PulmApps

Probability of Malignancy

Hover over each risk score to highlight the variables included.

McWilliams 2013 (Brock):

Not applicable

Swensen 2005 (Mayo):

Not applicable

Gould 2007 (VA):

Not applicable

Nodule Follow Up Recommendations

Incomplete Data

Lung Cancer Screening Eligibility

Not a candidate for annual screening.

Risk stratification scores are derived from composite likelihood ratios from equations published by McWilliams, et al. ( PMID: 24004118 ); Swensen, et al. (original: PMID: 9129544 ;Herder, et al. update: PMID: 16236914 ); and Gould, et al. ( PMID 17296637 ). The Brock (McWilliams, et al.) model is considered the most generalizable and versatile model as it was derived from a population of 2961 patients with an overall prevalence of cancer of approximately 5% and given that it accounts for nodules of different densities and the presence of multiple nodules. However, it is important to note that the data sets used to validate the Brock model (BCCA and PanCan) had relatively lower incidences of malignant nodules (3.7% and 5.5%, respectively) when compared to the other models. When used the with correction factors published by Herder, et al., the Swensen model can account for the FDG avidity of a nodule. However, it is important to note that lack of avidity is does NOT decrease the risk of malignancy. Additionally, the Swensen model does not take into account the presence of additional nodules. The prevalence of malignancy was 23% and 12% indeterminate. The Gould model was dervived from a cohort of VA beneficiaries (>95% male) with solid nodules 7-30mm and takes into account the years after quitting tobacco. The overall prevalence of malignant nodules was 54%. The Gould calculation is not provided for females given the lack of generalizability. As these risk scores were validated based upon baseline characteristics, they are not calculated for screening follow-ups. All scores were validated on populations approximately older than 50, and as such, scores are not shown for patients younger than 50.