Disentangling Lung-Cancer CT/LDCT AI: A Systematic Evidence Map of Clinical Tasks, Evidence Chains, and Translational Gaps

Abstract

Artificial-intelligence studies using computed tomography (CT) for lung cancer are often broadly labelled"prediction"despite addressing clinically distinct tasks. We systematically mapped CT/low-dose CT (LDCT)-centered lung-cancer AI using five-database retrieval, full-text eligibility assessment, role-aware modality/omics extraction, clinical-task classification, and a Multi-Tier Evidence Graph (MTEG). The final corpus comprised 293 studies (2016-2026): 230 Detection, 8 future Risk-prediction, and 55 Other studies. Clinical variables (96.2%), 3D CT/LDCT (73.0%), and radiomics (63.5%) predominated, whereas external validation (29.0%), calibration (20.5%), decision-curve analysis (13.0%), longitudinal CT (17.7%), and saliency/attribution XAI (21.5%) were less frequent. The MTEG comprised 377 nodes and 3,444 edges; only 31 studies (10.6%) completed the six-tier substantive evidence chain, with greatest attrition at reasoning/explanation. Overall, the literature is detection-dominated, genuine future risk prediction remains uncommon, and complete translational evidence chains are rare.