A NASAL CLINICAL-GENOMIC CLASSIFIER FOR ASSESSING RISK OF MALIGNANCY IN LUNG NODULES DEMONSTRATES ACCURATE PERFORMANCE INDEPENDENT OF NODULE SIZE OR CANCER STAGE

The next diagnostic step in cases of indeterminate radial probe endobronchial ultrasound (radial EBUS)-guided biopsy results remains uncertain. This study aimed to identify risk factors for malignancy based on clinical findings, chest computed tomography (CT), and radial EBUS images, and to estimate the risk of malignancy in lung nodules that showed indeterminate radial EBUS-guided biopsy results by constructing a nomogram. This retrospective study included 157 patients with indeterminate results on an initial radial EBUS biopsy performed at the Samsung Medical Center from January 2017 to December 2018, but with a definitive final diagnosis. Medical records, chest CT, radial EBUS images, and the final diagnoses were reviewed. Patients were randomly divided into training and validation sets. Factors related to malignancy were identified through logistic regression analysis, and a nomogram was constructed using the training set and subsequently applied to the validation set. Six factors in univariable and multivariable analyses, including upper lobe location, spiculation, satellite nodules, echogenicity, presence of dots or linear arcs, and patency of vessels and bronchi predicted malignancy. A nomogram was constructed based on these predictors. The area under the curve (AUC) value of the nomogram was 0.858 using the chest CT factors, which improved to 0.952 when radial EBUS factors were added. The calibration curve showed good agreement between the actual and nomogram-predicted malignancy outcomes. The utility of radial EBUS images for revealing risk factors of malignancy was confirmed. Furthermore, our nomogram was able to predict the probability of malignancy in lung nodules with indeterminate radial EBUS-guided biopsy results.

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SU-FF-I-07: Single- and Dual-Energy CT Calibration Lines for Assessing the Calcium Content of Lung Nodules: Effects of Patient Body and Lung Nodule Size

Medical Physics ◽

10.1118/1.2760383 ◽

2007 ◽

Vol 34 (6Part2) ◽

pp. 2339-2339

Author(s):

M Goodsitt ◽

H Chan ◽

T Way ◽

S Larson ◽

E Christodoulou

Keyword(s):

Lung Nodule ◽

Calcium Content ◽

Dual Energy ◽

Lung Nodules ◽

Dual Energy Ct ◽

Nodule Size

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Evaluation of undiagnosed solitary lung nodules according to the probability of malignancy in the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines

Radiology and Oncology ◽

10.2478/raon-2013-0064 ◽

2014 ◽

Vol 48 (1) ◽

pp. 50-55 ◽

Cited By ~ 10

Author(s):

Shinji Shinohara ◽

Takeshi Hanagiri ◽

Masaru Takenaka ◽

Yasuhiro Chikaishi ◽

Soich Oka ◽

...

Keyword(s):

Negative Predictive Value ◽

Roc Curve ◽

Predictive Value ◽

Lung Tumor ◽

Malignant Tumors ◽

Final Diagnosis ◽

Benign Disease ◽

Smoking History ◽

Lung Nodules ◽

Nodule Size

Abstract Background. This study retrospectively investigated the clinical significance of undiagnosed solitary lung nodules removed by surgical resection. Patients and methods. We retrospectively collected data on the age, smoking, cancer history, nodule size, location and spiculation of 241 patients who had nodules measuring 7 mm to 30 mm and a final diagnosis established by histopathology. We compared the final diagnosis of each patient with the probability of malignancy (POM) which was proposed by the American College of Chest Physicians (ACCP) guidelines. Results. Of the 241 patients, 203 patients were diagnosed to have a malignant lung tumor, while 38 patients were diagnosed with benign disease. There were significant differences in the patients with malignant and benign disease in terms of their age, smoking history, nodule size and spiculation. The mean value and the standard deviation of the POM in patients with malignant tumors were 51.7 + 26.1%, and that of patients with benign lesions was 34.6 + 26.7%. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.67. The best cut-off value provided from the ROC curve was 22.6. When the cut-off value was set at 22.6, the sensitivity was 83%, specificity 52%, positive predictive value 90%, negative predictive value 36% and accuracy 77%, respectively. Conclusions. The clinical prediction model proposed in the ACCP guidelines showed unsatisfactory results in terms of the differential diagnosis between malignant disease and benign disease of solitary lung nodules in our study, because the specificity, negative predictive value and AUC were relatively low.

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Toward a uniform pathway in managing incidental lung nodules on computerised tomography [CT] coronary angiography; for a cost effective and safe outcome

European Heart Journal ◽

10.1093/ehjci/ehaa946.0159 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

V Kanthasamy ◽

A Mahmood ◽

S Karde ◽

S Mason ◽

A Marshall ◽

...

