Evaluation of models for predicting the probability of malignancy in patients with pulmonary nodules

The post-imaging, mathematical predictive model was established by combining demographic and imaging characteristics with a pulmonary nodule risk score. The prediction model provides directions for the treatment of pulmonary nodules. Many studies have established predictive models for pulmonary nodules in different populations. However, the predictive factors contained in each model were significantly different. We hypothesized that applying different models to local research groups will make a difference in predicting the benign and malignant lung nodules, distinguishing between early and late lung cancers, and between adenocarcinoma and squamous cell carcinoma. In the present study, we compared four widely used and well-known mathematical prediction models.

We performed a retrospective study of 496 patients from January 2017 to October 2019, they were diagnosed with nodules by pathological. We evaluate models' performance by viewing 425 malignant and 71 benign patients' computed tomography results. At the same time, we use the calibration curve and the area under the receiver operating characteristic curve whose abbreviation is AUC to assess one model's predictive performance.

We find that in distinguishing the Benign and the Malignancy, Peking University People's Hospital model possessed excellent performance (AUC = 0.63), as well as differentiating between early and late lung cancers (AUC = 0.67) and identifying lung adenocarcinoma (AUC = 0.61). While in the identification of lung squamous cell carcinoma, the Veterans Affairs model performed the best (AUC = 0.69).

Geographic disparities are an extremely important influence factors, and which clinical features contained in the mathematical prediction model are the key to affect the precision and accuracy.