Predicting Invasiveness of Lung Adenocarcinoma from Chest CT with Few-shot Vision-Language Ternary Classification Model

Preoperative differentiation of preinvasive lesions, minimally invasive adenocarcinomas, and invasive adenocarcinomas within pure ground-glass nodules (pGGNs) is challenging. Herein, this study investigated the potential of vision-language models to assist radiologists in noninvasively predicting pGGN invasiveness on CT scans. This retrospective multicenter study enrolled 848 patients with pathologically-confirmed lung adenocarcinoma manifesting as pGGNs. GPT-4o was tasked with localizing pGGNs on CT scans to detect ten pGGN invasiveness-associated features to generate a diagnosis and was compared with Molmo. The twenty-shot GPT-4o model demonstrated superior performance in the ternary classification of pGGN invasiveness (Delong test, P < 0.01). Six radiologists' assessments revealed that GPT-4o output showed high reliability, willingness to use, reliance, low risk of harm, inappropriate content, and missing content. With GPT-4o assistance, another six radiologists achieved an average improvement in pGGN invasiveness diagnosis. The twenty-shot-based GPT-4o model exhibited superior diagnostic capability for pGGN invasiveness in lung adenocarcinoma, achieving significantly improved diagnostic accuracy by radiologists.