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Quantitative CT analysis of lung parenchyma to improve malignancy risk estimation in incidental pulmonary nodules. Eur Radiol 2022; 33:3908-3917. [PMID: 36538071 PMCID: PMC10181968 DOI: 10.1007/s00330-022-09334-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/18/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
Abstract
Objectives
To assess the value of quantitative computed tomography (QCT) of the whole lung and nodule-bearing lobe regarding pulmonary nodule malignancy risk estimation.
Methods
A total of 251 subjects (median [IQR] age, 65 (57–73) years; 37% females) with pulmonary nodules on non-enhanced thin-section CT were retrospectively included. Twenty percent of the nodules were malignant, the remainder benign either histologically or at least 1-year follow-up. CT scans were subjected to in-house software, computing parameters such as mean lung density (MLD) or peripheral emphysema index (pEI). QCT variable selection was performed using logistic regression; selected variables were integrated into the Mayo Clinic and the parsimonious Brock Model.
Results
Whole-lung analysis revealed differences between benign vs. malignant nodule groups in several parameters, e.g. the MLD (−766 vs. −790 HU) or the pEI (40.1 vs. 44.7 %). The proposed QCT model had an area-under-the-curve (AUC) of 0.69 (95%-CI, 0.62−0.76) based on all available data. After integrating MLD and pEI into the Mayo Clinic and Brock Model, the AUC of both clinical models improved (AUC, 0.91 to 0.93 and 0.88 to 0.91, respectively). The lobe-specific analysis revealed that the nodule-bearing lobes had less emphysema than the rest of the lung regarding benign (EI, 0.5 vs. 0.7 %; p < 0.001) and malignant nodules (EI, 1.2 vs. 1.7 %; p = 0.001).
Conclusions
Nodules in subjects with higher whole-lung metrics of emphysema and less fibrosis are more likely to be malignant; hereby the nodule-bearing lobes have less emphysema. QCT variables could improve the risk assessment of incidental pulmonary nodules.
Key Points
• Nodules in subjects with higher whole-lung metrics of emphysema and less fibrosis are more likely to be malignant.
• The nodule-bearing lobes have less emphysema compared to the rest of the lung.
• QCT variables could improve the risk assessment of incidental pulmonary nodules.
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Zhang K, Wei Z, Nie Y, Shen H, Wang X, Wang J, Yang F, Chen K. Comprehensive analysis of clinical logistic and machine learning based models for the evaluation of pulmonary nodules. JTO Clin Res Rep 2022; 3:100299. [PMID: 35392654 PMCID: PMC8980995 DOI: 10.1016/j.jtocrr.2022.100299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Over the years, multiple models have been developed for the evaluation of pulmonary nodules (PNs). This study aimed to comprehensively investigate clinical models for estimating the malignancy probability in patients with PNs. Methods PubMed, EMBASE, Cochrane Library, and Web of Science were searched for studies reporting mathematical models for PN evaluation until March 2020. Eligible models were summarized, and network meta-analysis was performed on externally validated models (PROSPERO database CRD42020154731). The cut-off value of 40% was used to separate patients into high prevalence (HP) and low prevalence (LP), and a subgroup analysis was performed. Results A total of 23 original models were proposed in 42 included articles. Age and nodule size were most often used in the models, whereas results of positron emission tomography-computed tomography were used when collected. The Mayo model was validated in 28 studies. The area under the curve values of four most often used models (PKU, Brock, Mayo, VA) were 0.830, 0.785, 0.743, and 0.750, respectively. High-prevalence group (HP) models had better results in HP patients with a pooled sensitivity and specificity of 0.83 (95% confidence interval [CI]: 0.78–0.88) and 0.71 (95% CI: 0.71–0.79), whereas LP models only achieved pooled sensitivity and specificity of 0.70 (95% CI: 0.60–0.79) and 0.70 (95% CI: 0.62–0.77). For LP patients, the pooled sensitivity and specificity decreased from 0.68 (95% CI: 0.57–0.78) and 0.93 (95% CI: 0.87–0.97) to 0.57 (95% CI: 0.21–0.88) and 0.82 (95% CI: 0.65–0.92) when the model changed from LP to HP models. Compared with the clinical models, artificial intelligence-based models have promising preliminary results. Conclusions Mathematical models can facilitate the evaluation of lung nodules. Nevertheless, suitable model should be used on appropriate cohorts to achieve an accurate result.
