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Doerr F, Giese A, Höpker K, Menghesha H, Schlachtenberger G, Grapatsas K, Baldes N, Baldus CJ, Hagmeyer L, Fallouh H, Pinto dos Santos D, Bender EM, Quaas A, Heldwein M, Wahlers T, Hautzel H, Darwiche K, Taube C, Schuler M, Hekmat K, Bölükbas S. LIONS PREY: A New Logistic Scoring System for the Prediction of Malignant Pulmonary Nodules. Cancers (Basel) 2024; 16:729. [PMID: 38398120 PMCID: PMC10887049 DOI: 10.3390/cancers16040729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/22/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
OBJECTIVES Classifying radiologic pulmonary lesions as malignant is challenging. Scoring systems like the Mayo model lack precision in predicting the probability of malignancy. We developed the logistic scoring system 'LIONS PREY' (Lung lesION Score PREdicts malignancY), which is superior to existing models in its precision in determining the likelihood of malignancy. METHODS We evaluated all patients that were presented to our multidisciplinary team between January 2013 and December 2020. Availability of pathological results after resection or CT-/EBUS-guided sampling was mandatory for study inclusion. Two groups were formed: Group A (malignant nodule; n = 238) and Group B (benign nodule; n = 148). Initially, 22 potential score parameters were derived from the patients' medical histories. RESULTS After uni- and multivariate analysis, we identified the following eight parameters that were integrated into a scoring system: (1) age (Group A: 64.5 ± 10.2 years vs. Group B: 61.6 ± 13.8 years; multivariate p-value: 0.054); (2) nodule size (21.8 ± 7.5 mm vs. 18.3 ± 7.9 mm; p = 0.051); (3) spiculation (73.1% vs. 41.9%; p = 0.024); (4) solidity (84.9% vs. 62.8%; p = 0.004); (5) size dynamics (6.4 ± 7.7 mm/3 months vs. 0.2 ± 0.9 mm/3 months; p < 0.0001); (6) smoking history (92.0% vs. 43.9%; p < 0.0001); (7) pack years (35.1 ± 19.1 vs. 21.3 ± 18.8; p = 0.079); and (8) cancer history (34.9% vs. 24.3%; p = 0.052). Our model demonstrated superior precision to that of the Mayo score (p = 0.013) with an overall correct classification of 96.0%, a calibration (observed/expected-ratio) of 1.1, and a discrimination (ROC analysis) of AUC (95% CI) 0.94 (0.92-0.97). CONCLUSIONS Focusing on essential parameters, LIONS PREY can be easily and reproducibly applied based on computed tomography (CT) scans. Multidisciplinary team members could use it to facilitate decision making. Patients may find it easier to consent to surgery knowing the likelihood of pulmonary malignancy. The LIONS PREY app is available for free on Android and iOS devices.
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Affiliation(s)
- Fabian Doerr
- Department of Thoracic Surgery, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Annika Giese
- Department of Anesthesiology and Intensive Care Medicine, Vinzenz Pallotti Hospital Bergisch Gladbach-Bensberg, GFO-Clinics Rhein-Berg, 51429 Bergisch Gladbach, Germany
| | - Katja Höpker
- Clinic III for Internal Medicine, Faculty of Medicine, University Hospital Cologne, University of Cologne, 50923 Cologne, Germany
| | - Hruy Menghesha
- Department of Thoracic Surgery, Helios Clinic Bonn/Rhein-Sieg, 53123 Bonn, Germany
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, Bonn University Hospital, 53127 Bonn, Germany
| | - Georg Schlachtenberger
- Department of Cardiothoracic Surgery, University Hospital of Cologne, University of Cologne, 50923 Cologne, Germany
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Natalie Baldes
- Department of Thoracic Surgery, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Christian J. Baldus
- Institute for Diagnostic and Interventional Radiology, University Hospital Dresden, 01307 Dresden, Germany
| | - Lars Hagmeyer
- Clinic for Pneumology and Allergology, Bethanien Hospital GmbH Solingen, 42699 Solingen, Germany
| | - Hazem Fallouh
- Department of Cardiothoracic Surgery, University Hospital of Birmingham, Birmingham B15 2GW, UK
| | - Daniel Pinto dos Santos
- Department of Radiology, University Hospital Cologne, 50937 Cologne, Germany
- Department of Radiology, Hospital of the Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Edward M. Bender
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA 94304, USA
| | - Alexander Quaas
- Institute of Pathology, University of Cologne, 50923 Cologne, Germany
| | - Matthias Heldwein
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, Bonn University Hospital, 53127 Bonn, Germany
| | - Thorsten Wahlers
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, Bonn University Hospital, 53127 Bonn, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany
| | - Kaid Darwiche
- Department of Pneumology, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
| | - Christian Taube
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany
| | - Martin Schuler
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen, 45239 Essen, Germany
- National Center for Tumor Diseases (NCT) West, Campus Essen, 45147 Essen, Germany
| | - Khosro Hekmat
