Advanced artificial intelligence framework for T classification of TNM lung cancer in¹⁸FDG-PET/CT imaging

The integration of artificial intelligence (AI) into lung cancer management offers immense potential to revolutionize diagnostic and treatment strategies. The aim is to develop a resilient AI framework capable of two critical tasks: firstly, achieving accurate and automated segmentation of lung tumors and secondly, facilitating the T classification of lung cancer according to the ninth edition of TNM staging 2024 based on PET/CT imaging. This study presents a robust AI framework for the automated segmentation of lung tumors and T classification of lung cancer using PET/CT imaging. The database includes axial DICOM CT and¹⁸FDG-PET/CT images. A modified ResNet-50 model was employed for segmentation, achieving high precision and specificity. Reconstructed 3D models of segmented slices enhance tumor boundary visualization, which is essential for treatment planning. The Pulmonary Toolkit facilitated lobe segmentation, providing critical diagnostic insights. Additionally, the segmented images were used as input for the T classification using a CNN ResNet-50 model. Our classification model demonstrated excellent performance, particularly for T1a, T2a, T2b, T3 and T4 tumors, with high precision, F1 scores, and specificity. The T stage is particularly relevant in lung cancer as it determines treatment approaches (surgery, chemotherapy and radiation therapy or supportive care) and prognosis assessment. In fact, for Tis-T2, each increase of one centimeter in tumor size results in a worse prognosis. For locally advanced tumors (T3-T4) and regardless of size, the prognosis is poorer. This AI framework marks a significant advancement in the automation of lung cancer diagnosis and staging, promising improved patient outcomes.