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Affiliation(s)
- Kai Zhang
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Zihan Wei
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
- Peking University Health Science Center, Beijing, People’s Republic of China
| | - Yuntao Nie
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Haifeng Shen
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Xin Wang
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
- Peking University Health Science Center, Beijing, People’s Republic of China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Fan Yang
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Kezhong Chen
- Department of Thoracic Surgery, Peking University People’s Hospital, Beijing, People’s Republic of China
- Corresponding author. Address for correspondence: Kezhong Chen, MD, Department of Thoracic Surgery, Peking University People’s Hospital, Xi Zhi Men South Avenue, Number 11, Beijing 100044, People’s Republic of China.
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Senent-Valero M, Librero J, Pastor-Valero M. Solitary pulmonary nodule malignancy predictive models applicable to routine clinical practice: a systematic review. Syst Rev 2021; 10:308. [PMID: 34872592 PMCID: PMC8650360 DOI: 10.1186/s13643-021-01856-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 11/18/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Solitary pulmonary nodule (SPN) is a common finding in routine clinical practice when performing chest imaging tests. The vast majority of these nodules are benign, and only a small proportion are malignant. The application of predictive models of nodule malignancy in routine clinical practice would help to achieve better diagnostic management of SPN. The present systematic review was carried out with the purpose of critically assessing studies aimed at developing predictive models of solitary pulmonary nodule (SPN) malignancy from SPN incidentally detected in routine clinical practice. METHODS We performed a search of available scientific literature until October 2020 in Pubmed, SCOPUS and Cochrane Central databases. The inclusion criteria were observational studies carried out in low-risk population from 35 years old onwards aimed at constructing predictive models of malignancy of pulmonary solitary nodule detected incidentally in routine clinical practice. Studies had to be published in peer-reviewed journals, either in Spanish, Portuguese or English. Exclusion criteria were non-human studies, or predictive models based in high-risk populations, or models based on computational approaches. Exclusion criteria were non-human studies, or predictive models based in high-risk populations, or models based on computational approaches (such as radiomics). We used The Transparent Reporting of a multivariable Prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement, to describe the type of predictive model included in each study, and The Prediction model Risk Of Bias ASsessment Tool (PROBAST) to evaluate the quality of the selected articles. RESULTS A total of 186 references were retrieved, and after applying the exclusion/inclusion criteria, 15 articles remained for the final review. All studies analysed clinical and radiological variables. The most frequent independent predictors of SPN malignancy were, in order of frequency, age, diameter, spiculated edge, calcification and smoking history. Variables such as race, SPN growth rate, emphysema, fibrosis, apical scarring and exposure to asbestos, uranium and radon were not analysed by the majority of the studies. All studies were classified as high risk of bias due to inadequate study designs, selection bias, insufficient population follow-up and lack of external validation, compromising their applicability for clinical practice. CONCLUSIONS The studies included have been shown to have methodological weaknesses compromising the clinical applicability of the evaluated SPN malignancy predictive models and their potential influence on clinical decision-making for the SPN diagnostic management. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020161559.
