• Anil Vachani, Chengyi Zheng, Amy LiuIn-LuILDepartment of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA., Brian Z Huang, Thearis A Osuji, and Michael K Gould.
• Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA.
• Chest. 2022 Feb 1; 161 (2): 562-571.

BackgroundThe frequency of cancer and accuracy of prediction models have not been studied in large, population-based samples of patients with incidental pulmonary nodules measuring > 8 mm in diameter.Research QuestionsHow does the frequency of cancer vary by size and smoking history among patients with incidental nodules? How accurate are two widely used models for identifying cancer in these patients?Study Design And MethodsWe assembled a retrospective cohort of individuals with incidental nodules measuring > 8 mm in diameter identified by chest CT imaging between 2006 and 2016. We used a validated natural language processing algorithm to identify nodules and their characteristics by scanning the text of dictated radiology reports. We reported patient and nodule characteristics stratified by the presence or absence of a lung cancer diagnosis within 27 months of nodule identification and estimated the area under the receiver operating characteristic curve (AUC) to compare the accuracy of the Mayo Clinic and Brock models for identifying cancer.ResultsThe sample included 23,780 individuals with a nodule measuring > 8 mm, including 2,356 patients (9.9%) with a lung cancer diagnosis within 27 months of nodule identification. Cancer was diagnosed in 5.4% of never smokers, 12.2% of former smokers, and 17.7% of current smokers. Cancer was diagnosed in 5.7% of patients with nodules measuring 9 to 15 mm, 12.1% of patients with nodules > 15 to 20 mm, and 18.4% of patients with nodules > 20 to 30 mm. In the full sample, the Mayo Clinic model (AUC, 0.747; 95% CI, 0.737-0.757) was more accurate than the Brock model (AUC, 0.713; 95% CI, 0.702-0.724; P < .0001). When restricted to ever smokers, the Mayo Clinic model was still more accurate. Both models overestimated the probability of cancer.InterpretationAlmost 10% of patients with an incidental pulmonary nodule measuring > 8 mm in diameter will receive a lung cancer diagnosis. Existing prediction models have only fair accuracy and overestimate the probability of cancer.Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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