title: Limited value of logistic regression analysis in solid solitary pulmonary nodules characterization: a single-center experience on 288 consecutive cases.
abstract: OBJECTIVE
  Preoperative characterization of the solitary pulmonary nodule is a delicate task faced by surgeons, radiologists, and clinicians. Mathematical models have been developed to overcome subjectivity. The Mayo Clinic model was suggested in the latest ACCP evidence-based clinical practice guidelines for the preoperative risk assessment of solitary pulmonary nodule malignancy. The aim of the study is to assess the validity of the Mayo Clinic model in a current continuous case series of biopsy-proven nodules.
  
  
  METHODS
  The Mayo Clinic model was applied to estimate probability of malignancy in 288 consecutive cases in this single-center retrospective study.
  
  
  RESULTS
  ROC curve analysis returned an AUC of 0.767, while analysis performed on 158 malignant nodules showed a mean predicted risk value of 38.15%. In our clinical setting, using a risk observational threshold set at 5% and a risk surgical threshold set at 60%, there would have been 4 cases of unnecessary surgery (false positives) at the cost of 13 cases of cancer progression (false negatives), while 68.75% of all nodules would have received non-decisional values.
  
  
  CONCLUSIONS
  Surgeons should be aware that current data shows how the Mayo Clinic model is of little use in preoperative nodule characterization.
authors.affiliation: Azienda Ospedaliera Universitaria Integrata di Verona, Piazzale Stefani 1, Verona, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Perandini
authors.forename: G A
authors.initials: GA
authors.lastname: Soardi
authors.forename: M
authors.initials: M
authors.lastname: Motton
authors.forename: C
authors.initials: C
authors.lastname: Dallaserra
authors.forename: S
authors.initials: S
authors.lastname: Montemezzi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000473:pathology*; D014057:Tomography, X-Ray Computed
keywords: lung cancer; preoperative risk assessment; solitary pulmonary nodule