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Affiliation(s)
- Marina Senent-Valero
- Department of Public Health, History of Science and Gynaecology, Faculty of Medicine, Miguel Hernández University, Sant Joan d’Alacant, Alicante, Spain
| | - Julián Librero
- Navarrabiomed, Complejo Hospitalario de Navarra, UPNA, Pamplona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - María Pastor-Valero
- Department of Public Health, History of Science and Gynaecology, Faculty of Medicine, Miguel Hernández University, Sant Joan d’Alacant, Alicante, Spain
- CIBER in Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Vachani A, Zheng C, Amy Liu IL, Huang BZ, Osuji TA, Gould MK. The Probability of Lung Cancer in Patients With Incidentally Detected Pulmonary Nodules: Clinical Characteristics and Accuracy of Prediction Models. Chest 2021; 161:562-571. [PMID: 34364866 DOI: 10.1016/j.chest.2021.07.2168] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The frequency of cancer and accuracy of prediction models have not been studied in large, population-based samples of patients with incidental pulmonary nodules measuring > 8 mm in diameter. RESEARCH QUESTIONS How does the frequency of cancer vary by size and smoking history among patients with incidental nodules? How accurate are two widely used models for identifying cancer in these patients? STUDY DESIGN AND METHODS We assembled a retrospective cohort of individuals with incidental nodules measuring > 8 mm in diameter identified by chest CT imaging between 2006 and 2016. We used a validated natural language processing algorithm to identify nodules and their characteristics by scanning the text of dictated radiology reports. We reported patient and nodule characteristics stratified by the presence or absence of a lung cancer diagnosis within 27 months of nodule identification and estimated the area under the receiver operating characteristic curve (AUC) to compare the accuracy of the Mayo Clinic and Brock models for identifying cancer. RESULTS The sample included 23,780 individuals with a nodule measuring > 8 mm, including 2,356 patients (9.9%) with a lung cancer diagnosis within 27 months of nodule identification. Cancer was diagnosed in 5.4% of never smokers, 12.2% of former smokers, and 17.7% of current smokers. Cancer was diagnosed in 5.7% of patients with nodules measuring 9 to 15 mm, 12.1% of patients with nodules > 15 to 20 mm, and 18.4% of patients with nodules > 20 to 30 mm. In the full sample, the Mayo Clinic model (AUC, 0.747; 95% CI, 0.737-0.757) was more accurate than the Brock model (AUC, 0.713; 95% CI, 0.702-0.724; P < .0001). When restricted to ever smokers, the Mayo Clinic model was still more accurate. Both models overestimated the probability of cancer. INTERPRETATION Almost 10% of patients with an incidental pulmonary nodule measuring > 8 mm in diameter will receive a lung cancer diagnosis. Existing prediction models have only fair accuracy and overestimate the probability of cancer.
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Affiliation(s)
- Anil Vachani
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Chengyi Zheng
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - In-Lu Amy Liu
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Brian Z Huang
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Thearis A Osuji
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Michael K Gould
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA.
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Toumazis I, Bastani M, Han SS, Plevritis SK. Risk-Based lung cancer screening: A systematic review. Lung Cancer 2020; 147:154-186. [DOI: 10.1016/j.lungcan.2020.07.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/03/2020] [Accepted: 07/04/2020] [Indexed: 12/17/2022]
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Cui X, Heuvelmans MA, Han D, Zhao Y, Fan S, Zheng S, Sidorenkov G, Groen HJM, Dorrius MD, Oudkerk M, de Bock GH, Vliegenthart R, Ye Z. Comparison of Veterans Affairs, Mayo, Brock classification models and radiologist diagnosis for classifying the malignancy of pulmonary nodules in Chinese clinical population. Transl Lung Cancer Res 2019; 8:605-613. [PMID: 31737497 DOI: 10.21037/tlcr.2019.09.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Several classification models based on Western population have been developed to help clinicians to classify the malignancy probability of pulmonary nodules. However, the diagnostic performance of these Western models in Chinese population is unknown. This paper aimed to compare the diagnostic performance of radiologist evaluation of malignancy probability and three classification models (Mayo Clinic, Veterans Affairs, and Brock University) in Chinese clinical pulmonology patients. Methods This single-center retrospective study included clinical patients from Tianjin Medical University Cancer Institute and Hospital with new, CT-detected pulmonary nodules in 2013. Patients with a nodule with diameter of 4-25 mm, and histological diagnosis or 2-year follow-up were included. Analysis of area under the receiver operating characteristic curve (AUC), decision curve analysis (DCA) and threshold of decision analysis was used to evaluate the diagnostic performance of radiologist diagnosis and the three classification models, with histological diagnosis or 2-year follow-up as the reference. Results In total, 277 patients (286 nodules) were included. Two hundred and seven of 286 nodules (72.4%) in 203 patients were malignant. AUC of the Mayo model (0.77; 95% CI: 0.72-0.82) and Brock model (0.77; 95% CI: 0.72-0.82) were similar to radiologist diagnosis (0.78; 95% CI: 0.73-0.83; P=0.68, P=0.71, respectively). The diagnostic performance of the VA model (AUC: 0.66) was significantly lower than that of radiologist diagnosis (P=0.003). A three-class classifying threshold analysis and DCA showed that the radiologist evaluation had higher discriminatory power for malignancy than the three classification models. Conclusions In a cohort of Chinese clinical pulmonology patients, radiologist evaluation of lung nodule malignancy probability demonstrated higher diagnostic performance than Mayo, Brock, and VA classification models. To optimize nodule diagnosis and management, a new model with more radiological characteristics could be valuable.
