Predicting malignancy of pulmonary ground-glass nodules and their invasiveness by random forest

Lung cancer is the leading cause of cancer-related deaths worldwide (1). The U.S. national lung screening trial (NLST) demonstrated that a 20% reduction in lung cancer mortality for low-dose computed tomography (LDCT) compared to chest radiography (2). However in the NLST trial, 96.4% of participants with pulmonary nodules were benign. The risk of major complications for invasive diagnostic procedures was 4.5 per 10,000 persons screened while 25% of surgically resected nodules were benign (2). An accurate and practical non-invasive tool that can predict the malignancy of lung nodules will thus greatly reduce costs and surgical complications and avoid unnecessary invasive diagnostic procedures or surgery