A Nomogram For Predicting The Risk Of Invasive Adenocarcinoma In Patients With A Peripheral Pulmonary Nodule

Part ?Objective The aim of this research is to assess the correlation between the radiological characteristics and the pathological results in the peripheral pulmonary nodules.Methods A retrospective study was conducted in patients underwent pulmonary nodule resections between Jan 2014 and Jan 2015.Clinical parameters and imaging features were analyzed by univariate and multivariate logistic regression analysis.Results Following multivariate analysis,except for sex,age,nodule location,the history of smoking,shape and the margin of the nodules,the CT attenuation,nodule size,signs of vascular convergence,spiculation and the solid proportion were found to be associated with malignant pathologic outcomes.Conclusions The larger the nodules in size,smaller in CT attenuation and the lower solid proportions,the more likelihood of being maligant.The signs of vascular convergence and spiculation are also highly correlated with the malignant results.Part IIObjective The subsolid nodule is a common clinical concern.The aim of this study was to construct a nomogram to predict the risk of invasive pulmonary adenocarcinoma in patients with a solitary peripheral subsolid nodule.Methods We reviewed the records of 293 patients who had undergone resection of a solitary peripheral subsolid nodule,including the results of pathologic examinations after surgical resection.Clinical parameters and imaging features were analyzed by the use of univariable and multivariable logistic regression analysis.A nomogram to predict the risk of invasive pulmonary adenocarcinoma was constructed and validated with bootstrap resampling.Results Two hundred seventy-three patients were included for analysis;35 were diagnosed as benign,3 as atypical adenomatous hyperplasia,18 as adenocarcinomain situ,58 as minimally invasive adenocarcinoma,and 159 as invasive pulmonary adenocarcinoma.After final regression analysis,the computed tomography attenuation,nodule size,spiculation,signs of vascular convergence,pleural tags,and solid proportion were identified and were entered into the nomogram.The nomogram showed a robust discrimination,with an area under the receiver operating characteristic curve of 0.894.The calibration curves for the probability of invasive pulmonary adenocarcinoma showed optimal agreement between the probability as predicted by the nomogram and the actual probability.Conclusions We developed a nomogram that can predict the risk of invasive pulmonary adenocarcinoma for patients with a solitary peripheral subsolid nodule.Validation by the use of bootstrap resampling revealed optimal discrimination and calibration,indicating that the nomogram may have clinical utility.This model has the potential to assist clinicians in making treatment recommendations.Part ?Objective:The pure ground-glass nodule is a common clinical concern.The purpose of this study was to develop a nomogram to predict the risk of invasive pulmonary adenocarcinoma with pure ground-glass nodules?1 cm in diameter based on the HRCT imaging features.Methods:We reviewed a total of 250 patients who had undergone resection of pure ground-glass nodules<lcm in diameter in our hospital from December 2015 to July 2017,including the data of histopathologic examinations after surgical resection.Clinical information and HRCT imaging features were analyzed by the use of univariable and multivariable binary logistic regression analysis.A nomogram to predict the risk of invasive pulmonary adenocarcinoma was developed and the calibration curves for the probability were drew.Results:Two hundred fifty patients were enrolled for analysis,included 63(25.2%)men and 187(74.8%)women,with age ranging from 18 to 79 years(mean 52.5±11.9 years);13 as benign lesions,8 as atypical adenomatous hyperplasia,64 as adenocarcinoma in situ,137 as minimally invasive adenocarcinoma,and 28 as invasive adenocarcinoma.On the basis of the final logistic regression analysis,the lesion size,spiculation,lobulation,air bronchogram,vascular convergence,pleural tag and the computed tomography window width were identified for predicting the risk of invasive pulmonary adenocarcinoma and were entered into the nomogram.High scores were added to lesion size and computed tomography window width.A total score could be calculated by adding score of each factor.Higher total score was associated with greater risk of IPA.The nomogram showed an excellent discrimination,with an area under the receiver operating characteristic curve of 0.916 for internal validation and 0.970 for external validation.The calibration curves for the probability of invasive pulmonary adenocarcinoma showed optimal agreement between the predicted probability by the nomogram and the actual probability.Conclusions:We constructed a novel nomogram that can predict the risk of invasive pulmonary adenocarcinoma for patients with pure ground-glass nodules?1 cm in diameter.With highly accurate,excellent calibration and discrimination of the model,clinicians could more precisely make a specific pretreatment strategy for each patient.