A Novel Radiomics-based Interpretable Model for Bladder Cancer Grade Prediction Using White-Light Cystoscopy Images

Abstract

Background and objective: White-light cystoscopy (WLC) is the standard diagnostic modality for bladder cancer, but preoperative grading remains inaccurate. We developed a multichannel radiomics model to predict tumour grade (low-grade [LG] vs high-grade [HG]) from WLC and to identify imaging biomarkers. Methods: WLC images were retrospectively collected from 423 patients across two centres. A total of 2624 tumour regions were segmented for training, with 584 and 358 regions for internal and external validation, respectively. Radiomic features were extracted from the greyscale and red-green-blue channels. Feature selection was performed using coefficient thresholding and the least absolute shrinkage and selection operator. Five machine-learning classifiers were trained. Model performance was assessed using discrimination, calibration, and decision curve analysis (DCA). Interpretability was assessed using SHapley Additive exPlanations (SHAP) and feature visualisation. Key findings and limitations: The support vector machine model achieved robust performance, with an area under the receiver operating characteristic curve of 0.87 (95% confidence interval [CI] = 0.84-0.89) for internal validation and 0.79 (95% CI = 0.73-0.85) for external validation. SHAP analysis revealed distinct radiomic patterns differentiating LG from HG tumours. Limitations include retrospective design, manual segmentation, and a small, imbalanced external set, so validation reflects preliminary transportability rather than robustness or generalisability. Although calibration was acceptable and net benefit appeared at thresholds >= 0.30, external data constraints warrant caution. Conclusions and clinical implications: The proposed multichannel radiomics model supports grade prediction from WLC images and identifies a green channel. This approach provides a basis for developing real-time, filter-based tools for intraoperative risk stratification. (c) 2026 The Author(s). Published by Elsevier B.V. on behalf of European Association of Urology. This is an open access article under the CC BY license (http://creativecommons. org/licenses/by/4.0/).