Pulmonary nodule malignancy probability: a diagnostic accuracy meta-analysis of the Mayo model

Abstract

To quantify the overall diagnostic accuracy of the Mayo model in predicting the probability of malignancy of solitary pulmonary nodules (SPNs) by carrying out a systematic review and meta-analysis. PubMed, Scopus, and references of relevant articles were searched systematically from inception up to 21 September 2021, to identify observational cohort studies, which reported on the diagnostic accuracy of the Mayo model in predicting the probability of malignancy in SPNs. The primary outcome was the pooled area under the receiver operating characteristic (ROC) curve (AUC). Secondary outcomes were sensitivity, specificity, and diagnostic odds ratio (DOR). The meta-analysis was registered with PROSPERO. Forty studies involving 46,694 patients were included. The overall pooled AUC was 0.730 (95% confidence interval [CI]: 0.704-0.755), while sensitivity and specificity were 0.78 (95% CI: 0.67-0.86) and 0.68 (95% CI: 0.57-0.77), respectively. Subgroup analyses revealed that the model had a better performance among datasets with increased prevalence of current/ex-smokers (AUC 0.762, 95% CI: 0.713-0.810, versus AUC 0.695, 95% CI: 0.660-0.730 and among studies conducted in continents other than Asia (AUC 0.769, 95% CI: 0.732-0.806 versus AUC 0.699, 95% CI: 0.669-0.729, p<0.001, I2=91.20%) CONCLUSIONS: The Mayo model seems a fair diagnostic tool; however, the synthesised evidence informs clinicians and researchers that it may be more applicable on certain patient populations, such as smokers and non-Asians.