The solitary pulmonary nodule. Decision analysis.

The management of a patient with a solitary pulmonary nodule is often problematic. Particularly in older patients and those with cardiorespiratory disease, the risks of intervention frequently equal or exceed its potential benefits. In this paper the choice between expectant management, thoracotomy, and transthoracic needle biopsy is examined for the asymptomatic patient with a solitary pulmonary nodule. We have designed and implemented a computer-assisted decision-analytic model of this clinical situation. The model incorporates age, sex, smoking history, and underlying cardiorespiratory status. It considers the probability of having a malignant nodule, the risks of biopsy and surgery, the sensitivity and specificity of biopsy, the resectability rate of malignant nodules, and the morbidity-adjusted life expectancies of patients in 16 outcome categories. Sensitivity analyses were performed and decision thresholds determined to assess the effect of varying the model's data base. These results can be of assistance in choosing therapy for patients with solitary pulmonary nodules and can provide a better understanding of the factors involved in this decision making process.