The Impact Prediction Models of Neoplasia for Lung Nodules in High-Risk Patients

Resumo

Objectives: This study aims to evaluate the impact of using three predictive models of lung nodule malignancy in a population of patients at high-risk for neoplasia according to previous analysis by physicians, as well as evaluate the clinical and radiological malignancy-predictors of the images. Material and Methods: This is a retrospective cohort study, with 135 patients, undergone surgical in the period from 01/07/2013 to 10/05/2016. The study included nodules with dimensions between 5mm and 30mm, excluding multiple nodules, alveolar consolidation, pleural effusion, and lymph node enlargement. The main variables analyzed were age, sex, smoking history, extrathoracic cancer, diameter, location, and presence of spiculation. The calculation of the area under the ROC curve assessed the accuracy of each prediction model. Results: The study analyzed 135 individuals, of which 96 (71.1%) had malignant nodules. The areas under the ROC curves for each prediction model were: Swensen 0.657; Brock 0.662; and Herder 0.633. The models Swensen, Brock, and Herder presented positive predictive values in high-risk patients, corresponding to 83.3%, 81.8%, and 82.9%, respectively. Patients with the intermediate and low-risk presented a high malignant nodule rate, ranging from 69.3-72.5% and 42.8-52.6%, respectively. Conclusion: None of the three quantitative models analyzed in this study was considered satisfactory (AUC> 0.7) and should be used with caution after specialized evaluation to avoid underestimation of the risk of neoplasia. The pretest calculations might not contemplate other factors than those predicted in the regressions, that could present a role in the clinical decision of resection.