The Probability of Malignancy in Solitary Pulmonary Nodules: Application to Small Radiologically Indeterminate Nodules

doi:10.1001/archinte.1997.00440290031002

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Vol. 157 No. 8, 28 APRIL 1997

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The Probability of Malignancy in Solitary Pulmonary Nodules

Application to Small Radiologically Indeterminate Nodules

Stephen J. Swensen, MD; Marc D. Silverstein, MD; Duane M. Ilstrup, MS; Cathy D. Schleck; Eric S. Edell, MD

Arch Intern Med. 1997;157(8):849-855.

Abstract

Background
A clinical prediction model to identify malignant nodules basedon clinical data and radiological characteristics of lung noduleswas derived using logistic regression from a random sample ofpatients (n=419) and tested on data from a separate group ofpatients (n=210).

Objective
To use multivariate logistic regression to estimate the probabilityof malignancy in radiologically indeterminate solitary pulmonarynodules (SPNs) in a clinically relevant subset of patients withSPNs that measured between 4 and 30 mm in diameter.

Patients and Methods
A retrospective cohort study at a multispecialty group practiceincluded 629 patients (320 men, 309 women) with newly discovered(between January 1, 1984, and May 1, 1986) 4- to 30-mm radiologicallyindeterminate SPNs on chest radiography. Patients with a diagnosisof cancer within 5 years prior to the discovery of the nodulewere excluded. Clinical data included age, sex, cigarette-smokingstatus, and history of extrathoracic malignant neoplasm, asbestosexposure, and chronic interstitial or obstructive lung disease;chest radiological data included the diameter, location, edgecharacteristics (eg, lobulation, spiculation, and shagginess),and other characteristics (eg, cavitation) of the SPNs. Predictorswere identified in a random sample of two thirds of the patientsand tested in the remaining one third.

Results
Sixty-five percent of the nodules were benign, 23% were malignant,and 12% were indeterminate. Three clinical characteristics (age,cigarette-smoking status, and history of cancer [diagnosis, $≥$ 5 years ago]) and 3 radiological characteristics (diameter,spiculation, and upper lobe location of the SPNs) were independentpredictors of malignancy. The area (±SE) under the evaluatedreceiver operating characteristic curve was 0.8328±0.0226.

Conclusion
Three clinical and 3 radiographic characteristics predictedthe malignancy in radiologically indeterminate SPNs.

Arch Intern Med. 1997;157:849-855

Author Affiliations

From the Department of Diagnostic Radiology (Dr Swensen), the Sections of Clinical Epidemiology (Dr Silverstein) and Biostatistics (Mr Ilstrup and Ms Schleck), and the Division of Pulmonary and Critical Care Medicine and Internal Medicine (Dr Edell), Mayo Clinic and Mayo Foundation, Rochester, Minn.

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