The probability of malignancy in solitary pulmonary nodules - Application to small radiologically indeterminate nodules
The probability of malignancy in solitary pulmonary nodules - Application to small radiologically indeterminate nodules
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DOI：
10.1001/archinte.157.8.849
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发表时间：
1997-04-28
影响因子：
--
通讯作者：
Edell, ES
中科院分区：
文献类型：
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作者：
Swensen, SJ;Silverstein, MD;Edell, ES
背景资料：基于临床数据和肺结节的放射学特征来识别恶性结节的临床预测模型是使用逻辑回归从患者的随机样本（n=419）导出的，并对来自单独患者组（n=210）的数据进行测试。采用多因素Logistic回归分析评估影像学不确定的孤立性肺结节（SPN）的恶性概率在患有直径在4和30 mm之间测量的SPN的临床相关患者亚组中。一项在多专业团体实践中进行的回顾性队列研究包括629名患者（320名男性，309名女性），在胸部X线检查中新发现（1984年1月1日至1986年5月1日）4至30 mm放射学不确定的SPN。在发现结节前5年内诊断为癌症的患者被排除在外。临床数据包括年龄、性别、吸烟状态、胸外恶性肿瘤、石棉暴露和慢性间质性或阻塞性肺病病史;胸部放射学数据包括SPN的直径、位置、边缘特征（例如分叶、毛刺和粗糙）和其他特征（例如空洞）。在随机抽样的三分之二的患者和测试在其余的三分之一。结果：65%的结节是良性的，23%是恶性的，12%是不确定的。3个临床特征（年龄、吸烟状态和癌症史[诊断，大于或等于5年前]）和3个放射学特征（直径、毛刺和SPN上叶位置）是恶性肿瘤的独立预测因子。受试者工作特征曲线下面积（+/-SE）为0.8328 ± 0.0226。结论：3个临床特征和3个影像学特征可预测影像学不确定的SPN的恶性程度。
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, greater than or equal to 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.