Keyword(s):

Cost Effectiveness ◽

Coronary Angiography ◽

Lung Nodule ◽

Pain Clinic ◽

Lung Nodules ◽

British Thoracic Society ◽

Team Approach ◽

Nodule Size ◽

Interval Change

Abstract Background National Institute for Health and Care Excellence guidelines (NICE CG95) recommends computed tomography coronary angiography [CTCA] as the first line investigation for all patients with suspected typical or atypical angina irrespective of pre-test probability due to its excellent performance and cost effectiveness. However previous cost effectiveness analyses have not factored in the burden of lung nodules [LN] or extracardiac incidentalomas, which are commonly identified on CTCA. Purpose As we increasingly detect LN on CTCA scans, it is prudent that a uniform pathway is followed for surveillance of LN. The British Thoracic Society (BTS) has enabled evidence-based development of an algorithm for the management of LN which defines a cut off LN size of ≥5mm requiring further follow up. We aimed to assess the compliance of LN follow up in our patients according to radiology recommendation on CTCA reports and also to assess how well these recommendations adhere to BTS guidelines. Method 117 patients who underwent CTCA as the initial diagnostic investigation were retrospectively identified from the rapid access chest pain clinic database. Data was collected during a 1 year period between January - December 2017. Data was analysed to determine whether appropriate surveillance pathway was followed for repeat imaging. According to BTS guidelines, nodules ≥5mm should have a systematic work up for surveillance and hence we have stratified our data based on the nodule size. In case of multiple nodules, the largest nodule size was considered. Results Out of 117 patients, 77% patients were female with average age 57.8±9.0 years. 40% patients were found to have incidental LN with an average size of 4.63±1.92mm; 44% had a history of cigarette smoking. Among patient with nodules, 22 (19%) had CT thorax to assess interval change and interestingly 16 (73%) had persisting LN; whereas in 4 (18%), the LN resolved and only 2 (9%) showed increase in LN size. Repeat CT chest was advised for these 2 patients; 1 was advised to undergo biopsy which eventually ruled out malignancy. 6 patients (5%) from group 1 were recommended for repeat CT despite having LN size <5mm. In the remaining 25 patients (21%) with LN, 15 (60%) did not have further surveillance imaging even though this was recommended by the reporting radiologist. Of these only 3 (12%) had LN ≥5mm which qualified for surveillance CT. Conclusion CTCA frequently detects incidentalomas especially LN which cannot be overlooked and require further imaging irrespective of the primary presentation. Our findings also suggest a discrepancy on surveillance CT recommendation against the current BTS guidelines, with potential significant impact on the overall cost effectiveness of CTCA. A systematic approach to LN surveillance could be best achieved with a multidisciplinary team approach (e.g. referral pathway to nodule MDT) and adherence to a standard guideline. Lung nodule surveillance following CTCA Funding Acknowledgement Type of funding source: None

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The Impact of Thyroid Nodule Size on the Risk of Malignancy and Accuracy of Fine-Needle Aspiration: A 10-Year Study from a Single Institution

Thyroid ◽

10.1089/thy.2012.0265 ◽

2012 ◽

Vol 22 (12) ◽

pp. 1251-1256 ◽

Cited By ~ 80

Author(s):

Merica Shrestha ◽

Barbara A. Crothers ◽

Henry B. Burch

Keyword(s):

Thyroid Nodule ◽

Fine Needle Aspiration ◽

Needle Aspiration ◽

Single Institution ◽

Fine Needle ◽

Nodule Size ◽

Risk Of Malignancy ◽

The Impact

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Percepta Genomic Sequencing Classifier and decision-making in patients with high-risk lung nodules: a decision impact study

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01772-4 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Sonali Sethi ◽

Scott Oh ◽

Alexander Chen ◽

Christina Bellinger ◽

Lori Lofaro ◽

...

Keyword(s):

Decision Making ◽

High Risk ◽

Diagnostic Procedures ◽

Lung Nodules ◽

Genomic Sequencing ◽

Curative Therapy ◽

Risk Of Malignancy ◽

Very High ◽

Independent Cohort

Abstract Background Incidental and screening-identified lung nodules are common, and a bronchoscopic evaluation is frequently nondiagnostic. The Percepta Genomic Sequencing Classifier (GSC) is a genomic classifier developed in current and former smokers which can be used for further risk stratification in these patients. Percepta GSC has the capability of up-classifying patients with a pre-bronchoscopy risk that is high (> 60%) to “very high risk” with a positive predictive value of 91.5%. This prospective, randomized decision impact survey was designed to test the hypothesis that an up-classification of risk of malignancy from high to very high will increase the rate of referral for surgical or ablative therapy without additional intervening procedures while increasing physician confidence. Methods Data were collected from 37 cases from the Percepta GSC validation cohort in which the pre-bronchoscopy risk of malignancy was high (> 60%), the bronchoscopy was nondiagnostic, and the patient was up-classified to very high risk by Percepta GSC. The cases were randomly presented to U.S pulmonologists in three formats: a pre-post cohort where each case is presented initially without and then with a GSG result, and two independent cohorts where each case is presented either with or without with a GSC result. Physicians were surveyed with respect to subsequent management steps and confidence in that decision. Results One hundred and one survey takers provided a total of 1341 evaluations of the 37 patient cases across the three different cohorts. The rate of recommendation for surgical resection was significantly higher in the independent cohort with a GSC result compared to the independent cohort without a GSC result (45% vs. 17%, p < 0.001) In the pre-post cross-over cohort, the rate increased from 17 to 56% (p < 0.001) following the review of the GSC result. A GSC up-classification from high to very high risk of malignancy increased Pulmonologists’ confidence in decision-making following a nondiagnostic bronchoscopy. Conclusions Use of the Percepta GSC classifier will allow more patients with early lung cancer to proceed more rapidly to potentially curative therapy while decreasing unnecessary intervening diagnostic procedures following a nondiagnostic bronchoscopy.

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