Soardi et al reported a model for evaluating a patient with a solid solitary pulmonary nodule. This can help to identify a patient who may or may not have a lung malignancy. The authors are from Azienda Ospedaliera Universitaria Integrata di Verona in Verona, Italy.
Patient selection: solid solitary pulmonary nodule, < 89 years, size 4 to 30 mm
Parameters:
(1) age in years
(2) smoking history
(3) history of previous malignancy (not defined)
(4) diameter in mm
(5) lobe
(6) edges
(7) volume doubling time in days
(8) minimum HU value
(9) enhancement at CE-CT (presumably contrast-enhanced CT)
(10) FDG-PET SUV
|
Parameter |
Finding |
Likelihood Ratio |
|
age in years |
< 40 years |
0.603 |
|
|
40 to 49 years |
0.905 |
|
|
50 to 59 years |
0.980 |
|
|
60 to 69 years |
0.762 |
|
|
70 to 79 years |
1.616 |
|
|
80 to 89 years |
0.884 |
|
smoking history |
never |
0.619 |
|
|
< 40 pack years |
1.216 |
|
|
>= 40 pack years |
3.7 |
|
previous malignancy |
no |
0.72 |
|
|
yes |
2.454 |
|
diameter |
4 to 10 mm |
0.4 |
|
|
11 to 15 mm |
0.882 |
|
|
16 to 20 mm |
2.308 |
|
|
21 to 25 mm |
2.284 |
|
|
26 to 30 mm |
3.391 |
|
lobe |
lower |
0.889 |
|
|
middle or lingula |
1.271 |
|
|
upper |
1.044 |
|
edges |
smooth, elliptical, polygonal |
0.293 |
|
|
minimally lobulated |
0.735 |
|
|
deeply lobulated |
1.888 |
|
|
frayed |
3.71 |
|
|
spiculated |
7.884 |
|
volume doubling time |
25 to 400 days |
14.472 |
|
|
401 to 900 days |
2.412 |
|
|
> 900 days |
0.085 |
|
minimum HU value |
< - 60 HU |
0.239 |
|
|
-60 to -30 HU |
0.922 |
|
|
> - 30 HU |
1.462 |
|
enhancement at CE-CT |
< 15 HU |
0.258 |
|
|
15 to 40 HU |
0.586 |
|
|
> 40 HU |
5.004 |
|
FDG-PET SUV |
SUV < 1 |
0.636 |
|
|
SUV 1 to 2.49 |
0.687 |
|
|
SUV >= 2.5 |
1.812 |
cumulative likelihood ratio =
= PRODUCT(likelihood ratios all of the parameters)
Interpretation:
• minimum cumulative likelihood ratio: 0.0000933
• maximum cumulative likelihood ratio: 95,651
post-test odds of malignancy =
= (pre-test odds) * (cumulative likelihood ratio)
Specialty: Pulmonology, Hematology Oncology
