title: A Prediction Model to Help with the Assessment of Adenopathy in Lung Cancer: HAL.
abstract: Estimating the probability of finding N2 or N3 (prN2/3) malignant nodal disease on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with non-small cell lung cancer (NSCLC) can facilitate the selection of subsequent management strategies.
  
  
  
  To develop a clinical prediction model for estimating the prN2/3.
  
  
  
  We used the AQuIRE (American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education) registry to identify patients with NSCLC with clinical radiographic stage T1-3, N0-3, M0 disease that had EBUS-TBNA for staging. The dependent variable was the presence of N2 or N3 disease (vs. N0 or N1) as assessed by EBUS-TBNA. Univariate followed by multivariable logistic regression analysis was used to develop a parsimonious clinical prediction model to estimate prN2/3. External validation was performed using data from three other hospitals.
  
  
  
  The model derivation cohort (n = 633) had a 25% prevalence of malignant N2 or N3 disease. Younger age, central location, adenocarcinoma histology, and higher positron emission tomography-computed tomography N stage were associated with a higher prN2/3. Area under the receiver operating characteristic curve was 0.85 (95% confidence interval, 0.82-0.89), model fit was acceptable (Hosmer-Lemeshow, P = 0.62; Brier score, 0.125). We externally validated the model in 722 patients. Area under the receiver operating characteristic curve was 0.88 (95% confidence interval, 0.85-0.90). Calibration using the general calibration model method resulted in acceptable goodness of fit (Hosmer-Lemeshow test, P = 0.54; Brier score, 0.132).
  
  
  
  Our prediction rule can be used to estimate prN2/3 in patients with NSCLC. The model has the potential to facilitate clinical decision making in the staging of NSCLC.
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: Oisin J
authors.initials: OJ
authors.lastname: O'Connell
authors.affiliation: 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Almeida
authors.affiliation: 3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; and.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Simoff
authors.affiliation: 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Lonny
authors.initials: L
authors.lastname: Yarmus
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: Ray
authors.initials: R
authors.lastname: Lazarus
authors.affiliation: 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Young
authors.affiliation: 3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; and.
authors.forename: Yu
authors.initials: Y
authors.lastname: Chen
authors.affiliation: 3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; and.
authors.forename: Roy
authors.initials: R
authors.lastname: Semaan
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Saettele
authors.affiliation: 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Joseph
authors.initials: J
authors.lastname: Cicenia
authors.affiliation: 3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; and.
authors.forename: Harmeet
authors.initials: H
authors.lastname: Bedi
authors.affiliation: 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Corrine
authors.initials: C
authors.lastname: Kliment
authors.affiliation: 5 Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Liang
authors.initials: L
authors.lastname: Li
authors.affiliation: 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Sonali
authors.initials: S
authors.lastname: Sethi
authors.affiliation: 3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; and.
authors.forename: Javier
authors.initials: J
authors.lastname: Diaz-Mendoza
authors.affiliation: 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: David
authors.initials: D
authors.lastname: Feller-Kopman
authors.affiliation: 5 Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas.
authors.forename: Juhee
authors.initials: J
authors.lastname: Song
authors.affiliation: 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gildea
authors.affiliation: 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Hans
authors.initials: H
authors.lastname: Lee
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: Horiana B
authors.initials: HB
authors.lastname: Grosu
authors.affiliation: 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Michael
authors.initials: M
authors.lastname: Machuzak
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: Macarena
authors.initials: M
authors.lastname: Rodriguez-Vial
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: George A
authors.initials: GA
authors.lastname: Eapen
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Jimenez
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: Roberto F
authors.initials: RF
authors.lastname: Casal
authors.affiliation: 1 Department of Pulmonary Medicine and.
authors.forename: David E
authors.identifier: 0000-0001-6351-5552
authors.initials: DE
authors.lastname: Ost
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology*; D008198:Lymph Nodes / Q000473:pathology*; D000072281:Lymphadenopathy / Q000473:pathology*; D008207:Lymphatic Metastasis; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies
keywords: endobronchial ultrasound; lung cancer; lung cancer staging; mediastinal adenopathy