Abstract
The next diagnostic step in cases of indeterminate radial probe endobronchial ultrasound (radial EBUS)-guided biopsy results remains uncertain. This study aimed to identify risk factors for malignancy based on clinical findings, chest computed tomography (CT), and radial EBUS images, and to estimate the risk of malignancy in lung nodules that showed indeterminate radial EBUS-guided biopsy results by constructing a nomogram. This retrospective study included 157 patients with indeterminate results on an initial radial EBUS biopsy performed at the Samsung Medical Center from January 2017 to December 2018, but with a definitive final diagnosis. Medical records, chest CT, radial EBUS images, and the final diagnoses were reviewed. Patients were randomly divided into training and validation sets. Factors related to malignancy were identified through logistic regression analysis, and a nomogram was constructed using the training set and subsequently applied to the validation set. Six factors in univariable and multivariable analyses, including upper lobe location, spiculation, satellite nodules, echogenicity, presence of dots or linear arcs, and patency of vessels and bronchi predicted malignancy. A nomogram was constructed based on these predictors. The area under the curve (AUC) value of the nomogram was 0.858 using the chest CT factors, which improved to 0.952 when radial EBUS factors were added. The calibration curve showed good agreement between the actual and nomogram-predicted malignancy outcomes. The utility of radial EBUS images for revealing risk factors of malignancy was confirmed. Furthermore, our nomogram was able to predict the probability of malignancy in lung nodules with indeterminate radial EBUS-guided biopsy results.
Highlights
Diagnosing peripheral pulmonary nodules remains a significant challenge for pulmonologists
Based on the identified risk factors, we developed a nomogram to estimate the risk of malignancy in indeterminate radial radial probe endobronchial ultrasound (EBUS)-guided biopsy results, which enables us to identify patients who may receive greater benefit from additional procedures
We retrospectively reviewed the medical records of 494 patients who underwent radial EBUS biopsy at the Samsung Medical Center, Seoul, Korea from January 2017 to December 2018
Summary
Diagnosing peripheral pulmonary nodules remains a significant challenge for pulmonologists. Several quantitative models have been developed to estimate the pretest probability of malignancy of pulmonary nodules, to expedite treatment of malignant nodules and minimize procedures for benign ones [1]. Classical models for determining the probability of malignancy constructed by the Mayo. Clinic [2], the Veterans Association (VA) [3], and Brock University [4] include clinical factors, such as age, smoking history, cancer history, and radiological characteristics on chest computed tomography (CT), such as the diameter and location of the nodule. Many attempts have been made to identify risk factors for malignancy of pulmonary nodules, which may inform the diagnostic step. With the detection of pulmonary nodules rising, this has led to improve diagnostic sensitivity of advanced bronchoscopic techniques, including radial probe endobronchial ultrasound (radial EBUS) [5]. In a meta-analysis performed in 2017, the overall diagnostic yield for radial EBUS was 70.6% [6]
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