Rethinking Lung Cancer Screening: AI Nodule Detection and Diagnosis Outperforms Radiologists, Leading Models, and Standards Beyond Size and Growth

Abstract: Early detection of malignant lung nodules is critical, but its dependence on size and growth in screening inherently delays diagnosis. We present an AI system that redefines lung cancer screening by performing both detection and malignancy diagnosis directly at the nodule level on low-dose CT scans. To address limitations in dataset scale and explainability, we designed an ensemble of shallow deep learning and feature-based specialized models. Trained and evaluated on 25,709 scans with 69,449 annotated nodules, the system outperforms radiologists, Lung-RADS, and leading AI models (Sybil, Brock, Google, Kaggle). It achieves an area under the receiver operating characteristic curve (AUC) of 0.98 internally and 0.945 on an independent cohort. With 0.5 false positives per scan at 99.3\% sensitivity, it addresses key barriers to AI adoption. Critically, it outperforms radiologists across all nodule sizes and stages, excelling in stage 1 cancers, and all growth-based metrics, including the least accurate: Volume-Doubling Time. It also surpasses radiologists by up to one year in diagnosing indeterminate and slow-growing nodules.