status in patients with papillary thyroid carcinoma(PTC). METHODS: In this retrospective study, researchers recruited 544 patients with PTC and randomly assigned them to training and test sets. SR ultrasound images were acquired using SR technology to improve image resolution, and artificial features and DL features were extracted from the original (OR) and SR images, respectively, to construct a ML, DL model. The best model was selected and aggregated with clinical parameters to construct the nomogram. The performance of the model is evaluated by ROC curves, calibration curves and decision curves. RESULTS: In distinguishing the presence or absence of metastatic lymph nodes, the predictive performance of the SR_ResNet 101 and SR_SVM models based on SR outperformed those based on OR. In the test set, SR_SVM AUC was 0.878 (95% CI 0.8203-0.9358), accuracy 0.854, while OR_SVM AUC was 0.822 (95% CI 0.7500-0.8937), accuracy 0.665. SR_ResNet 101 AUC was 0.799 (95% CI 0.7175-0.8806), accuracy 0.793, and OR_ResNet101 AUC was 0.751 (95% CI 0.6620-0.8401), accuracy 0.713. Subsequently, Nomogram_A and Nomogram_B were constructed by integrating the SR_SVM model and SR_ResNet 101 model, respectively, with clinical parameters, while Nomogram_C was constructed solely based on clinical indicators. In the test set, Nomogram_A demonstrated the best performance with an AUC of 0.930 (95% CI 0.8913-0.9682) and accuracy was 0.829. Nomogram_B AUC 0.868 (95% CI 0.8102-0.9261) and accuracy was 0.829, while Nomogram_C AUC 0.880 (95% CI 0.8257-0.9349) and accuracy was 0.787. The DeLong test revealed that the diagnostic performance of Nomogram_A based on SR_SVM was significantly higher than that of Nomogram_B, Nomogram_C, and the level of Radiologist (P < 0.05). The calibration curves and Hosmer-Lemeshow tests confirmed a high degree of fit, and the decision curve analysis demonstrated clinical value and potential patient benefit. CONCLUSIONS: The predictive model constructed using SR reconstructed ultrasound images demonstrated superior performance in predicting preoperative cervical lymph node metastasis in PTC compared to OR images. The nomogram prediction model based on SR images has the potential to enhance the accuracy of predictive models and aid in clinical decision-making.