An Interpretable Deep Hierarchical Semantic Convolutional Neural Network for Lung Nodule Malignancy Classification

While deep learning methods are increasingly being applied to tasks such as computer-aided diagnosis, these models are difficult to interpret, do not incorporate prior domain knowledge, and are often considered as a "black-box." The lack of model interpretability hinders them from being fully understood by target users such as radiologists. In this paper, we present a novel interpretable deep hierarchical semantic convolutional neural network (HSCNN) to predict whether a given pulmonary nodule observed on a computed tomography (CT) scan is malignant. Our network provides two levels of output: 1) low-level radiologist semantic features, and 2) a high-level malignancy prediction score. The low-level semantic outputs quantify the diagnostic features used by radiologists and serve to explain how the model interprets the images in an expert-driven manner. The information from these low-level tasks, along with the representations learned by the convolutional layers, are then combined and used to infer the high-level task of predicting nodule malignancy. This unified architecture is trained by optimizing a global loss function including both low- and high-level tasks, thereby learning all the parameters within a joint framework. Our experimental results using the Lung Image Database Consortium (LIDC) show that the proposed method not only produces interpretable lung cancer predictions but also achieves significantly better results compared to common 3D CNN approaches

Pre-training autoencoder for lung nodule malignancy assessment using CT images

Lung cancer late diagnosis has a large impact on the mortality rate numbers, leading to a very low five-year survival rate of 5%. This issue emphasises the importance of developing systems to support a diagnostic at earlier stages. Clinicians use Computed Tomography (CT) scans to assess the nodules and the likelihood of malignancy. Automatic solutions can help to make a faster and more accurate diagnosis, which is crucial for the early detection of lung cancer. Convolutional neural networks (CNN) based approaches have shown to provide a reliable feature extraction ability to detect the malignancy risk associated with pulmonary nodules. This type of approach requires a massive amount of data to model training, which usually represents a limitation in the biomedical field due to medical data privacy and security issues. Transfer learning (TL) methods have been widely explored in medical imaging applications, offering a solution to overcome problems related to the lack of training data publicly available. For the clinical annotations experts with a deep understanding of the complex physiological phenomena represented in the data are required, which represents a huge investment. In this direction, this work explored a TL method based on unsupervised learning achieved when training a Convolutional Autoencoder (CAE) using images in the same domain. For this, lung nodules from the Lung Image Database Consortium and Image Database Resource Initiative (LIDC-IDRI) were extracted and used to train a CAE. Then, the encoder part was transferred, and the malignancy risk was assessed in a binary classification—benign and malignant lung nodules, achieving an Area Under the Curve (AUC) value of 0.936. To evaluate the reliability of this TL approach, the same architecture was trained from scratch and achieved an AUC value of 0.928. The results reported in this comparison suggested that the feature learning achieved when reconstructing the input with an encoder-decoder based architecture can be considered an useful knowledge that might allow overcoming labelling constraints.This work is financed by National Funds through the Portuguese funding agency, FCT—Fundação para a Ciência e a Tecnologia within project UIDB/50014/2020

Artificial intelligence in cancer imaging: Clinical challenges and applications

Judgement, as one of the core tenets of medicine, relies upon the integration of multilayered data with nuanced decision making. Cancer offers a unique context for medical decisions given not only its variegated forms with evolution of disease but also the need to take into account the individual condition of patients, their ability to receive treatment, and their responses to treatment. Challenges remain in the accurate detection, characterization, and monitoring of cancers despite improved technologies. Radiographic assessment of disease most commonly relies upon visual evaluations, the interpretations of which may be augmented by advanced computational analyses. In particular, artificial intelligence (AI) promises to make great strides in the qualitative interpretation of cancer imaging by expert clinicians, including volumetric delineation of tumors over time, extrapolation of the tumor genotype and biological course from its radiographic phenotype, prediction of clinical outcome, and assessment of the impact of disease and treatment on adjacent organs. AI may automate processes in the initial interpretation of images and shift the clinical workflow of radiographic detection, management decisions on whether or not to administer an intervention, and subsequent observation to a yet to be envisioned paradigm. Here, the authors review the current state of AI as applied to medical imaging of cancer and describe advances in 4 tumor types (lung, brain, breast, and prostate) to illustrate how common clinical problems are being addressed. Although most studies evaluating AI applications in oncology to date have not been vigorously validated for reproducibility and generalizability, the results do highlight increasingly concerted efforts in pushing AI technology to clinical use and to impact future directions in cancer care

