Prediction of malignancy for solitary pulmonary nodules based on imaging, clinical characteristics and tumor marker levels

Abstract

Objective To establish a prediction model of malignancy for solitary pulmonary nodules (SPNs) on the basis of imaging, clinical characteristics and tumor marker levels. Methods Totally, 341 cases of SPNs were enrolled in this retrospective study, in which 70% were selected as the training group ( n = 238) and the rest 30% as the verification group ( n = 103). The imaging, clinical characteristics and tumor marker levels of patients with benign and malignant SPNs were compared. Influencing factors were identified using multivariate logistic regression analysis. The model was assessed by the area under the curve (AUC) of the receiver operating characteristic curve. Results Differences were evident between patients with benign and malignant SPNs in age, gender, smoking history, carcinoembryonic antigen (CEA), neuron-specific enolase, nodule location, edge smoothing, spiculation, lobulation, vascular convergence sign, air bronchogram, ground-glass opacity, vacuole sign and calcification (all P < 0.05). Influencing factors for malignancy included age, gender, nodule location, spiculation, vacuole sign and CEA (all P < 0.05). The established model was as follows: Y = −5.368 + 0.055 × age + 1.012 × gender (female = 1, male = 0) + 1.302 × nodule location (right upper lobe = 1, others = 0) + 1.208 × spiculation (yes = 1, no = 0) + 2.164 × vacuole sign (yes = 1, no = 0) −0.054 × CEA. The AUC of the model with CEA was 0.818 (95% confidence interval, 0.763–0.865), with a sensitivity of 64.80% and a specificity of 84.96%, and the stability was better through internal verification. Conclusions The prediction model established in our study exhibits better accuracy and internal stability in predicting the probability of malignancy for SPNs.

Factors associated with concurrent malignancy risk among patients with incidental solitary pulmonary nodule: A systematic review taskforce for developing rapid recommendations

“…After the screening of the titles and abstracts, the full text of 192 records were assessed for eligibility. Eventually, 32 studies were included in the systematic review 16,20–50 . The literature selection process was presented in Figure 1.…”

“…A total of 23 studies analyzed age as a continuous variable, and found significant association between increased age and malignant SPNs (aOR = 1.06, 95% CI: 1.05–1.07, p < 0.001 , I 2 = 66.0%; Supplementary Figure S1). 16,20–24,26–28,31,34,38,40,41,44,46,48–50 …”

“…Twenty studies analyzed the spiculation sign and found it significantly associated with malignant SPNs (aOR = 3.41, 95% CI: 2.64-4.41, p < 0.001, I 2 = 71.4%; Supplementary Figure S13). 16,[22][23][24][25][26]31,33,34,[36][37][38][39][40][46][47][48]50 Zhao 2021 suggested that nodules with spiculation sign were associated with a lower risk of lung cancer 50 and explained that this finding might be a result of undifferentiated short and long spines (which was a sign for inflammatory pseudotumors) in this study. 51…”

“…A total of 23 studies analyzed age as a continuous variable, and found significant association between increased age and malignant SPNs (aOR = 1.06, 95% CI: 1.05-1.07, p < 0.001, I 2 = 66.0%; Supplementary Figure S1). 16,[20][21][22][23][24][26][27][28]31,34,38,40,41,44,46,[48][49][50] Four studies analyzed age as a categorical variable, all studies suggested an association between elder age and malignant SPNs (OR:…”

Efficacy and Safety of Chinese Medicine in the Treatment of Patients with Pulmonary Nodules-A Multicenter Open Label Randomized Controlled Study: A Study Protocol for a Randomized Controlled Trial

“…There are also some limitations that cannot be determined in this protocol, such as the pathological nature of pulmonary nodules but the observation of tumor markers and immune indicators, combined with the changes of nodule size and risk level, also reflect the curative effect of traditional Chinese medicine to a certain extent. At present, there is a consensus on that tumor markers can be used as one of the evaluation methods of differentiating benign and malignant lung nodules [30], and we should observe lung cancer for abnormally elevated or progressive tumor markers such as carcinoembryonic antigen (CEA), neuron specific enolase (NSE) [38][39][40][41]. The percentage of T cell subsets in peripheral blood is an index to judge the anti-tumor immunity of patients.…”