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The Probability of Malignancy in Solitary Pulmonary Nodules:  Application to Small Radiologically Indeterminate Nodules

Stephen J. Swensen, MD; Marc D. Silverstein, MD; Duane M. Ilstrup, MS; Cathy D. Schleck; Eric S. Edell, MD
Arch Intern Med. 1997;157(8):849-855. doi:10.1001/archinte.1997.00440290031002.
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Background:  A clinical prediction model to identify malignant nodules based on clinical data and radiological characteristics of lung nodules was derived using logistic regression from a random sample of patients (n=419) and tested on data from a separate group of patients (n=210).

Objective:  To use multivariate logistic regression to estimate the probability of malignancy in radiologically indeterminate solitary pulmonary nodules (SPNs) in a clinically relevant subset of patients with SPNs that measured between 4 and 30 mm in diameter.

Patients and Methods:  A retrospective cohort study at a multispecialty group practice included 629 patients (320 men, 309 women) with newly discovered (between January 1, 1984, and May 1, 1986) 4- to 30-mm radiologically indeterminate SPNs on chest radiography. Patients with a diagnosis of cancer within 5 years prior to the discovery of the nodule were excluded. Clinical data included age, sex, cigarette-smoking status, and history of extrathoracic malignant neoplasm, asbestos exposure, and chronic interstitial or obstructive lung disease; chest radiological data included the diameter, location, edge characteristics (eg, lobulation, spiculation, and shagginess), and other characteristics (eg, cavitation) of the SPNs. Predictors were identified in a random sample of two thirds of the patients and tested in the remaining one third.

Results:  Sixty-five percent of the nodules were benign, 23% were malignant, and 12% were indeterminate. Three clinical characteristics (age, cigarette-smoking status, and history of cancer [diagnosis, ≥5 years ago]) and 3 radiological characteristics (diameter, spiculation, and upper lobe location of the SPNs) were independent predictors of malignancy. The area (±SE) under the evaluated receiver operating characteristic curve was 0.8328±0.0226.

Conclusion:  Three clinical and 3 radiographic characteristics predicted the malignancy in radiologically indeterminate SPNs.Arch Intern Med. 1997;157:849-855

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