Evaluation of undiagnosed solitary lung nodules according to the probability of malignancy in the ACCP evidence-based clinical practice guidelines
[Aims] This study retrospectively investigated the clinical significance of undiagnosed solitary lung nodules removed by surgical resection.
[Subjects] 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 guidelines.
[Results] Of the 241 patients, 203 patients was 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 was 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, specificity, positive predictive value, negative predictive value and accuracy were 83%, 52%, 90%, 36% and 77%, respectively.
[Conclusion] 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.