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Affiliation(s)
- Xiaonan Cui
- Department of Radiology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Centre of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China.,Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolein A Heuvelmans
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Daiwei Han
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Yingru Zhao
- Department of Radiology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Centre of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Shuxuan Fan
- Department of Radiology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Centre of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
| | - Sunyi Zheng
- Department of Radiotherapy, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Grigory Sidorenkov
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Harry J M Groen
- Department of Pulmonary Diseases, Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands
| | - Monique D Dorrius
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Matthijs Oudkerk
- Faculty of Medical Sciences, University of Groningen, Groningen, The Netherlands.,i-DNA BV, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Zhaoxiang Ye
- Department of Radiology, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Centre of Cancer, Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China
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Accuracy of the Vancouver Lung Cancer Risk Prediction Model Compared With That of Radiologists. Chest 2019; 156:112-119. [DOI: 10.1016/j.chest.2019.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/20/2019] [Accepted: 04/02/2019] [Indexed: 12/17/2022] Open
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Zhao W, Liu H, Leader JK, Wilson D, Meng X, Wang L, Chen LA, Pu J. Computerized identification of the vasculature surrounding a pulmonary nodule. Comput Med Imaging Graph 2019; 74:1-9. [PMID: 30903961 DOI: 10.1016/j.compmedimag.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The idea of inferring the prognosis of lung tumor via its surrounding vasculature is novel, but not supported by available technology. In this study, we described and validated a computerized method to identify the vasculature surrounding a pulmonary nodule depicted on low-dose computed tomography (LDCT). MATERIALS AND METHODS The proposed computerized scheme identified the vessels surrounding a lung nodule by using novel computational geometric solutions and quantified them by decomposing the vessels into independent vessel branches. We validated this scheme by testing it on a dataset consisting of 100 chest CT examinations, with 50-paired benign and malignant nodules. Two experienced pulmonologists were asked to measure the vessel branches associated with a nodule under the aid of a visualization tool. We used the Bland-Altman plots and the concordance correlation coefficient (CCC) to assess the agreement between the results of the computer algorithm and two experienced pulmonologists. RESULTS Bland-Altman different analysis demonstrated a mean bias of 0.61 ± 4.17 in terms of vessel branches between the computer results and the human experts, while the inter-rater mean bias was -0.61 ± 1.60. The CCC-based agreements between the computer and the two raters were 0.90 / 0.86, 0.79 / 0.83 for benign and malignant nodules, respectively. CONCLUSION The small width of the limits of agreement between the computer algorithm and the human experts suggests that the results from the computer and the pulmonologist experts were relatively consistent, namely the computerized scheme is capable of reliably identifying the vasculature surrounding a nodule.
