Abstract
BACKGROUND/OBJECTIVES: Lung cancer remains the leading cause of cancer-related mortality, underscoring the need for improved diagnostic methods. This study seeks to enhance the classification accuracy of confocal laser endomicroscopy (pCLE) images for lung cancer by applying a dual transfer learning (TL) approach that incorporates histological imaging data. METHODS: Histological samples and pCLE images, collected from 40 patients undergoing curative lung cancer surgeries, were selected to create 2 balanced datasets (800 benign and 800 malignant images each). Three CNN architectures-AlexNet, GoogLeNet, and ResNet-were pre-trained on ImageNet and re-trained on pCLE images (confocal TL) or using dual TL (first re-trained on histological images, then pCLE). Model performance was evaluated using accuracy and AUC across 50 independent runs with 10-fold cross-validation. RESULTS: The dual TL approach statistically significant outperformed confocal TL, with AlexNet achieving a mean accuracy of 94.97% and an AUC of 0.98, surpassing GoogLeNet (91.43% accuracy, 0.97 AUC) and ResNet (89.87% accuracy, 0.96 AUC). All networks demonstrated statistically significant (p < 0.001) improvements in performance with dual TL. Additionally, dual TL models showed reductions in both false positives and false negatives, with class activation mappings highlighting enhanced focus on diagnostically relevant regions. CONCLUSIONS: Dual TL, integrating histological and pCLE imaging, results in a statistically significant improvement in lung cancer classification. This approach offers a promising framework for enhanced tissue classification. and with future development and testing, iy has the potential to improve patient outcomes.