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Open Access 01-10-2017 | Chest

Malignancy risk estimation of screen-detected nodules at baseline CT: comparison of the PanCan model, Lung-RADS and NCCN guidelines

Authors: Sarah J. van Riel, Francesco Ciompi, Colin Jacobs, Mathilde M. Winkler Wille, Ernst Th. Scholten, Matiullah Naqibullah, Stephen Lam, Mathias Prokop, Cornelia Schaefer-Prokop, Bram van Ginneken

Published in: European Radiology | Issue 10/2017

Abstract

Objectives

To compare the PanCan model, Lung-RADS and the 1.2016 National Comprehensive Cancer Network (NCCN) guidelines for discriminating malignant from benign pulmonary nodules on baseline screening CT scans and the impact diameter measurement methods have on performances.

Methods

From the Danish Lung Cancer Screening Trial database, 64 CTs with malignant nodules and 549 baseline CTs with benign nodules were included. Performance of the systems was evaluated applying the system's original diameter definitions: D^longest-C (PanCan), D^meanAxial (NCCN), both obtained from axial sections, and D^mean3D (Lung-RADS). Subsequently all diameter definitions were applied uniformly to all systems. Areas under the ROC curves (AUC) were used to evaluate risk discrimination.

Results

PanCan performed superiorly to Lung-RADS and NCCN (AUC 0.874 vs. 0.813, p = 0.003; 0.874 vs. 0.836, p = 0.010), using the original diameter specifications. When uniformly applying D^longest-C, D^mean3D and D^meanAxial, PanCan remained superior to Lung-RADS (p < 0.001 – p = 0.001) and NCCN (p < 0.001 – p = 0.016). Diameter definition significantly influenced NCCN’s performance with D^longest-C being the worst (D^longest-C vs. D^mean3D, p = 0.005; D^longest-C vs. D^meanAxial, p = 0.016).

Conclusions

Without follow-up information, the PanCan model performs significantly superiorly to Lung-RADS and the 1.2016 NCCN guidelines for discriminating benign from malignant nodules. The NCCN guidelines are most sensitive to nodule size definition.

Key Points

• PanCan model outperforms Lung-RADS and 1.2016 NCCN guidelines in identifying malignant pulmonary nodules.

• Nodule size definition had no significant impact on Lung-RADS and PanCan model.

• 1.2016 NCCN guidelines were significantly superior when using mean diameter to longest diameter.

• Longest diameter achieved lowest performance for all models.

• Mean diameter performed equivalently when derived from axial sections and from volumetry.

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Title: Malignancy risk estimation of screen-detected nodules at baseline CT: comparison of the PanCan model, Lung-RADS and NCCN guidelines
Authors: Sarah J. van Riel
Francesco Ciompi
Colin Jacobs
Mathilde M. Winkler Wille
Ernst Th. Scholten
Matiullah Naqibullah
Stephen Lam
Mathias Prokop
Cornelia Schaefer-Prokop
Bram van Ginneken
Publication date: 01-10-2017
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 10/2017
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-017-4767-2

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Malignancy risk estimation of screen-detected nodules at baseline CT: comparison of the PanCan model, Lung-RADS and NCCN guidelines

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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