- Division of Thoracic Surgery, Department of General, Thoracic and Vascular Surgery, Bonn University Hospital, 53127 Bonn, Germany
| | - Servet Bölükbas
- Department of Thoracic Surgery, West German Cancer Center, University Medical Center Essen-Ruhrlandklinik, University Duisburg-Essen, 45239 Essen, Germany
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Marrer É, Jolly D, Arveux P, Lejeune C, Woronoff-Lemsi MC, Jégu J, Guillemin F, Velten M. Incidence of solitary pulmonary nodules in Northeastern France: a population-based study in five regions. BMC Cancer 2017; 17:47. [PMID: 28077100 PMCID: PMC5225556 DOI: 10.1186/s12885-016-3029-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/22/2016] [Indexed: 02/07/2023] Open
Abstract
Background The discovery of a solitary pulmonary nodule (SPN) on a chest imaging exam is of major clinical concern. However, the incidence rates of SPNs in a general population have not been estimated. The objective of this study was to provide incidence estimates of SPNs in a general population in 5 northeastern regions of France. Methods This population-based study was undertaken in 5 regions of northeastern France in May 2002-March 2003 and May 2004-June 2005. SPNs were identified by chest CT reports collected from all radiology centres in the study area by trained readers using a standardised procedure. All reports for patients at least 18 years old, without a previous history of cancer and showing an SPN between 1 and 3 cm, were included. Results A total of 11,705 and 20,075 chest CT reports were collected for the 2002–2003 and 2004–2005 periods, respectively. Among them, 154 and 297 reports showing a SPN were included, respectively for each period. The age-standardised incidence rate (IR) was 10.2 per 100,000 person-years (95% confidence interval 8.5–11.9) for 2002–2003 and 12.6 (11.0–14.2) for 2004–2005. From 2002 to 2005, the age-standardised IR evolved for men from 16.4 (13.2–19.6) to 17.7 (15.0–20.4) and for women from 4.9 (3.2–6.6) to 8.2 (6.4–10.0). In multivariate Poisson regression analysis, gender, age, region and period were significantly associated with incidence variation. Conclusions This study provides reference incidence rates of SPN in France. Incidence was higher for men than women, increased with age for both gender and with time for women. Trends in smoking prevalence and improvement in radiological equipment may be related to incidence variations.
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Affiliation(s)
- Émilie Marrer
- Department of Epidemiology and Public Health, Faculty of medicine, EA 3430, Strasbourg University, Strasbourg, France
| | - Damien Jolly
- Clinical research Coordination, University Hospital, Reims, France.,Reims Champagne-Ardenne University, EA 3797, Reims, France
| | - Patrick Arveux
- Medical Information Department, Centre Georges-François Leclerc, Dijon, France
| | - Catherine Lejeune
- Institut national de la santé et de la recherche médicale (INSERM), Unité 866, Faculty of Medicine, Dijon University, Dijon, France
| | - Marie-Christine Woronoff-Lemsi
- Besançon University Hospital, Délégation à la Recherche Clinique et à l'Innovation, Place Saint-Jacques, Besançon, France.,Franche-Comté University, EA 4267, Besançon, France
| | - Jérémie Jégu
- Department of Epidemiology and Public Health, Faculty of medicine, EA 3430, Strasbourg University, Strasbourg, France.,Department of Public Health, University Hospital of Strasbourg, Strasbourg, France
| | - Francis Guillemin
- Nancy-University, EA 4360 Apemac, Nancy, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), Centre d'Investigation Clinique - Épidémiologie Clinique, Nancy University Hospital, Nancy, France
| | - Michel Velten
- Department of Epidemiology and Public Health, Faculty of medicine, EA 3430, Strasbourg University, Strasbourg, France. .,Department of Public Health, University Hospital of Strasbourg, Strasbourg, France. .,Department of Epidemiology and Biostatistics, Centre Paul Strauss, Strasbourg, France.
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Poschenrieder F, Beyer L, Rehbock B, Diederich S, Wormanns D, Stroszczynski C, Hamer OW. [Management of solid pulmonary nodules]. Radiologe 2015; 54:436-48. [PMID: 24824378 DOI: 10.1007/s00117-013-2601-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The increasing availability of computed tomography has meant that the number of incidentally detected solitary pulmonary nodules (SPN) has greatly increased in recent years. A reasonable management of these SPN is necessary in order to firstly be able to detect malignant lesions early on and secondly to avoid upsetting the patient unnecessarily or carrying out further stressful diagnostic procedures. This review article shows how the dignity of SPNs can be estimated and based on this how the management can be accomplished taking established guidelines into consideration.
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Affiliation(s)
- F Poschenrieder
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93042, Regensburg, Deutschland
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