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A web-based dynamic nomogram for preoperative identification of Warthin tumor among parotid tumors: Development and
Jianghui Dong1, Hengshuai Zhao2, Xiannian Shao3
1Baise Key Laboratory of Precision Molecular Diagnostic Medicine, Baise People's Hospital, Affiliated Southwest Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China; Department of Joint Surgery, Baise People's Hospital, Affiliated Southwest Hospital of Youjiang Medical University for Nationalities, Baise, 533000, Guangxi, China.
Background:
Preoperative identification of Warthin tumor (WT) can inform surgical planning and patient counseling. This study aimed to develop and externally validate a simple clinical prediction model based on routinely available preoperative variables.
Methods:
This two-center retrospective study included 230 patients in the development cohort and 245 in the external validation cohort. Nine routinely available preoperative variables were assessed using LASSO-penalized logistic regression with stratified five-fold cross-validation. Model performance was evaluated using discrimination, calibration, overall prediction error, 1000-resample bootstrap internal validation, decision curve analysis, and clinical impact curves.
Results:
Among 475 patients, 81 (17.1%) had histopathologically confirmed WT. The final model included age (OR = 1.037, 95% CI: 1.008-1.067), male sex (OR = 3.828, 95% CI: 1.146-12.783), and smoking history (OR = 3.591, 95% CI: 1.550-8.316). The AUC was 0.791 (95% CI: 0.721-0.862) in the development cohort and 0.868 (95% CI: 0.816-0.919) in external validation. After bootstrap correction, the AUC was 0.785, the calibration intercept was -0.048, the calibration slope was 0.942, the Brier score was 0.129, and Emax was 0.088. In the external cohort, the calibration intercept and slope were 0.379 and 1.503, respectively; the Brier score was 0.101 and Emax was 0.139. Decision curve analysis suggested potential net benefit across selected threshold ranges.
Conclusions:
A model based on age, sex, and smoking history showed useful preoperative discrimination between WT and other parotid tumors. The web-based dynamic nomogram may support initial assessment and patient counseling, although further prospective and geographically diverse validation is needed.