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Probability of cancer in pulmonary nodules detected on first screening CT.
- Source :
-
The New England journal of medicine [N Engl J Med] 2013 Sep 05; Vol. 369 (10), pp. 910-9. - Publication Year :
- 2013
-
Abstract
- Background: Major issues in the implementation of screening for lung cancer by means of low-dose computed tomography (CT) are the definition of a positive result and the management of lung nodules detected on the scans. We conducted a population-based prospective study to determine factors predicting the probability that lung nodules detected on the first screening low-dose CT scans are malignant or will be found to be malignant on follow-up.<br />Methods: We analyzed data from two cohorts of participants undergoing low-dose CT screening. The development data set included participants in the Pan-Canadian Early Detection of Lung Cancer Study (PanCan). The validation data set included participants involved in chemoprevention trials at the British Columbia Cancer Agency (BCCA), sponsored by the U.S. National Cancer Institute. The final outcomes of all nodules of any size that were detected on baseline low-dose CT scans were tracked. Parsimonious and fuller multivariable logistic-regression models were prepared to estimate the probability of lung cancer.<br />Results: In the PanCan data set, 1871 persons had 7008 nodules, of which 102 were malignant, and in the BCCA data set, 1090 persons had 5021 nodules, of which 42 were malignant. Among persons with nodules, the rates of cancer in the two data sets were 5.5% and 3.7%, respectively. Predictors of cancer in the model included older age, female sex, family history of lung cancer, emphysema, larger nodule size, location of the nodule in the upper lobe, part-solid nodule type, lower nodule count, and spiculation. Our final parsimonious and full models showed excellent discrimination and calibration, with areas under the receiver-operating-characteristic curve of more than 0.90, even for nodules that were 10 mm or smaller in the validation set.<br />Conclusions: Predictive tools based on patient and nodule characteristics can be used to accurately estimate the probability that lung nodules detected on baseline screening low-dose CT scans are malignant. (Funded by the Terry Fox Research Institute and others; ClinicalTrials.gov number, NCT00751660.).
- Subjects :
- Evidence-Based Medicine
Female
Follow-Up Studies
Humans
Logistic Models
Lung pathology
Lung Neoplasms diagnostic imaging
Male
Models, Statistical
Multiple Pulmonary Nodules diagnostic imaging
Multiple Pulmonary Nodules pathology
Probability
Prospective Studies
Solitary Pulmonary Nodule pathology
Tomography, X-Ray Computed
Lung diagnostic imaging
Lung Neoplasms pathology
Solitary Pulmonary Nodule diagnostic imaging
Subjects
Details
- Language :
- English
- ISSN :
- 1533-4406
- Volume :
- 369
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- The New England journal of medicine
- Publication Type :
- Academic Journal
- Accession number :
- 24004118
- Full Text :
- https://doi.org/10.1056/NEJMoa1214726