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Affiliation(s)
- Wei Zhao
- Respiratory Department, Chinese PLA General Hospital, Beijing, China
| | - Han Liu
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Joseph K Leader
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - David Wilson
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Xin Meng
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lei Wang
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Liang-An Chen
- Respiratory Department, Chinese PLA General Hospital, Beijing, China
| | - Jiantao Pu
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Models to Estimate the Probability of Malignancy in Patients with Pulmonary Nodules. Ann Am Thorac Soc 2018; 15:1117-1126. [DOI: 10.1513/annalsats.201803-173cme] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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10
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Yang P. Editorial commentary: meeting a paramount challenge. Transl Lung Cancer Res 2018; 7:S158-S159. [PMID: 29780709 DOI: 10.21037/tlcr.2018.03.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Ping Yang
- Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
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Hammer MM, Nachiappan AC, Barbosa EJM. Limited Utility of Pulmonary Nodule Risk Calculators for Managing Large Nodules. Curr Probl Diagn Radiol 2017; 47:23-27. [PMID: 28571906 DOI: 10.1067/j.cpradiol.2017.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/23/2017] [Accepted: 04/06/2017] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES The optimal management of large pulmonary nodules, at higher risk for lung cancer, has not been determined, and it remains unclear as to which patients should undergo follow-up imaging vs invasive tissue diagnosis via biopsy or surgical resection. MATERIALS AND METHODS Through search of radiology reports, 86 nodules from our institution were identified using the inclusion criterion of solid nodules measuring greater than 8mm. We evaluated these nodules with a number of risk prediction calculators, including the Brock University model, and compared these against the proven diagnosis. RESULTS Of 86 nodules, 59 (69%) nodules were malignant. The most accurate predictive model, the Brock University calculator, underestimated the risk for this group at 33%. At its optimal threshold, this model had a positive predictive value of 81% and negative predictive value of 53%. Notwithstanding the low negative predictive value, the positive predictive value was no better than patients clinically selected for biopsy (86% of biopsies were malignant). CONCLUSION Existing nodule risk prediction calculators are of limited usage in guiding the management of large pulmonary nodules. At present, the accuracy of these models in this setting is inferior to expert clinical judgment, and future work is needed to develop management algorithms for higher-risk nodules.
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Affiliation(s)
- Mark M Hammer
- Department of Radiology, Brigham and Women's Hospital, Boston, MA
| | - Arun C Nachiappan
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Renal Cell Carcinoma With Pulmonary Metastasis and Metachronous Non-Small Cell Lung Cancer. Clin Genitourin Cancer 2017; 15:e675-e680. [PMID: 28258962 DOI: 10.1016/j.clgc.2017.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/24/2017] [Accepted: 01/28/2017] [Indexed: 01/05/2023]
Abstract
INTRODUCTION The development of a second primary malignancy in a patient with a preexisting diagnosis of metastatic cancer may be easily overlooked or misattributed to progression of disease. We report 3 patients with clear-cell renal cell carcinoma (RCC) metastatic to the lungs who were subsequently diagnosed with non-small-cell lung cancer (NSCLC). We examined the frequency of this occurrence within our institution and report on the radiographic findings that may help distinguish between metastatic RCC and primary lung cancers. METHODS Patients who received systemic targeted therapy for metastatic RCC at our institution between January 2006 and October 2013 were identified, and the proportion and incidence rate for developing NSCLC with preexisting metastatic RCC were calculated. RESULTS Two percent (3/151; 95% confidence interval [CI], 0.68%-5.68%) of patients treated for metastatic RCC with systemic targeted therapies at our institution were subsequently diagnosed with NSCLC, increasing to 3.5% (3/85; 95% CI, 1.21%-9.87%) among patients with known RCC pulmonary metastasis. The incident rate for development of NSCLC in patients with metastatic RCC was 0.87 per 100 person-years (95% CI, 0.22-2.4). CONCLUSION The subsequent diagnosis of a primary lung cancer in metastatic RCC patients occurred in 2% of patients at our institution and is underreported in the literature. Primary NSCLC may be underdiagnosed in patients with metastatic RCC. Both the radiographic appearance and clinical behavior of a lesion may hold clues that can help distinguish between a new primary and progression of metastatic disease.
