Grad-CAM-guided radiomics reveals extratumoral CT features for esophageal fistula prediction

Grad-CAM-guided CT radiomics predicts esophageal fistula in ESCC: Lung Radscore OR 11.55 (p=0.038) & Esophageal Tumor Radscore OR 192.3 (p=0.040) associated with fistula; conventional CT markers lost significance. Exploratory study.

• The 3D-CNN achieved a mean AUC of 0.848 for fistula prediction.
• Grad-CAM highlighted activation in the lungs and thoracic spine, not just the mediastinum.
• In multivariable analysis, only Lung and Esophageal Tumor Radscores remained significant, while conventional CT markers did not; findings are exploratory and require external validation.

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