Chest
Original Research: Lung CancerThe Utility of Nodule Volume in the Context of Malignancy Prediction for Small Pulmonary Nodules
Section snippets
Subjects
Consecutive subjects with at least one newly diagnosed pulmonary nodule were recruited between February 1, 2006, and May 1, 2010, from our institution's pulmonary clinic and were included if they had a thoracic CT scan, at least one nodule < 15 mm in diameter detected on the scan, and images satisfactory for volume assessment (slice thickness ≤ 2.5 mm). Although we had no lower limit cutoff per se, on the basis of detectability, no nodules were < 3 mm in size. The Institutional Review Board at
Results
Two hundred thirty-three nodules were observed among 221 subjects, with 37% being malignant. The average ± SD age was 62.4 ± 10.2 years, and 79% were classified as ever smokers. Prior extrathoracic cancers were noted in 34% of subjects. The average nodule diameter and volume were 9.2 ± 3.2 mm (range, 3.0-14.9 mm) and 723 mm3, respectively. Table 1 shows a comparison between study subjects with benign nodules and those with malignant nodules; no significant differences between groups were noted
Discussion
This study is one of the first, to our knowledge, to focus on malignancy prediction in nodules measuring < 15 mm in diameter and has several important findings. First, the addition of nodule volume to the Swensen model significantly enhances its predictive ability. The novel models incorporating nodule volume, volume to diameter ratio, and sphericity index performed relatively similar to one another. All three outperformed the original Swensen model and correctly classified more subjects as
Acknowledgments
Author contributions: Dr Silvestri had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Dr Mehta: contributed to the study design, data collection, and manuscript writing.
Dr Ravenel: contributed to the study design, data collection, and manuscript writing.
Ms Shaftman: contributed to the study design, statistical analysis, and manuscript writing.
Dr Tanner: contributed to the study design, data collection, and
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For editorial comment 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].
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