Classification of malignant/benign groups in lung cancer by machine learning and investigation of feature significance of parameters

This study aimed to apply machine learning (ML) models to enhance lung cancer (LC) classification, distinguishing malignant from benign tumors, using data from 73 patients. The dataset included PET/CT biomarkers and demographic factors, with SMOTE applied to address class imbalance. Three models were evaluated using 10-fold cross-validation to compare Random Forest (RF), Decision Tree (DT), Extra Trees Classifier (ETC), and XGBoost algorithms based on accuracy and AUC. ETC performed best in Model 1 (86% accuracy, AUC 0.95), RF in Model 2 (94% accuracy, AUC 0.97), and XGBoost in Model 3 (94% accuracy, AUC 0.98). XGBoost consistently outperformed others, particularly in Model 3, which included age and smoking. Feature importance analysis highlighted SUVmax as the most predictive variable, with smoking having a moderate influence and gender being minimal. Integrating clinical and lifestyle data with PET/CT parameters significantly improved LC classification. XGBoost emerged as the most effective model, demonstrating that comprehensive models enhance diagnostic accuracy beyond traditional metrics. © 2026 the author(s), published by De Gruyter, Berlin/Boston.