Preoperative computed tomography semantic features in predicting lymph node metastasis of part-solid nodules in non-small cell lung cancer: a multicenter retrospective study

Lymph node metastasis (LNM) is the most common route of metastasis for lung cancer, and it is an independent risk factor for long-term survival and recurrence in patients with non-small cell lung cancer (NSCLC). The purpose of this study was to explore the value of preoperative computed tomography (CT) semantic features in the differential diagnosis of LNM in part-solid nodules (PSNs) of NSCLC. A total of 955 patients with NSCLC confirmed by postoperative pathology were retrospectively enrolled from January 2019 to March 2023. The clinical, pathological data and preoperative CT images of these patients were investigated and statistically analyzed in order to identify the risk factors for LNM. Multivariate logistic regression was used to select independent risk factors and establish different prediction models. Ten-fold cross-validation was used for model training and validation. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated, and the Delong test was used to compare the predictive performance between the models. LNM occurred in 68 of 955 patients. After univariate analysis and adjustment for confounding factors, smoking history, pulmonary disease, solid component proportion, pleural contact type, and mean diameter were identified as the independent risk factors for LNM. The image predictors model established by the four independent factors of CT semantic features, except smoking history, showed a good diagnostic efficacy for LNM. The AUC in the validation group was 0.857, and the sensitivity, specificity, and accuracy of the model were all 77.6%. Preoperative CT semantic features have good diagnostic value for the LNM of NSCLC. The image predictors model based on pulmonary disease, solid component proportion, pleural contact type, and mean diameter demonstrated excellent diagnostic efficacy and can provide non-invasive evaluation in clinical practice.