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Tanner NT, Porter A, Gould MK, Li XJ, Vachani A, Silvestri GA. Physician Assessment of Pretest Probability of Malignancy and Adherence With Guidelines for Pulmonary Nodule Evaluation. Chest 2017; 152:263-270. [PMID: 28115167 DOI: 10.1016/j.chest.2017.01.018] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/25/2016] [Accepted: 01/02/2017] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The annual incidence of pulmonary nodules is estimated at 1.57 million. Guidelines recommend using an initial assessment of nodule probability of malignancy (pCA). A previous study found that despite this recommendation, physicians did not follow guidelines. METHODS Physician assessments (N = 337) and two previously validated risk model assessments of pretest probability of cancer were evaluated for performance in 337 patients with pulmonary nodules based on final diagnosis and compared. Physician-assessed pCA was categorized into low, intermediate, and high risk, and the next test ordered was evaluated. RESULTS The prevalence of malignancy was 47% (n = 158) at 1 year. Physician-assessed pCA performed better than nodule prediction calculators (area under the curve, 0.85 vs 0.75; P < .001 and .78; P = .0001). Physicians did not follow indicated guidelines when selecting the next test in 61% of cases (n = 205). Despite recommendations for serial CT imaging in those with low pCA, 52% (n = 13) were managed more aggressively with PET imaging or biopsy; 12% (n = 3) underwent biopsy procedures for benign disease. Alternatively, in the high-risk category, the majority (n = 103 [75%]) were managed more conservatively. Stratified by diagnosis, 92% (n = 22) with benign disease underwent more conservative management with CT imaging (20%), PET scanning (15%), or biopsy (8%), although three had surgery (8%). CONCLUSIONS Physician assessment as a means for predicting malignancy in pulmonary nodules is more accurate than previously validated nodule prediction calculators. Despite the accuracy of clinical intuition, physicians did not follow guideline-based recommendations when selecting the next diagnostic test. To provide optimal patient care, focus in the areas of guideline refinement, implementation, and dissemination is needed.
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Affiliation(s)
- Nichole T Tanner
- Thoracic Oncology Research Group, Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston, SC; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Veterans Affairs Hospital, Charleston, SC.
| | | | | | | | - Anil Vachani
- Pulmonary, Allergy, and Critical Care Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Gerard A Silvestri
- Thoracic Oncology Research Group, Division of Pulmonary and Critical Care, Medical University of South Carolina, Charleston, SC
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Armato SG, Drukker K, Li F, Hadjiiski L, Tourassi GD, Engelmann RM, Giger ML, Redmond G, Farahani K, Kirby JS, Clarke LP. LUNGx Challenge for computerized lung nodule classification. J Med Imaging (Bellingham) 2016; 3:044506. [PMID: 28018939 PMCID: PMC5166709 DOI: 10.1117/1.jmi.3.4.044506] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 11/17/2016] [Indexed: 11/14/2022] Open
Abstract
The purpose of this work is to describe the LUNGx Challenge for the computerized classification of lung nodules on diagnostic computed tomography (CT) scans as benign or malignant and report the performance of participants' computerized methods along with that of six radiologists who participated in an observer study performing the same Challenge task on the same dataset. The Challenge provided sets of calibration and testing scans, established a performance assessment process, and created an infrastructure for case dissemination and result submission. Ten groups applied their own methods to 73 lung nodules (37 benign and 36 malignant) that were selected to achieve approximate size matching between the two cohorts. Area under the receiver operating characteristic curve (AUC) values for these methods ranged from 0.50 to 0.68; only three methods performed statistically better than random guessing. The radiologists' AUC values ranged from 0.70 to 0.85; three radiologists performed statistically better than the best-performing computer method. The LUNGx Challenge compared the performance of computerized methods in the task of differentiating benign from malignant lung nodules on CT scans, placed in the context of the performance of radiologists on the same task. The continued public availability of the Challenge cases will provide a valuable resource for the medical imaging research community.
