Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part I. Theory.

Only two radiographic findings allow reliable distinction of benign from malignant solitary pulmonary nodules. Intuitively, it is clear that other radiographic and clinical findings should also be important in making this distinction. Subjectively incorporating these other findings into the decision of whether a nodule is benign or malignant is difficult. Likelihood ratios, which indicate the degree of malignancy or benignity represented by a test result or clinical finding, can be combined by means of the Bayes theorem to quantitate the probability of malignancy of a given nodule. From a literature survey, likelihood ratios were derived for six radiographic and four clinical characteristics associated with solitary pulmonary nodules. There were a total of 15 malignant and 19 benign findings, the most important of which were radiographic characteristics. For malignant nodules, the most important radiographic characteristics were thickness of the cavity wall spicular edge, and diameter of over 3 cm. For benign nodules, the most important radiographic characteristics were benign growth rate and a benign pattern of calcification.