University of Colorado, Division of Pulmonary Sciences and Critical Care Medicine, Aurora, CO; Rocky Mountain Regional VA Medical Center, Aurora, CO.
Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.
Clin Lung Cancer. 2023 Jul;24(5):407-414. doi: 10.1016/j.cllc.2023.02.006. Epub 2023 Mar 4.
Indeterminate pulmonary nodules present a common challenge for clinicians who must recommend surveillance or intervention based on an assessed risk of malignancy.
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.
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.
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.
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.
对于临床医生来说，诊断不确定的肺部结节是一个常见的挑战，他们必须根据恶性肿瘤的风险评估来建议进行监测或干预。
在这项队列研究中，在参与科罗拉多州肺癌 SPORE 的站点就诊的诊断不确定的肺部结节患者入组。他们进行前瞻性随访，如果他们有明确的恶性诊断、良性诊断、或结节的影像学消退或稳定超过 2 年，则纳入分析。
在退伍军人事务部（VA）和非 VA 站点评估的患者发生恶性诊断的可能性相同（48%）。VA 队列在吸烟史和慢性阻塞性肺疾病（COPD）方面比非 VA 队列具有更高的风险。VA 恶性结节中更多的是鳞状细胞癌诊断（25%比 10%），并且 VA 患者的诊断分期更晚。风险计算器的区分度和校准产生的估计值范围广泛，且在风险评分计算器之间以及 VA/非 VA 队列之间存在差异。将当前美国胸科医师学会指南应用于我们的组中，可能导致 12%的良性结节被不适当切除。
VA 与非 VA 患者的比较显示出基础风险、恶性结节的组织学和诊断分期方面的重要差异。这项研究强调了将风险计算器应用于临床环境中的挑战，因为模型的区分度和校准在计算器之间以及我们的高风险 VA 和低风险非 VA 组之间存在差异。
诊断不确定的肺部结节（IPN）的风险分层和管理是一个常见的临床问题。在这项来自退伍军人事务部（VA）和非 VA 站点的 282 例 IPN 患者的前瞻性队列研究中，我们发现患者和结节特征、组织学和诊断分期以及风险计算器性能存在差异。我们的研究结果突显了当前 IPN 管理指南和工具的挑战和不足。
