Flexible state space modelling for accurate and efficient 3D lung nodule detection

Early and accurate detection of pulmonary nodules in computed tomography (CT) scans is critical for reducing lung cancer mortality. While convolutional neural networks (CNNs) and Transformer-based architectures have been widely used for this task, they often suffer from insufficient global context awareness, quadratic complexity, and dependence on post-processing steps such as non-maximum suppression (NMS). This study aims to develop a novel 3D lung nodule detection framework that balances local and global contextual awareness with low computational complexity, while minimizing reliance on manual threshold tuning and redundant post-processing. We propose FCMamba, a flexible connected visual state-space model adapted from the recently introduced Mamba architecture. To enhance spatial modelling, we introduce a flexible path encoding strategy that reorders 3D feature sequences adaptively based on input relevance. In addition, a Top Query Matcher, guided by the Hungarian matching algorithm, is integrated into the training process to replace traditional NMS and enable end-to-end one-to-one nodule matching. The model is trained and evaluated using 10-fold cross-validation on the LIDC-IDRI dataset, which contains 888 CT scans. FCMamba outperforms several state-of-the-art methods, including CNN, Transformer, and hybrid models, across seven predefined false positives per scan (FPs/scan) levels. It achieves a sensitivity improvement of 2.6% to 20.3% at low FPs/scan (0.125) and delivers the highest CPM and FROC-AUC scores. The proposed method demonstrates balanced performance across nodule sizes, reduced false positives, and improved robustness, particularly in high-confidence predictions. FCMamba provides an efficient, scalable and accurate solution for 3D lung nodule detection. Its flexible spatial modeling and elimination of post-processing make it well-suited for clinical usage and adaptable to other medical imaging tasks.