title: Evaluation of undiagnosed solitary lung nodules according to the probability of malignancy in the American College of Chest Physicians (ACCP) evidence-based clinical practice guidelines.
abstract: BACKGROUND
  This study retrospectively investigated the clinical significance of undiagnosed solitary lung nodules removed by surgical resection.
  
  
  METHODS
  We retrospectively collected data on the age, smoking, cancer history, nodule size, location and spiculation of 241 patients who had nodules measuring 7 mm to 30 mm and a final diagnosis established by histopathology. We compared the final diagnosis of each patient with the probability of malignancy (POM) which was proposed by the American College of Chest Physicians (ACCP) guidelines.
  
  
  RESULTS
  Of the 241 patients, 203 patients were diagnosed to have a malignant lung tumor, while 38 patients were diagnosed with benign disease. There were significant differences in the patients with malignant and benign disease in terms of their age, smoking history, nodule size and spiculation. The mean value and the standard deviation of the POM in patients with malignant tumors were 51.7 + 26.1%, and that of patients with benign lesions was 34.6 + 26.7%. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.67. The best cut-off value provided from the ROC curve was 22.6. When the cut-off value was set at 22.6, the sensitivity was 83%, specificity 52%, positive predictive value 90%, negative predictive value 36% and accuracy 77%, respectively.
  
  
  CONCLUSIONS
  The clinical prediction model proposed in the ACCP guidelines showed unsatisfactory results in terms of the differential diagnosis between malignant disease and benign disease of solitary lung nodules in our study, because the specificity, negative predictive value and AUC were relatively low.
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Shinohara
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hanagiri
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Takenaka
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Chikaishi
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Soich
authors.initials: S
authors.lastname: Oka
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Shimokawa
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Nakagawa
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Uramoto
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: So
authors.affiliation: Department of Radiology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Tanaka
keywords: computed tomography; inflammatory lung nodule; non-small cell lung cancer; solitary pulmonary nodules; surgical resection; undiagnosed lung nodule