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Affiliation(s)
- Samuel G. Armato
- The University of Chicago, Department of Radiology, 5841 South Maryland Avenue, MC 2026, Chicago, Illinois 60637, United States
| | - Karen Drukker
- The University of Chicago, Department of Radiology, 5841 South Maryland Avenue, MC 2026, Chicago, Illinois 60637, United States
| | - Feng Li
- The University of Chicago, Department of Radiology, 5841 South Maryland Avenue, MC 2026, Chicago, Illinois 60637, United States
| | - Lubomir Hadjiiski
- University of Michigan, Department of Radiology, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109, United States
| | - Georgia D. Tourassi
- Health Data Sciences Institute, Biomedical Science and Engineering Center, Oak Ridge National Laboratory, P.O. Box 2008 MS6085 Oak Ridge, Tennessee 37831-6085, United States
| | - Roger M. Engelmann
- The University of Chicago, Department of Radiology, 5841 South Maryland Avenue, MC 2026, Chicago, Illinois 60637, United States
| | - Maryellen L. Giger
- The University of Chicago, Department of Radiology, 5841 South Maryland Avenue, MC 2026, Chicago, Illinois 60637, United States
| | - George Redmond
- National Cancer Institute, Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, 9609 Medical Center Drive, Bethesda, Maryland 20892, United States
| | - Keyvan Farahani
- National Cancer Institute, Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, 9609 Medical Center Drive, Bethesda, Maryland 20892, United States
| | - Justin S. Kirby
- Leidos Biomedical Research, Inc., Frederick National Laboratory for Cancer Research, Cancer Imaging Program, 8560 Progress Drive, Frederick, Maryland 21702, United States
| | - Laurence P. Clarke
- National Cancer Institute, Cancer Imaging Program, Division of Cancer Treatment and Diagnosis, 9609 Medical Center Drive, Bethesda, Maryland 20892, United States
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Shi Z, Wang Y, He X. Differential diagnosis of solitary pulmonary nodules with dual-source spiral computed tomography. Exp Ther Med 2016; 12:1750-1754. [PMID: 27588092 PMCID: PMC4997995 DOI: 10.3892/etm.2016.3528] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 07/15/2016] [Indexed: 01/20/2023] Open
Abstract
The aim of the present study was to analyze the value of applying dual-source 64-layer spiral computed tomography (CT) in the differential diagnosis of solitary pulmonary nodules (SPNs). Mediastinal windows from 45 cases were selected to study SPNs (maximum diameter, ≤3 cm), and the pathological nature of lesions was determined by clinical and pathological diagnosis. Conventional 64-layer spiral CT scanning, local enhancement and 3D recombination technologies were used to determine the occurrence rate, lesion diameter, degree of enhancement, lobular sign, spicule sign, pleural indentation sign, vessel convergence sign and bronchus sign. The final diagnoses indicated 34 cases of malignant SPNs (75.6%) and 11 benign cases (24.4%). When the nodule diameter in the malignant group was compared with that of the benign group, the difference was not statistically significant (P>0.05). Nodules in the malignant group showed inhomogeneous enhancement while nodules in the benign group showed homogeneous enhancement. The enhanced CT values in the malignant group were higher than those in the benign group, and the difference was statistically significant (P<0.05). The proportion of nodules with lobular sign in the malignant group was significantly higher than that in the benign group (P<0.05). The proportion of nodules with calcification, vessel convergence sign and bronchus sign in the malignant group were significantly higher than those in the benign group, and the differences were statistically significant (P<0.05). A comparison of vacuole sign, pleural indentation sign, spiculate protuberance and fat occurrence between the two groups yielded no statistically significant differences (P>0.05). The sensitivity of CT enhancement was 85.6%, specificity was 79.6%, positive predicated value was 92.3%, and the negative predicted value was 85.2%. In conclusion, SPNs diagnosed by CT enhancement manifested with enhancement degree, lobular sign, calcification, vessel convergence sign and bronchus sign with high diagnostic accuracy.
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Affiliation(s)
- Zhitao Shi
- CT Room, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Yanhui Wang
- CT Room, Affiliated Hospital of Jining Medical University, Jining, Shandong 272029, P.R. China
| | - Xueqi He
- Jining Medical University, Jining, Shandong 272029, P.R. China
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