title: Malignancy risk estimation of screen-detected nodules at baseline CT: comparison of the PanCan model, Lung-RADS and NCCN guidelines.
abstract: OBJECTIVE
  To compare the PanCan model, Lung-RADS and the 1.2016 National Comprehensive Cancer Network (NCCN) guidelines for discriminating malignant from benign pulmonary nodules on baseline screening CT scans and the impact diameter measurement methods have on performances.
  
  
  METHODS
  From the Danish Lung Cancer Screening Trial database, 64 CTs with malignant nodules and 549 baseline CTs with benign nodules were included. Performance of the systems was evaluated applying the system's original diameter definitions: Dlongest-C(PanCan), DmeanAxial(NCCN), both obtained from axial sections, and Dmean3D(Lung-RADS). Subsequently all diameter definitions were applied uniformly to all systems. Areas under the ROC curves (AUC) were used to evaluate risk discrimination.
  
  
  RESULTS
  PanCan performed superiorly to Lung-RADS and NCCN (AUC 0.874 vs. 0.813, p = 0.003; 0.874 vs. 0.836, p = 0.010), using the original diameter specifications. When uniformly applying Dlongest-C, Dmean3Dand DmeanAxial, PanCan remained superior to Lung-RADS (p < 0.001 - p = 0.001) and NCCN (p < 0.001 - p = 0.016). Diameter definition significantly influenced NCCN's performance with Dlongest-Cbeing the worst (Dlongest-Cvs. Dmean3D, p = 0.005; Dlongest-Cvs. DmeanAxial, p = 0.016).
  
  
  CONCLUSIONS
  Without follow-up information, the PanCan model performs significantly superiorly to Lung-RADS and the 1.2016 NCCN guidelines for discriminating benign from malignant nodules. The NCCN guidelines are most sensitive to nodule size definition.
  
  
  CONCLUSIONS
  • PanCan model outperforms Lung-RADS and 1.2016 NCCN guidelines in identifying malignant pulmonary nodules. • Nodule size definition had no significant impact on Lung-RADS and PanCan model. • 1.2016 NCCN guidelines were significantly superior when using mean diameter to longest diameter. • Longest diameter achieved lowest performance for all models. • Mean diameter performed equivalently when derived from axial sections and from volumetry.
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands. s.j.vanriel3@gmail.com.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: van Riel
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ciompi
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Colin
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: Department of Pulmonology Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
authors.forename: Mathilde M
authors.initials: MM
authors.lastname: Winkler Wille
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Ernst Th
authors.initials: ET
authors.lastname: Scholten
authors.affiliation: Department of Pulmonology Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
authors.forename: Matiullah
authors.initials: M
authors.lastname: Naqibullah
authors.affiliation: Department of Integrative Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
authors.forename: Stephen
authors.initials: S
authors.lastname: Lam
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Mathias
authors.initials: M
authors.lastname: Prokop
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.|Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Schaefer-Prokop
authors.affiliation: Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Bram
authors.initials: B
authors.lastname: van Ginneken
mesh_terms: D000368:Aged; D019540:Area Under Curve; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000473:pathology; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging* / Q000473:pathology; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012306:Risk; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Computer tomography; Diagnostic imaging; Lung cancer screening; Risk; Solitary pulmonary nodule