Summary of studies that developed composite prediction models
| Reference | Subjects | Study setting | Age (years), mean (range) | Male (%) | Current/ former smokers (%) | Nodule size (mm), mean (range) | Nodule count (mm), | Prevalence of malignancy (%) | Predictors of malignancy or benignity | Odds ratio (95% CI) | AUC (95% CI) | ||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Benign | Malignant | Benign | Malignant | ||||||||||
| McWilliams et al46 Parsimonious | 2961 (1871 developed 1090 tested) | Multicentre screening study, Canada | 62 (50–75) | 53 | 100 | 4.1 (1–70) | 15.7 (2–86) | 6.2 (1–31) | 4.8 (1–19) | 5.5 | Female sex Nodule size Upper lobe Nodule count per scan, per each additional nodule Spiculation | 1.91 (1.19 to 3.07) - (non-linear) 1.82 (1.12 to 2.98) 0.92 (0.85 to 1.00) 2.54 (1.45 to 4.43) | 0.94 (0.91 to 0.96) 0.91 for nodules <10 mm |
| McWilliams et al46 Full model | 2961 (1871 developed 1090 tested) | Multicentre screening study, Canada | 62 (50–75) | 53 | 100 | 4.1 (1–70) | 15.7 (2–86) | 6.2 (1–31) | 4.8 (1–19) | Age per year Female sex Family history Emphysema Nodule size Ground glass Part solid Upper lobe Nodule count per scan, per each additional nodule Spiculation | 1.03 (0.99 to 1.07) 1.82 (1.12 to 2.97) 1.34 (0.83 to 2.17) 1.34 (0.78 to 2.33) Non-linear 0.88 (0.48 to 1.62) 1.46 (0.74 to 2.88) 1.93 (1.14 to 3.27) 0.92 (0.85 to 1.00) 2.17 (1.16 to 4.05) | 0.97 0.93 for nodules <10 mm | |
| Gould et al49 | 375 | Newly detected SPNs on CXR 7–30 mm referred for PET, multicentre, USA | 66 (range not given) | 98 | 94 | 14.8 (7–30) | 18.9 (7–30) | Not applicable | 54 | Smoking Age (per 10 years) Diameter (per mm) Time since quitting (per 10 years) | 7.9 (2.6 to 23.6) 2.2 (1.7 to 2.8) 1.1 (1.1 to 2.2) 0.6 (0.4 to 0.7) | 0.79 (0.74 to 0.84) | |
| Swensen et al64 | 639 | Newly detected SPNs on CXR 4–30 mm, single centre, USA | 62 (15–82) | 51 | 68 | 11.6 (4–30) | 17.8 (5–30) | Not applicable | 23 | Age Ever smoker Cancer ≥5 years Diameter Spiculation Upper lobe | 1.04 (1.01 to 1.07) 2.21 (1.17 to 4.16) 3.8 (1.39 to 10.5) 1.14 (1.09 to 1.19) 2.83 (1.47 to 5.45) 2.19 (1.27 to 3.79) | 0.83 (0.81 to 0.85) | |
| Herder et al55 | 106 | Patients with indeterminate SPNs <30 mm referred for PET | 64 (32–85) | 58 | 75 | <10 mm 49% 11–20 mm 36% 21–30mm 16% | <10 mm 18% 11–20 mm 43% 21–30 mm 39% | Not applicable | 57 | Same as Swensen | Not applicable | Validated Mayo model—AUC 0.79 (0.70 to 0.87) Addition of PET results increased AUC to 0.92 (0.87 to 0.97) | |
AUC, area under the receiver operating characteristic curve; CXR, chest X-ray; PET, positron emission tomography; SPNs, solitary pulmonary nodules.