Limited Value of Logistic Regression Analysis in Solid Solitary Pulmonary Nodules Characterization: A Single-Center Experience on 288 Consecutive Cases
Limited Value of Logistic Regression Analysis in Solid Solitary Pulmonary Nodules Characterization: A Single-Center Experience on 288 Consecutive Cases
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DOI：
10.1002/jso.23730
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发表时间：
2014-12-01
影响因子：
2.5
通讯作者：
Montemezzi, S.
中科院分区：
文献类型：
--
作者：
Perandini, S.;Soardi, G. A.;Montemezzi, S.
背景和目的孤立性肺结节的术前特征是外科医生、放射科医生和临床医生面临的一项微妙任务。为了克服主观性，已经开发了数学模型。在最新的ACCP循证临床实践指南中提出了Mayo诊所模式，用于孤立性肺结节恶性肿瘤术前风险评估。方法在这项单中心回顾性研究中，应用Mayo临床模型对288例连续病例的恶性概率进行估计。结果ROC曲线分析的AUC值为0.767，而对158个恶性结节的分析结果显示平均预测风险值为38.15%。在我们的临床环境中，使用5%的风险观察阈值和60%的风险手术阈值，将有4例不必要的手术(假阳性)以13例癌症进展(假阴性)为代价，而68.75%的结节将收到非决定性的值。结论外科医生应该意识到，目前的数据显示，Mayo诊所模型在术前结节特征方面用处很小。J·奥科尔外科医生。2014年110：883-887。(C)2014年威利期刊公司。
Background and ObjectivesPreoperative characterization of the solitary pulmonary nodule is a delicate task faced by surgeons, radiologists, and clinicians. Mathematical models have been developed to overcome subjectivity. The Mayo Clinic model was suggested in the latest ACCP evidence-based clinical practice guidelines for the preoperative risk assessment of solitary pulmonary nodule malignancy. The aim of the study is to assess the validity of the Mayo Clinic model in a current continuous case series of biopsy-proven nodules.MethodsThe Mayo Clinic model was applied to estimate probability of malignancy in 288 consecutive cases in this single-center retrospective study.ResultsROC curve analysis returned an AUC of 0.767, while analysis performed on 158 malignant nodules showed a mean predicted risk value of 38.15%. In our clinical setting, using a risk observational threshold set at 5% and a risk surgical threshold set at 60%, there would have been 4 cases of unnecessary surgery (false positives) at the cost of 13 cases of cancer progression (false negatives), while 68.75% of all nodules would have received non-decisional values.ConclusionsSurgeons should be aware that current data shows how the Mayo Clinic model is of little use in preoperative nodule characterization. J. Surg. Oncol. 2014 110:883-887. (c) 2014 Wiley Periodicals, Inc.