A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules
A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules
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DOI：
10.1378/chest.06-1261
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发表时间：
2007-02-01
期刊：
影响因子：
9.6
通讯作者：
Barnett, Paul G.
中科院分区：
文献类型：
--
作者：
Gould, Michael K.;Ananth, Lakshmi;Barnett, Paul G.
背景：估计孤立性肺结节(SPN)患者的临床恶性概率有助于后续诊断试验的选择和解释。方法：我们使用多元Logistic回归分析来确定独立的恶性临床预测因素，并开发简约的临床预测模型来估计地理多样性的375例SPN退伍军人的恶性预测概率。我们使用了退伍军人事务部(VA)行政数据库的数据和最近完成的VA合作研究，该研究评估了正电子发射断层扫描(PET)扫描诊断SPN的准确性。结果：样本中受试者的平均(+/-SD)年龄为65.9+/-10.7岁。恶性SPN的发生率为54%。大多数参与者要么是现在吸烟者(n=177)，要么是曾经吸烟者(n=177)。恶性SPN的独立预测因素包括阳性吸烟史(优势比[OR]，7.9；95%可信区间[CI]，2.6~23.6)、年龄大(OR，每10年增加2.2个；95%CI，1.7~2.8)、结节直径较大(OR，每I-mm增加1.1个；95%CI，1.1~1.2)、戒烟时间(OR，每10年增加0.6个；95%CI，0.5~0.7)。模型精度很高(受试者工作特性曲线下面积为0.79；95%可信区间为0.74~0.84)，预测概率与SPN的观察频率有很好的一致性。结论：我们的预测规则可用于估计SPN患者的预测恶性概率，从而在选择和解释PET等诊断试验结果时为临床决策提供帮助。
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 I-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.