BACKGROUND: Estimating the clinical probability of malignancy in patients with a solitary pulmonary nodule (SPN) can facilitate the selection and interpretation of subsequent diagnostic tests. METHODS: We used multiple logistic regression analysis to identify independent clinical predictors of malignancy and to develop a parsimonious clinical prediction model to estimate the pretest probability of malignancy in a geographically diverse sample of 375 veterans with SPNs. We used data from Department of Veterans Affairs (VA) administrative databases and a recently completed VA Cooperative Study that evaluated the accuracy of positron emission tomography (PET) scans for the diagnosis of SPNs. RESULTS: The mean (+/- SD) age of subjects in the sample was 65.9 +/- 10.7 years. The prevalence of malignant SPNs was 54%. Most participants were either current smokers (n = 177) or former smokers (n = 177). Independent predictors of malignant SPNs included a positive smoking history (odds ratio [OR], 7.9; 95% confidence interval [CI], 2.6 to 23.6), older age (OR, 2.2 per 10-year increment; 95% CI, 1.7 to 2.8), larger nodule diameter (OR, 1.1 per 1-mm increment; 95% CI, 1.1 to 1.2), and time since quitting smoking (OR, 0.6 per 10-year increment; 95% CI, 0.5 to 0.7). Model accuracy was very good (area under the curve of the receiver operating characteristic, 0.79; 95% CI, 0.74 to 0.84), and there was excellent agreement between the predicted probability and the observed frequency of malignant SPNs. CONCLUSIONS: Our prediction rule can be used to estimate the pretest probability of malignancy in patients with SPNs, and thereby facilitate clinical decision making when selecting and interpreting the results of diagnostic tests such as PET imaging.
BACKGROUND: Estimating the clinical probability of malignancy in patients with a solitary pulmonary nodule (SPN) can facilitate the selection and interpretation of subsequent diagnostic tests. METHODS: We used multiple logistic regression analysis to identify independent clinical predictors of malignancy and to develop a parsimonious clinical prediction model to estimate the pretest probability of malignancy in a geographically diverse sample of 375 veterans with SPNs. We used data from Department of Veterans Affairs (VA) administrative databases and a recently completed VA Cooperative Study that evaluated the accuracy of positron emission tomography (PET) scans for the diagnosis of SPNs. RESULTS: The mean (+/- SD) age of subjects in the sample was 65.9 +/- 10.7 years. The prevalence of malignant SPNs was 54%. Most participants were either current smokers (n = 177) or former smokers (n = 177). Independent predictors of malignant SPNs included a positive smoking history (odds ratio [OR], 7.9; 95% confidence interval [CI], 2.6 to 23.6), older age (OR, 2.2 per 10-year increment; 95% CI, 1.7 to 2.8), larger nodule diameter (OR, 1.1 per 1-mm increment; 95% CI, 1.1 to 1.2), and time since quitting smoking (OR, 0.6 per 10-year increment; 95% CI, 0.5 to 0.7). Model accuracy was very good (area under the curve of the receiver operating characteristic, 0.79; 95% CI, 0.74 to 0.84), and there was excellent agreement between the predicted probability and the observed frequency of malignant SPNs. CONCLUSIONS: Our prediction rule can be used to estimate the pretest probability of malignancy in patients with SPNs, and thereby facilitate clinical decision making when selecting and interpreting the results of diagnostic tests such as PET imaging.
Authors: Michael K Gould; Gillian D Sanders; Paul G Barnett; Chara E Rydzak; Courtney C Maclean; Mark B McClellan; Douglas K Owens Journal: Ann Intern Med Date: 2003-05-06 Impact factor: 25.391
Authors: Christopher G Slatore; Nanda Horeweg; James R Jett; David E Midthun; Charles A Powell; Renda Soylemez Wiener; Juan P Wisnivesky; Michael K Gould Journal: Am J Respir Crit Care Med Date: 2015-08-15 Impact factor: 21.405
Authors: Johanna Uthoff; Nicholas Koehn; Jared Larson; Samantha K N Dilger; Emily Hammond; Ann Schwartz; Brian Mullan; Rolando Sanchez; Richard M Hoffman; Jessica C Sieren Journal: Eur Radiol Date: 2019-04-01 Impact factor: 5.315
Authors: Mathilde M Winkler Wille; Sarah J van Riel; Zaigham Saghir; Asger Dirksen; Jesper Holst Pedersen; Colin Jacobs; Laura Hohwü Thomsen; Ernst Th Scholten; Lene T Skovgaard; Bram van Ginneken Journal: Eur Radiol Date: 2015-03-13 Impact factor: 5.315
Authors: Ying Liu; Yoganand Balagurunathan; Thomas Atwater; Sanja Antic; Qian Li; Ronald C Walker; Gary T Smith; Pierre P Massion; Matthew B Schabath; Robert J Gillies Journal: Clin Cancer Res Date: 2016-09-23 Impact factor: 12.531
Authors: Andrew V Kossenkov; Rehman Qureshi; Noor B Dawany; Jayamanna Wickramasinghe; Qin Liu; R Sonali Majumdar; Celia Chang; Sandy Widura; Trisha Kumar; Wen-Hwai Horng; Eric Konnisto; Gerard Criner; Jun-Chieh J Tsay; Harvey Pass; Sai Yendamuri; Anil Vachani; Thomas Bauer; Brian Nam; William N Rom; Michael K Showe; Louise C Showe Journal: Cancer Res Date: 2018-11-28 Impact factor: 12.701