Preoperative nomogram for identifying invasive pulmonary adenocarcinoma in patients with pure ground-glass nodule: A multi-institutional study

Abstract

PurposeTo construct a preoperative nomogram to differentiate invasive pulmonary adenocarcinomas (IPAs) from preinvasive lesions in patients with solitary pure ground-glass nodules (GGN).MethodsA primary cohort of patients with pathologically confirmed pulmonary solitary pure GGN after surgery were retrospectively studied at five institutions from January 2009 to September 2015. Half of the patients were randomly selected and assigned to a model-development cohort, and the remaining patients were assigned to a validation cohort. A nomogram predicting the invasive extent of the solitary GGNs was constructed based on the independent risk factors. Predictive performance was evaluated by concordance index (C-index) and calibration curve.ResultsOut of 898 cases included in the study, 501 (55.8%) were preinvasive lesions and 397 (44.2%) were IPAs. In the univariate analysis, lesion size (p < 0.001), lesion margin (p = 0.041), lesion shape (p < 0.001), mean computed tomography (CT) value (p = 0.018), presence of pleural indentation (p = 0.017), and smoking status (p = 0.014) were significantly associated with invasive extent. In multivariate analysis, lesion size (p < 0.001), lesion margin (p = 0.042), lesion shape (p < 0.001), mean CT value (p = 0.014), presence of pleural indentation (p = 0.026), and smoking status (p = 0.004) remained the predictive factors of invasive extent. A nomogram was developed and validation results showed a C-index of 0.94, demonstrating excellent concordance between predicted and observed results.ConclusionsWe established and validated a novel nomogram that can identify IPAs from preinvasive lesions in patients with solitary pure GGN.

Advances in intelligent diagnosis methods for pulmonary ground-glass opacity nodules

“…Some researchers have begun to study the relation between smokers and lung cancer mortality [ 13 , 14 ]. She et al [ 13 ] identified preinvasive lesions and invasive pulmonary adenocarcinomas (IPAs) based on data from patients with solitary pulmonary pure GGNs that had been confirmed from January 2009 to September 2015. It was found that smoking status was one of the predictors of the invasive extent.…”

Radiomics for lung adenocarcinoma manifesting as pure ground-glass nodules: invasive prediction

“…These data indicated that many pGGNs were active and should not be neglected. Also, several studies demonstrated that 40.2-55.3% of pGGNs were invasive lesions [8][9][10][11]. The appearance of invasive components was considered to be a sign that tumor cells broke the balance of indolent period and entered the rapid growth time.…”

Development and validation of a nomogram to estimate the pretest probability of cancer in Chinese patients with solid solitary pulmonary nodules: A multi‐institutional study

“…In this study, we used the data collected from five Chinese centers from patients with SPNs diagnosed by thin‐section CT (TSCT), which may better define the characteristics of nodules to develop a new model to estimate the pretest probability of malignancy. Nomogram has been accepted as a reliable tool to quantify the risk by incorporating important factors for clinical decisions . By creating an intuitive graph of a statistical predictive model, a nomogram gives rise to a numerical probability of a clinical event, such as malignancy.…”

“…Nomogram has been accepted as a reliable tool to quantify the risk by incorporating important factors for clinical decisions. [13][14][15][16][17] By creating an intuitive graph of a statistical predictive model, a nomogram gives rise to a numerical probability of a clinical event, such as malignancy.…”