Radiomics in Lung Cancer Imaging: A Narrative Review of Current Evidence

Background: Lung cancer remains the leading cause of cancer-related mortality worldwide, and early diagnosis and accurate disease stratification are still major clinical challenges. Radiomics has emerged as a quantitative imaging approach that extracts high-dimensional features from radiological imaging, with applications in diagnosis, prognosis, radio genomics, and assessment of treatment response. However, its clinical translation is still limited by methodological heterogeneity and a lack of standardization. Aim: This narrative review synthesizes evidence from systematic reviews and meta-analyses on radiomics in thoracic imaging for lung cancer, focusing on clinical applications, methodological limitations, and translational challenges. Methods: A structured search was conducted in PubMed and Scopus using predefined keywords related to radiomics, lung cancer, and imaging modalities. Only peer-reviewed systematic reviews and meta-analyses published in English were included. In total, 27 studies were selected and synthesized using a structured narrative approach guided by the ANDJ checklist. A differential integrative framework was adopted to connect evidence from systematic reviews and meta-analyses with primary empirical studies and policy documents through an intermediate layer of translational recommendations, ensuring a multi-level and interpretation-driven synthesis. Results: Radiomics demonstrated consistent potential across multiple clinical domains, including lesion classification, histological differentiation, molecular profiling, prognostic stratification, and prediction of treatment response. Machine learning and deep learning approaches frequently improved predictive performance. However, key limitations were identified, including heterogeneity in imaging protocols, lack of external validation, small single-centre datasets, and limited reproducibility of radiomic features. Conclusions: Radiomics in lung cancer imaging shows strong clinical potential but remains constrained by methodological and translational barriers. Future progress will depend on standardization, external validation, multimodal data integration, and improved interpretability, alongside alignment with regulatory and clinical implementation frameworks.