Original Investigation

Machine Learning–Guided Detection of Malignancy of Lung Nodules With Molecular Imaging–Guided Surgery

JAMA Network Open 10.1001/jamanetworkopen.2025.51734

January 13, 2026 at 11:00 AM EST

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Can a combination of machine learning–guided image recognition and molecular imaging technology optically biopsy lung nodules?This cohort study with 322 patients evaluates the use of machine learning–based algorithms in conjunction with robust nomograms during intraoperative molecular imaging (IMI)–guided lung cancer resections. Results suggest that the algorithm can identify and estimate malignant potential of an indeterminate lung nodule in a fast and efficient manner, with an area under the curve of 0.865 to 0.893 for malignant nodule assessment.These findings suggest availability and implementation of artificial intelligence or machine learning–guided optical biopsy represents an area of new development in surgical oncology. The combination of computational processing power and IMI can serve as a useful adjunct for fast clinical decision-making intraoperatively.

Corresponding Author: Feredun Azari, MD, Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, 9500 Euclid Ave, Desk J4-1, Cleveland, OH 44195 (azarif@ccf.org).

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