Early detection of lung cancer has been proven to decrease mortality significantly. A recent development in computed tomography (CT), spectral CT, can potentially improve diagnostic accuracy, as it yields more information per scan than regular CT. However, the shear workload involved with analyzing a large number of scans drives the need for automated diagnosis methods. Therefore, we propose a detection and classification system for lung nodules in CT scans. Furthermore, we want to observe whether spectral images can increase classifier performance. For the detection of nodules we trained a VGG-like 3D convolutional neural net (CNN). To obtain a primary tumor classifier for our dataset we pre-trained a 3D CNN with similar architecture on nodule malignancies of a large publicly available dataset, the LIDC-IDRI dataset. Subsequently we used this pre-trained network as feature extractor for the nodules in our dataset. The resulting feature vectors were classified into two (benign/malignant) and three (benign/primary lung cancer/metastases) classes using support vector machine (SVM). This classification was performed both on nodule- and scan-level. We obtained state-of-the art performance for detection and malignancy regression on the LIDC-IDRI database. Classification performance on our own dataset was higher for scan- than for nodule-level predictions. For the three-class scan-level classification we obtained an accuracy of 78%. Spectral features did increase classifier performance, but not significantly. Our work suggests that a pre-trained feature extractor can be used as primary tumor origin classifier for lung nodules, eliminating the need for elaborate fine-tuning of a new network and large datasets. Code is available at url{https://github.com/tueimage/lung-nodule-msc-2018}.
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