title: Novel and convenient method to evaluate the character of solitary pulmonary nodule-comparison of three mathematical prediction models and further stratification of risk factors.
abstract: OBJECTIVE
  To study risk factors that affect the evaluation of malignancy in patients with solitary pulmonary nodules (SPN) and verify different predictive models for malignant probability of SPN.
  
  
  METHODS
  Retrospectively analyzed 107 cases of SPN with definite post-operative histological diagnosis whom underwent surgical procedures in China-Japan Friendship Hospital from November of 2010 to February of 2013. Age, gender, smoking history, malignancy history of patients, imaging features of the nodule including maximum diameter, position, spiculation, lobulation, calcification and serum level of CEA and Cyfra21-1 were assessed as potential risk factors. Univariate analysis model was used to establish statistical correlation between risk factors and post-operative histological diagnosis. Receiver operating characteristic (ROC) curves were drawn using different predictive models for malignant probability of SPN to get areas under the curves (AUC values), sensitivity, specificity, positive predictive values, negative predictive values for each model, respectively. The predictive effectiveness of each model was statistically assessed subsequently.
  
  
  RESULTS
  In 107 patients, 78 cases were malignant (72.9%), 29 cases were benign (27.1%). Statistical significant difference was found between benign and malignant group in age, maximum diameter, serum level of Cyfra21-1, spiculation, lobulation and calcification of the nodules. The AUC values were 0.786±0.053 (Mayo model), 0.682±0.060 (VA model) and 0.810±0.051 (Peking University People's Hospital model), respectively.
  
  
  CONCLUSIONS
  Serum level of Cyfra21-1, patient's age, maximum diameter of the nodule, spiculation, lobulation and calcification of the nodule are independent risk factors associated with the malignant probability of SPN. Peking University People's Hospital model is of high accuracy and clinical value for patients with SPN. Adding serum index (e.g. Cyfra21-1) into the prediction models as a new risk factor and adjusting the weight of age in the models might improve the accuracy of prediction for SPN.
authors.affiliation: Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Xiao
authors.forename: Deruo
authors.initials: D
authors.lastname: Liu
authors.forename: Yongqing
authors.initials: Y
authors.lastname: Guo
authors.forename: Bin
authors.initials: B
authors.lastname: Shi
authors.forename: Zhiyi
authors.initials: Z
authors.lastname: Song
authors.forename: Yanchu
authors.initials: Y
authors.lastname: Tian
authors.forename: Chaoyang
authors.initials: C
authors.lastname: Liang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000951:Antigens, Neoplasm / Q000378:metabolism; D019540:Area Under Curve; D002681:China; D005260:Female; D006801:Humans; D007564:Japan; D053539:Keratin-19 / Q000378:metabolism; D008175:Lung Neoplasms / Q000175:diagnosis / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011336:Probability; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D055815:Young Adult
chemical_list: D000951:Antigens, Neoplasm; D053539:Keratin-19; C102012:antigen CYFRA21.1