Lung nodules: size still matters

The incidence of indeterminate pulmonary nodules has risen constantly over the past few years. Determination of lung nodule malignancy is pivotal, because the early diagnosis of lung cancer could lead to a definitive intervention. According to the current international guidelines, size and growth rate represent the main indicators to determine the nature of a pulmonary nodule. However, there are some limitations in evaluating and characterising nodules when only their dimensions are taken into account. There is no single method for measuring nodules, and intrinsic errors, which can determine variations in nodule measurement and in growth assessment, do exist when performing measurements either manually or with automated or semi-automated methods. When considering subsolid nodules the presence and size of a solid component is the major determinant of malignancy and nodule management, as reported in the latest guidelines. Nevertheless, other nodule morphological characteristics have been associated with an increased risk of malignancy. In addition, the clinical context should not be overlooked in determining the probability of malignancy. Predictive models have been proposed as a potential means to overcome the limitations of a sized-based assessment of the malignancy risk for indeterminate pulmonary nodules

Convolutional Neural Network based Malignancy Detection of Pulmonary Nodule on Computer Tomography

Without performing biopsy that could lead physical damages to nerves and vessels, Computerized Tomography (CT) is widely used to diagnose the lung cancer due to the high sensitivity of pulmonary nodule detection. However, distinguishing pulmonary nodule in-between malignant and benign is still not an easy task. As the CT scans are mostly in relatively low resolution, it is not easy for radiologists to read the details of the scan image. In the past few years, the continuing rapid growth of CT scan analysis system has generated a pressing need for advanced computational tools to extract useful features to assist the radiologist in reading progress. Computer-aided detection (CAD) systems have been developed to reduce observational oversights by identifying the suspicious features that a radiologist looks for during case review. Most previous CAD systems rely on low-level non-texture imaging features such as intensity, shape, size or volume of the pulmonary nodules. However, the pulmonary nodules have a wide variety in shapes and sizes, and also the high visual similarities between benign and malignant patterns, so relying on non-texture imaging features is difficult for diagnosis of the nodule types. To overcome the problem of non-texture imaging features, more recent CAD systems adopted the supervised or unsupervised learning scheme to translate the content of the nodules into discriminative features. Such features enable high-level imaging features highly correlated with shape and texture. Convolutional neural networks (ConvNets), supervised methods related to deep learning, have been improved rapidly in recent years. Due to their great success in computer vision tasks, they are also expected to be helpful in medical imaging. In this thesis, a CAD based on a deep convolutional neural network (ConvNet) is designed and evaluated for malignant pulmonary nodules on computerized tomography. The proposed ConvNet, which is the core component of the proposed CAD system, is trained on the LUNGx challenge database to classify benign and malignant pulmonary nodules on CT. The architecture of the proposed ConvNet consists of 3 convolutional layers with maximum pooling operations and rectified linear units (ReLU) activations, followed by 2 denser layers with full-connectivities, and the architecture is carefully tailored for pulmonary nodule classification by considering the problems of over-fitting, receptive field, and imbalanced data. The proposed CAD system achieved the sensitivity of 0.896 and specificity of 8.78 at the optimal cut-off point of the receiver operating characteristic curve (ROC) with the area under the curve (AUC) of 0.920. The testing results showed that the proposed ConvNet achieves 10% higher AUC compared to the state-of-the-art work related to the unsupervised method. By integrating the proposed highly accurate ConvNet, the proposed CAD system also outperformed the other state-of-the-art ConvNets explicitly designed for diagnosis of pulmonary nodules detection or classification

Lung nodule diagnosis and cancer histology classification from computed tomography data by convolutional neural networks: A survey

Lung cancer is among the deadliest cancers. Besides lung nodule classification and diagnosis, developing non-invasive systems to classify lung cancer histological types/subtypes may help clinicians to make targeted treatment decisions timely, having a positive impact on patients' comfort and survival rate. As convolutional neural networks have proven to be responsible for the significant improvement of the accuracy in lung cancer diagnosis, with this survey we intend to: show the contribution of convolutional neural networks not only in identifying malignant lung nodules but also in classifying lung cancer histological types/subtypes directly from computed tomography data; point out the strengths and weaknesses of slice-based and scan-based approaches employing convolutional neural networks; and highlight the challenges and prospective solutions to successfully apply convolutional neural networks for such classification tasks. To this aim, we conducted a comprehensive analysis of relevant Scopus-indexed studies involved in lung nodule diagnosis and cancer histology classification up to January 2022, dividing the investigation in convolutional neural network-based approaches fed with planar or volumetric computed tomography data. Despite the application of convolutional neural networks in lung nodule diagnosis and cancer histology classification is a valid strategy, some challenges raised, mainly including the lack of publicly-accessible annotated data, together with the lack of reproducibility and clinical interpretability. We believe that this survey will be helpful for future studies involved in lung nodule diagnosis and cancer histology classification prior to lung biopsy by means of convolutional neural networks