Disentangling Lung-Cancer CT/LDCT AI: A Systematic Evidence Map of Clinical Tasks, Evidence Chains, and Translational Gaps

Laryngeal cancer imaging research lacks standardised public datasets to enable reproducible deep learning (DL) model development. We present LaryngealCT, a curated benchmark of 1,029 computed tomography (CT) scans aggregated from six collections from The Cancer Imaging Archive (TCIA). Uniform 1 mm isotropic volumes of interest encompassing the larynx were extracted using a weakly supervised parameter search framework validated by clinical experts. Six 3D DL architectures (custom 3D CNN, ResNet18,50,101, DenseNet121 and MedicalNet-pretrained ResNet50) were benchmarked on (i) early (Tis,T1,T2) vs. advanced (T3,T4) and (ii) T4 vs. non-T4 classification tasks. On the independent test set, the 3D CNN achieved the strongest overall performance across global and per-class metrics (Accuracy 0.854, F1-macro 0.841) in early vs. advanced classification. In the T4 task, AU-ROC values exceeded 0.82 for most models, but sensitivity for T4 disease remained limited (less than or equal to 0.412), with ResNet101 showing the most promising calibrated T4 recall (0.706. Model explainability assessed using GradCAMpp with thyroid cartilage overlays for T4 classification task revealed anatomically plausible peri-cartilage activations, although spatial overlap was modest. Through open-source data, pretrained models, and integrated explainability tools, LaryngealCT offers a reproducible foundation for AI-driven research to support future clinical decision-making in laryngeal oncology.

Radiomics is the established approach for CT-based lung cancer phenotyping, yet comparisons with foundation models rarely isolate contributions of feature extractor, classification head, and segmentation choice, or test cross-cohort robustness. We benchmark five feature extractors (Curia, Curia-2, DINOv3, Radiomics2D, Radiomics3D), seven classification heads (TabPFN, TabICL, XGBoost, CatBoost, Random Forest, logistic regression, Ridge), and three segmentation regimes on five tasks: tumor volume and stage classification, 2-year survival prediction, histology classification, and age prediction. Models are trained on LUNG1 (n=338) and evaluated on an internal test set (n=84) and the external LUNG2 cohort (n=211), with worst-case cross-cohort performance as the primary metric. The dominant design factor is task-dependent: segmentation drives volume and stage classification, while classifier choice drives survival, histology, and age prediction. Radiomics is competitive for tumor volume, tumor stage and survival (partly due to label-derivation effects for the former); Curia variants reach comparable peak scores for survival; DINOv3 falls slightly short across tasks. Patch and slice aggregation have negligible impact. We recommend Curia with tumor segmentation and a CatBoost head as a safe default, achieving the best mean rank across the three primary clinical tasks, though task-specific selection consistently outperforms any cross-task default. When tumor delineations are unavailable, Curia-2 with lung segmentation and logistic regression offers a competitive alternative. All pipelines use a two-stage design suited to small cohort sizes where end-to-end fine-tuning would risk overfitting.

Lung cancer is the leading cause of cancer-related mortality, with approximately 2.5 million new cases and 1.8 million deaths annually, making reliable diagnosis a clinical priority. Although deep learning models have achieved strong performance in lung cancer classification, evaluation has largely focused on predictive accuracy, leaving their decision-making processes insufficiently examined. This study compares three architecturally distinct models: a Convolutional Neural Network (CNN), a pretrained ResNet50, and a Vision Transformer (ViT), trained on the IQ-OTH/NCCD lung cancer CT dataset. Local Interpretable Model-Agnostic Explanations (LIME) were applied to investigate model reasoning. In addition to standard performance metrics, a dual-correlation framework was introduced to measure both prediction agreement and explanation agreement across model pairs. All three models achieved strong classification performance, with ResNet50 attaining 98.61% accuracy, CNN 97.91%, and ViT 93.75%, while all achieved ROC-AUC scores of 0.99. Prediction correlations exceeded 0.99 across all model pairs, indicating highly consistent outputs. However, LIME explanation correlations remained below 0.26, revealing substantial differences in the image regions used to reach those predictions. Analysis of misclassified samples further identified a consistent spatial pattern: incorrect predictions were associated with attention outside the lung parenchyma, whereas correct predictions focused primarily within lung regions. These findings demonstrate that prediction agreement is a poor proxy for reasoning consistency, and that interpretability evaluation must be treated as an independent validation criterion alongside predictive performance in clinical AI systems.