Solitary pulmonary nodule malignancy risk (Cummings prediction model: Bayesian approach)

 

Input
 

Patient age 20 to 29 years old (0.05) 30 to 39 years old (0.24) 40 to 49 years old (0.94) 50 to 59 years old (1.9) 60 to 69 years old (2.64) ≥70 years old (4.16)

Nodule size 0 to 1 cm (0.52) 1.1 to 2 cm (0.74) 2.1 to 3 cm (3.67) >3 cm (5.23)

Edge on CXR Well defined, smooth (0.36) Well defined, lobular (1.27) Ill defined (2.51)

Tomographic appearance Not available (1) Malignant (37.2) Intermediate (0.73) Benign (0)

Edge by CT Not available (1) Smooth (0.3) Lobulated (0.74) Irregular/spicular (5.54)

Calcification on tomography Not available (1) Calcified (0) Noncalcified (1.5)

Calcification on CT Not available (1) In phantom (benign) (0.07) In phantom (2.2)

Growth rate Not available (1) <7 days (0) 7 to 465 days (3.4) >465 days (0.01)

Location Lower lobe (0.66) Upper or middle lobe (1.22)

Max cavity wall thickness Not available (1) ≤4 mm (0.07) 5 to 15 mm (0.72) ≥16 mm (37.97)

Smoking history Never smoker (0.19) Current cigarette smoker (2.27) Pipe or cigar smoker (1) Ex-cigarette smoker (0.92) Ex pipe or cigar smoker (0.55)

Hemoptysis No (1) Yes (5.08)

Previous malignancy No (1) Yes (4.95)

 

Results
 

Post test odds
Cancer probability		% fraction ratio
Decimal Precision   0 1 2 3

 

 

Notes

• This calculator incorporates a pretest odds of 0.28:1. Local prevalence may be different than the population studied in the Gurney articles.^1,2

 
Equations used
 

Post test odds = 0.28 * Patient age * Nodule size * Edge on CXR * Tomographic appearance * Edge by CT * Calcification on tomography * Calcification on CT * Growth rate * Location * Max cavity wall thickness * Smoking history * Hemoptysis * Previous malignancy

Posttestodds = 0.28 * Patientage * Nodulesize * EdgeonCXR * Tomographicappearance * EdgebyCT * Calcificationontomography * CalcificationonCT * Growthrate * Location * Maxcavitywallthickness * Smokinghistory * Hemoptysis * Previousmalignancy

Cancer probability = 100 * Post test odds / (1 + Post test odds)

Cancerprobability = 100 * Posttestodds / (1 + Posttestodds)

 

 

References

1. Gurney JW. Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part I. Theory. Radiology. 1993 Feb;186(2):405-13. PubMed ID: 8421743
2. Gurney JW, Lyddon DM, McKay JA. Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part II. Application. Radiology. 1993 Feb;186(2):415-22. PubMed ID: 8421744