TY - JOUR
T1 - A prediction model to help with the assessment of adenopathy in lung cancer
T2 - HAL
AU - O'Connell, Oisin J.
AU - Almeida, Francisco A.
AU - Simoff, Michael J.
AU - Yarmus, Lonny
AU - Lazarus, Ray
AU - Young, Benjamin
AU - Chen, Yu
AU - Semaan, Roy
AU - Saettele, Timothy M.
AU - Cicenia, Joseph
AU - Bedi, Harmeet
AU - Kliment, Corrine
AU - Li, Liang
AU - Sethi, Sonali
AU - Diaz-Mendoza, Javier
AU - Feller-Kopman, David
AU - Song, Juhee
AU - Gildea, Thomas
AU - Lee, Hans
AU - Grosu, Horiana B.
AU - Machuzak, Michael
AU - Rodriguez-Vial, Macarena
AU - Eapen, George A.
AU - Jimenez, Carlos A.
AU - Casal, Roberto F.
AU - Ost, David E.
N1 - Publisher Copyright:
© Copyright 2017 by the American Thoracic Society.
PY - 2017/6/15
Y1 - 2017/6/15
N2 - Rationale: Estimating the probability of finding N2 or N3 (prN2/3) malignant nodal disease on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with non-small cell lung cancer (NSCLC) can facilitate the selection of subsequent management strategies. Objectives: To develop a clinical prediction model for estimating the prN2/3. Methods: We used the AQuIRE (American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education) registry to identify patients with NSCLC with clinical radiographic stage T1-3, N0-3, M0 disease that had EBUS-TBNA for staging. The dependent variable was the presence of N2 or N3 disease (vs. N0 or N1) as assessed by EBUS-TBNA. Univariate followed by multivariable logistic regression analysis was used to develop a parsimonious clinical prediction model to estimate prN2/3. External validation was performed using data from three other hospitals. Measurements and Main Results: The model derivation cohort (n = 633) had a 25% prevalence of malignant N2 or N3 disease. Younger age, central location, adenocarcinoma histology, and higher positron emission tomography-computed tomography N stage were associated with a higher prN2/3. Area under the receiver operating characteristic curve was 0.85 (95% confidence interval, 0.82-0.89), model fit was acceptable (Hosmer-Lemeshow, P = 0.62; Brier score, 0.125). We externally validated the model in 722 patients. Area under the receiver operating characteristic curve was 0.88 (95% confidence interval, 0.85-0.90). Calibration using the general calibration model method resulted in acceptable goodness of fit (Hosmer-Lemeshow test, P = 0.54; Brier score, 0.132). Conclusions: Our prediction rule can be used to estimate prN2/3 in patients with NSCLC. The model has the potential to facilitate clinical decision making in the staging of NSCLC.
AB - Rationale: Estimating the probability of finding N2 or N3 (prN2/3) malignant nodal disease on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with non-small cell lung cancer (NSCLC) can facilitate the selection of subsequent management strategies. Objectives: To develop a clinical prediction model for estimating the prN2/3. Methods: We used the AQuIRE (American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education) registry to identify patients with NSCLC with clinical radiographic stage T1-3, N0-3, M0 disease that had EBUS-TBNA for staging. The dependent variable was the presence of N2 or N3 disease (vs. N0 or N1) as assessed by EBUS-TBNA. Univariate followed by multivariable logistic regression analysis was used to develop a parsimonious clinical prediction model to estimate prN2/3. External validation was performed using data from three other hospitals. Measurements and Main Results: The model derivation cohort (n = 633) had a 25% prevalence of malignant N2 or N3 disease. Younger age, central location, adenocarcinoma histology, and higher positron emission tomography-computed tomography N stage were associated with a higher prN2/3. Area under the receiver operating characteristic curve was 0.85 (95% confidence interval, 0.82-0.89), model fit was acceptable (Hosmer-Lemeshow, P = 0.62; Brier score, 0.125). We externally validated the model in 722 patients. Area under the receiver operating characteristic curve was 0.88 (95% confidence interval, 0.85-0.90). Calibration using the general calibration model method resulted in acceptable goodness of fit (Hosmer-Lemeshow test, P = 0.54; Brier score, 0.132). Conclusions: Our prediction rule can be used to estimate prN2/3 in patients with NSCLC. The model has the potential to facilitate clinical decision making in the staging of NSCLC.
KW - Endobronchial ultrasound
KW - Lung cancer
KW - Lung cancer staging
KW - Mediastinal adenopathy
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U2 - 10.1164/rccm.201607-1397OC
DO - 10.1164/rccm.201607-1397OC
M3 - Article
C2 - 28002683
AN - SCOPUS:85021077865
SN - 1073-449X
VL - 195
SP - 1651
EP - 1660
JO - American journal of respiratory and critical care medicine
JF - American journal of respiratory and critical care medicine
IS - 12
ER -