Multiple Tumor-related autoantibodies test enhances CT-based deep learning performance in diagnosing lung cancer with diameters < 70 mm: a prospective study in China

Background: Deep learning (DL) demonstrates high sensitivity but low specificity in lung cancer (LC) detection during CT screening, and the seven Tumor-associated antigens autoantibodies (7-TAAbs), known for its high specificity in LC, was employed to improve the DL’s specificity for the efficiency of LC screening in China. Purpose: To develop and evaluate a risk model combining 7-TAAbs test and DL scores for diagnosing LC with pulmonary lesions < 70 mm. Materials and methods: Four hundreds and six patients with 406 lesions were enrolled and assigned into training set (n = 313) and test set (n = 93) randomly. The malignant lesions were defined as those lesions with high malignant risks by DL or those with positive expression of 7-TAAbs panel. Model performance was assessed using the area under the receiver operating characteristic curves (AUC). Results: In the training set, the AUCs for DL, 7-TAAbs, combined model (DL and 7-TAAbs) and combined model (DL or 7-TAAbs) were 0.771, 0.638, 0.606, 0.809 seperately. In the test set, the combined model (DL or 7-TAAbs) achieved achieved the highest sensitivity (82.6%), NPV (81.8%) and accuracy (79.6%) among four models, and the AUCs of DL model, 7-TAAbs model, combined model (DL and 7-TAAbs), and combined model (DL or 7-TAAbs) were 0.731, 0.679, 0.574, and 0.794, respectively. Conclusion: The 7-TAAbs test significantly enhances DL performance in predicting LC with pulmonary leisons < 70 mm in China.