Pre-treatment determination of renal cell carcinoma aggressiveness may help guide clinical decision-making. We aimed to differentiate low-grade (Fuhrman I–II) from high-grade (Fuhrman III–IV) renal cell carcinoma using radiomics features extracted from routine MRI. 482 pathologically confirmed renal cell carcinoma lesions from 2008 to 2019 in a multicenter cohort were retrospectively identified. 439 lesions with information on Fuhrman grade from 4 institutions were divided into training and test sets with an 8:2 split for model development and internal validation. Another 43 lesions from a separate institution were set aside for independent external validation. The performance of TPOT (Tree-Based Pipeline Optimization Tool), an automatic machine learning pipeline optimizer, was compared to hand-optimized machine learning pipeline. The best-performing hand-optimized pipeline was a Bayesian classifier with Fischer Score feature selection, achieving an external validation ROC AUC of 0.59 (95% CI 0.49–0.68), accuracy of 0.77 (95% CI 0.68–0.84), sensitivity of 0.38 (95% CI 0.29–0.48), and specificity of 0.86 (95% CI 0.78–0.92). The best-performing TPOT pipeline achieved an external validation ROC AUC of 0.60 (95% CI 0.50–0.69), accuracy of 0.81 (95% CI 0.72–0.88), sensitivity of 0.12 (95% CI 0.14–0.30), and specificity of 0.97 (95% CI 0.87–0.97). Automated machine learning pipelines can perform equivalent to or better than hand-optimized pipeline on an external validation test non-invasively predicting Fuhrman grade of renal cell carcinoma using conventional MRI.
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