Limited value of logistic regression analysis in solid solitary pulmonary nodules characterization: a single-center
S Perandini1, G A Soardi, M Motton
1Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani 1, Verona, Italy.
Background And Objectives:
Preoperative characterization of the solitary pulmonary nodule is a delicate task faced by surgeons, radiologists, and clinicians. Mathematical models have been developed to overcome subjectivity. The Mayo Clinic model was suggested in the latest ACCP evidence-based clinical practice guidelines for the preoperative risk assessment of solitary pulmonary nodule malignancy. The aim of the study is to assess the validity of the Mayo Clinic model in a current continuous case series of biopsy-proven nodules.
Methods:
The Mayo Clinic model was applied to estimate probability of malignancy in 288 consecutive cases in this single-center retrospective study.
Results:
ROC curve analysis returned an AUC of 0.767, while analysis performed on 158 malignant nodules showed a mean predicted risk value of 38.15%. In our clinical setting, using a risk observational threshold set at 5% and a risk surgical threshold set at 60%, there would have been 4 cases of unnecessary surgery (false positives) at the cost of 13 cases of cancer progression (false negatives), while 68.75% of all nodules would have received non-decisional values.
Conclusions:
Surgeons should be aware that current data shows how the Mayo Clinic model is of little use in preoperative nodule characterization.
