Abstract
Background
Indeterminate pulmonary nodules present a common challenge for clinicians who must
recommend surveillance or intervention based on an assessed risk of malignancy.
Patients and Methods
In this cohort study, patients presenting for indeterminate pulmonary nodule evaluation
were enrolled at sites participating in the Colorado SPORE in Lung Cancer. They were
followed prospectively and included for analysis if they had a definitive malignant
diagnosis, benign diagnosis, or radiographic resolution or stability of their nodule
for >2 years.
Results
Patients evaluated at the Veterans Affairs (VA) and non-VA sites were equally as likely
to have a malignant diagnosis (48%). The VA cohort represented a higher-risk group
than the non-VA cohort regarding smoking history and chronic obstructive pulmonary
disease (COPD). There were more squamous cell carcinoma diagnoses among VA malignant
nodules (25% vs 10%) and a later stage at diagnosis among VA patients. Discrimination
and calibration of risk calculators produced estimates that were wide-ranging and
different when comparing between risk score calculators as well as between VA/non-VA
cohorts. Application of current American College of Chest Physicians guidelines to
our groups could have resulted in inappropriate resection of 12% of benign nodules.
Conclusion
Comparison of VA with non-VA patients shows important differences in underlying risk,
histology of malignant nodules, and stage at diagnosis. This study highlights the
challenge in applying risk calculators to a clinical setting, as the model discrimination
and calibration were variable between calculators and between our higher-risk VA and
lower-risk non-VA groups.
MicroAbstract
: Risk stratification and management of indeterminate pulmonary nodules (IPNs) is
a common clinical problem. In this prospective cohort study of 282 patients with IPNs
from Veterans Affairs (VA) and non-VA sites, we found differences in patient and nodule
characteristics, histology and diagnostic stage, and risk calculator performance.
Our findings highlight challenges and shortcomings of current IPN management guidelines
and tools.
Keywords
Abbreviation:
AUC (Area under the receiver operating curve), CT (Computed tomography), EMR (Electronic medical record), IPN (Indeterminate pulmonary nodule), NSCLC (Non-small cell lung cancer), VA (Veterans Affairs)To read this article in full you will need to make a payment
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Article info
Publication history
Accepted:
February 10,
2023
Received in revised form:
February 6,
2023
Received:
August 19,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
Clinical Trials Number: NCT01085864
Identification
Copyright
Published by Elsevier Inc.
