A Robust Deep Learning Method with Uncertainty Estimation for the Pathological Classification of Renal Cell Carcinoma Based on CT Images

This study developed and validated a deep learning–based diagnostic model with uncertainty estimation to aid radiologists in the preoperative differentiation of pathological subtypes of renal cell carcinoma (RCC) based on computed tomography (CT) images. Data from 668 consecutive patients with pathologically confirmed RCC were retrospectively collected from Center 1, and the model was trained using fivefold cross-validation to classify RCC subtypes into clear cell RCC (ccRCC), papillary RCC (pRCC), and chromophobe RCC (chRCC). An external validation with 78 patients from Center 2 was conducted to evaluate the performance of the model. In the fivefold cross-validation, the area under the receiver operating characteristic curve (AUC) for the classification of ccRCC, pRCC, and chRCC was 0.868 (95% CI, 0.826–0.923), 0.846 (95% CI, 0.812–0.886), and 0.839 (95% CI, 0.802–0.88), respectively. In the external validation set, the AUCs were 0.856 (95% CI, 0.838–0.882), 0.787 (95% CI, 0.757–0.818), and 0.793 (95% CI, 0.758–0.831) for ccRCC, pRCC, and chRCC, respectively. The model demonstrated robust performance in predicting the pathological subtypes of RCC, while the incorporated uncertainty emphasized the importance of understanding model confidence. The proposed approach, integrated with uncertainty estimation, offers clinicians a dual advantage: accurate RCC subtype predictions complemented by diagnostic confidence metrics, thereby promoting informed decision-making for patients with RCC.