Development of a multivariate model to predict the likelihood of carcinoma in patients with indeterminate peripheral lung nodules after a nondiagnostic bronchoscopic evaluation

Jesse S. Voss, Seher Iqbal, Sarah M. Jenkins, Michael R. Henry, Amy C. Clayton, James R. Jett, Benjamin R. Kipp, Kevin C. Halling, Fabien Maldonado

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Summary Studies have shown that fluorescence in situ hybridization (FISH) testing increases lung cancer detection on cytology specimens in peripheral nodules. The goal of this study was to determine whether a predictive model using clinical features and routine cytology with FISH results could predict lung malignancy after a nondiagnostic bronchoscopic evaluation. Patients with an indeterminate peripheral lung nodule that had a nondiagnostic bronchoscopic evaluation were included in this study (N = 220). FISH was performed on residual bronchial brushing cytology specimens diagnosed as negative (n = 195), atypical (n = 16), or suspicious (n = 9). FISH results included hypertetrasomy (n = 30) and negative (n = 190). Primary study end points included lung cancer status along with time to diagnosis of lung cancer or date of last clinical follow-up. Hazard ratios (HRs) were calculated using Cox proportional hazards regression model analyses, and P values <.05 were considered statistically significant. The mean age of the 220 patients was 66.7 years (range, 35-91), and most (58%) were men. Most patients (79%) were current or former smokers with a mean pack year history of 43.2 years (median, 40; range, 1-200). After multivariate analysis, hypertetrasomy FISH (HR = 2.96, P <.001), pack years (HR = 1.03 per pack year up to 50, P =.001), age (HR = 1.04 per year, P =.02), atypical or suspicious cytology (HR = 2.02, P =.04), and nodule spiculation (HR = 2.36, P =.003) were independent predictors of malignancy over time and were used to create a prediction model (C-statistic = 0.78). These results suggest that this multivariate model including test results and clinical features may be useful following a nondiagnostic bronchoscopic examination.

Original languageEnglish (US)
Pages (from-to)41-47
Number of pages7
JournalHuman Pathology
Volume45
Issue number1
DOIs
StatePublished - Jan 2014

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Fluorescence In Situ Hybridization
Cell Biology
Carcinoma
Lung
Lung Neoplasms
Proportional Hazards Models
Neoplasms
Multivariate Analysis
Regression Analysis

Keywords

  • Bronchoscopy
  • Cytology
  • Lung cancer
  • Pulmonary nodule

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Development of a multivariate model to predict the likelihood of carcinoma in patients with indeterminate peripheral lung nodules after a nondiagnostic bronchoscopic evaluation. / Voss, Jesse S.; Iqbal, Seher; Jenkins, Sarah M.; Henry, Michael R.; Clayton, Amy C.; Jett, James R.; Kipp, Benjamin R.; Halling, Kevin C.; Maldonado, Fabien.

In: Human Pathology, Vol. 45, No. 1, 01.2014, p. 41-47.

Research output: Contribution to journalArticle

Voss, Jesse S. ; Iqbal, Seher ; Jenkins, Sarah M. ; Henry, Michael R. ; Clayton, Amy C. ; Jett, James R. ; Kipp, Benjamin R. ; Halling, Kevin C. ; Maldonado, Fabien. / Development of a multivariate model to predict the likelihood of carcinoma in patients with indeterminate peripheral lung nodules after a nondiagnostic bronchoscopic evaluation. In: Human Pathology. 2014 ; Vol. 45, No. 1. pp. 41-47.
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abstract = "Summary Studies have shown that fluorescence in situ hybridization (FISH) testing increases lung cancer detection on cytology specimens in peripheral nodules. The goal of this study was to determine whether a predictive model using clinical features and routine cytology with FISH results could predict lung malignancy after a nondiagnostic bronchoscopic evaluation. Patients with an indeterminate peripheral lung nodule that had a nondiagnostic bronchoscopic evaluation were included in this study (N = 220). FISH was performed on residual bronchial brushing cytology specimens diagnosed as negative (n = 195), atypical (n = 16), or suspicious (n = 9). FISH results included hypertetrasomy (n = 30) and negative (n = 190). Primary study end points included lung cancer status along with time to diagnosis of lung cancer or date of last clinical follow-up. Hazard ratios (HRs) were calculated using Cox proportional hazards regression model analyses, and P values <.05 were considered statistically significant. The mean age of the 220 patients was 66.7 years (range, 35-91), and most (58{\%}) were men. Most patients (79{\%}) were current or former smokers with a mean pack year history of 43.2 years (median, 40; range, 1-200). After multivariate analysis, hypertetrasomy FISH (HR = 2.96, P <.001), pack years (HR = 1.03 per pack year up to 50, P =.001), age (HR = 1.04 per year, P =.02), atypical or suspicious cytology (HR = 2.02, P =.04), and nodule spiculation (HR = 2.36, P =.003) were independent predictors of malignancy over time and were used to create a prediction model (C-statistic = 0.78). These results suggest that this multivariate model including test results and clinical features may be useful following a nondiagnostic bronchoscopic examination.",
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AU - Henry, Michael R.

AU - Clayton, Amy C.

AU - Jett, James R.

AU - Kipp, Benjamin R.

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AU - Maldonado, Fabien

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AB - Summary Studies have shown that fluorescence in situ hybridization (FISH) testing increases lung cancer detection on cytology specimens in peripheral nodules. The goal of this study was to determine whether a predictive model using clinical features and routine cytology with FISH results could predict lung malignancy after a nondiagnostic bronchoscopic evaluation. Patients with an indeterminate peripheral lung nodule that had a nondiagnostic bronchoscopic evaluation were included in this study (N = 220). FISH was performed on residual bronchial brushing cytology specimens diagnosed as negative (n = 195), atypical (n = 16), or suspicious (n = 9). FISH results included hypertetrasomy (n = 30) and negative (n = 190). Primary study end points included lung cancer status along with time to diagnosis of lung cancer or date of last clinical follow-up. Hazard ratios (HRs) were calculated using Cox proportional hazards regression model analyses, and P values <.05 were considered statistically significant. The mean age of the 220 patients was 66.7 years (range, 35-91), and most (58%) were men. Most patients (79%) were current or former smokers with a mean pack year history of 43.2 years (median, 40; range, 1-200). After multivariate analysis, hypertetrasomy FISH (HR = 2.96, P <.001), pack years (HR = 1.03 per pack year up to 50, P =.001), age (HR = 1.04 per year, P =.02), atypical or suspicious cytology (HR = 2.02, P =.04), and nodule spiculation (HR = 2.36, P =.003) were independent predictors of malignancy over time and were used to create a prediction model (C-statistic = 0.78). These results suggest that this multivariate model including test results and clinical features may be useful following a nondiagnostic bronchoscopic examination.

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