Integrating Radiomics Features and CT Semantic Characteristics for Predicting Visceral Pleural Invasion in clinical stage Ia peripheral Lung Adenocarcinoma

Objectives The aim of this study was to non-invasively predict the visceral pleural invasion (VPI) of peripheral lung adenocarcinoma (LA) highly associated with pleura of clinical stage Ia based on preoperative chest computed tomography (CT) scanning. Methods A total of 537 patients diagnosed with clinical stage Ia LA underwent resection and were stratified into training and external validation cohorts at a ratio of 7:3. Radiomics features were extracted using PyRadiomics software following tumor lesion segmentation and were subsequently filtered through spearman correlation analysis, minimum redundancy maximum relevance, and least absolute shrinkage and selection operator regression analysis. Univariate and multivariable logistic regression analyses were conducted to identify independent predictors. A predictive model was established with visual nomogram and external validation, and evaluated in terms of area under the receiver operating characteristic curve (AUC). Results The independent predictors of VPI were identified: pleural attachment (p < 0.001), pleural contact angle (p = 0.018) and Rad-score (p < 0.001). The combined model showed good calibration with an AUC of 0.822 (95% confidence intervals (CI): 0.785, 0.869), compared with 0.719 (95% CI: 0.677, 0.760; DeLong’s test p < 0.001) when radiomics was used alone. For validation group, the accuracy of combined prediction model was reasonable with an AUC of 0.785 (95% CI: 0.742, 0.821). Conclusion Our predictive model, which integrated radiomics features of primary tumors and peritumoral CT semantic characteristics, offers a non-invasive method for evaluating VPI in patients with clinical stage Ia LA. Additionally, it provides prognostic information and supports surgeons in making more personalized treatment decisions.