Assessment of the cancer risk factors of solitary pulmonary nodules

Abstract

There are no large samples or exact prediction models for assessing the cancer risk factors of solitary pulmonary nodules (SPNs) in the Chinese population. We retrospectively analyzed the clinical and imaging data of patients with SPNs who underwent computer tomography guided needle biopsy in our hospital from Jan 1st of 2011 to March 30th of 2016. These patients were divided into a development data set and a validation data set. These groups included 1078 and 344 patients, respectively. A prediction model was developed from the development data set and was validated with the validation data set using logistic regression. The predictors of cancer in our model included female gender, age, pack-years of smoking, a previous history of malignancy, nodule size, lobulated and spiculated edges, lobulation alone and spiculation alone. The Area Under the Curves, sensitivity and specificity of our model in the development and validation data sets were significantly higher than those of the Mayo model and VA model (p < 0.001). We established the largest sampling risk prediction model of SPNs in a Chinese cohort. This model is particularly applicable to SPNs > 8 mm in size. SPNs in female patients, as well as SPNs featuring a combination of lobulated and spiculated edges or lobulated edges alone, should be evaluated carefully due to the probability that they are malignant.

Solitary Pulmonary Nodule Malignancy Predictive Models Applicable to Routine Clinical Practice: A Systematic Review&nbsp;

“…In relation to nodule consistency, the majority of the studies n= (8) did not specify the nodule consistency (15)(16)(17)(18)(19)22,25,27) whereas the other 7 studies included this information: 1 study reported subsolid nodules(23), 2 studies collected patients with only solid nodules (21,24), and 4 (23,26,28,29) included both (solid and subsolid nodules). However, only 1(23) of the 7 studies analysed the predictive risk of nodule consistency and found that mixed ground-glass nodules showed a higher risk of malignancy compared to solid nodules.…”

“…The mean age of patients with benign nodules ranged from 48 to 62 years, and that of patients with malignant nodules ranged from 50 to 68 years. Previous cancer history was present in 11 articles (15,17,29,18,19,21,(24)(25)(26)(27)(28). and ranged from 1.7% to 13.9%.…”

“…In Appendix A, according to the TRIPOD classi cation (14), four studies were type 1a (16,23,26,29), one study was type 1b(27), 5 were type 2a (15,17,20,22,24) and 5 were type 3 (18,19,21,25,28). The sample size of the validations ranged from 120 to 344 participants.…”

“…Regarding the Participants dimension, only 3 of the 15 studies were rated as appropriate by PROBAST, as case-control studies nested in a cohort (17,27,29). The rest were non-nested case-control studies (15,16,18,19,21,(23)(24)(25)(26); in 3 (20,22,28) the type of study was not clear. Only two studies (17,29) included all patients in routine clinical practice; the other studies selected those who underwent surgery/biopsy or who had suspected malignancy.…”

“…Furthermore, in one study (27) predictors were not evaluated similarly because radiographs were studied by different radiologists. Regarding the Results dimension, the method of determining malignancy (surgery, biopsy or follow-up) was not adequate in 8 studies (15,16,18,19,(21)(22)(23)26), and was ambiguously estimated in 5 (20,24,25,27,28), only being correct in two (17,29). None reported whether the measurement of the results was performed without the predictors analysed being known.…”