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Original Research: Lung Cancer |

The Utility of Nodule Volume in the Context of Malignancy Prediction for Small Pulmonary NodulesVolume of Pulmonary Nodules Predicts Malignancy

Hiren J. Mehta, MD; James G. Ravenel, MD; Stephanie R. Shaftman, MSc, MS; Nichole T. Tanner, MD, FCCP; Luca Paoletti, MD, FCCP; Katherine K. Taylor, MS; Martin C. Tammemagi, PhD; Mario Gomez, MD; Paul J. Nietert, PhD; Michael K. Gould, MD, FCCP; Gerard A. Silvestri, MD, FCCP
Author and Funding Information

From the Division of Pulmonary, Critical Care, and Sleep Medicine (Dr Mehta), University of Florida College of Medicine, Gainesville, FL; Department of Radiology and Radiological Sciences (Dr Ravenel), Division of Biostatistics and Epidemiology (Ms Shaftman and Dr Nietert), and Division of Pulmonary and Critical Care Medicine (Drs Tanner, Paoletti, and Silvestri and Ms Taylor), Department of Medicine, Medical University of South Carolina, Charleston, SC; Department of Community Health Sciences (Dr Tammemagi), Brock University, St. Catharines, ON, Canada; Pulmonary & Sleep Center of the Valley (Dr Gomez), Weslaco, TX; and Department of Research and Evaluation (Dr Gould), Kaiser Permanente Southern California, Pasadena, CA.

Correspondence to: Gerard A. Silvestri, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 810, Charleston, SC 29425; e-mail: silvestri@musc.edu


For editorial comment see page 440

Funding/Support: This study was supported by the Department of Defense [award W81XWH-05-1-0378], the National Cancer Institute [award 5K24CA120494], and the National Center for Research Resources [award 5UL1RR029882].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(3):464-472. doi:10.1378/chest.13-0708
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Background:  An estimated 150,000 pulmonary nodules are identified each year, and the number is likely to increase given the results of the National Lung Screening Trial. Decision tools are needed to help with the management of such pulmonary nodules. We examined whether adding any of three novel functions of nodule volume improves the accuracy of an existing malignancy prediction model of CT scan-detected nodules.

Methods:  Swensen’s 1997 prediction model was used to estimate the probability of malignancy in CT scan-detected nodules identified from a sample of 221 patients at the Medical University of South Carolina between 2006 and 2010. Three multivariate logistic models that included a novel function of nodule volume were used to investigate the added predictive value. Several measures were used to evaluate model classification performance.

Results:  With use of a 0.5 cutoff associated with predicted probability, the Swensen model correctly classified 67% of nodules. The three novel models suggested that the addition of nodule volume enhances the ability to correctly predict malignancy; 83%, 88%, and 88% of subjects were correctly classified as having malignant or benign nodules, with significant net improved reclassification for each (P < .0001). All three models also performed well based on Nagelkerke R2, discrimination slope, area under the receiver operating characteristic curve, and Hosmer-Lemeshow calibration test.

Conclusions:  The findings demonstrate that the addition of nodule volume to existing malignancy prediction models increases the proportion of nodules correctly classified. This enhanced tool will help clinicians to risk stratify pulmonary nodules more effectively.

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