Cancers (Feb 2024)

LIONS PREY: A New Logistic Scoring System for the Prediction of Malignant Pulmonary Nodules

  • Fabian Doerr,
  • Annika Giese,
  • Katja Höpker,
  • Hruy Menghesha,
  • Georg Schlachtenberger,
  • Konstantinos Grapatsas,
  • Natalie Baldes,
  • Christian J. Baldus,
  • Lars Hagmeyer,
  • Hazem Fallouh,
  • Daniel Pinto dos Santos,
  • Edward M. Bender,
  • Alexander Quaas,
  • Matthias Heldwein,
  • Thorsten Wahlers,
  • Hubertus Hautzel,
  • Kaid Darwiche,
  • Christian Taube,
  • Martin Schuler,
  • Khosro Hekmat,
  • Servet Bölükbas

DOI
https://doi.org/10.3390/cancers16040729
Journal volume & issue
Vol. 16, no. 4
p. 729

Abstract

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Objectives: Classifying radiologic pulmonary lesions as malignant is challenging. Scoring systems like the Mayo model lack precision in predicting the probability of malignancy. We developed the logistic scoring system ‘LIONS PREY’ (Lung lesION Score PREdicts malignancY), which is superior to existing models in its precision in determining the likelihood of malignancy. Methods: We evaluated all patients that were presented to our multidisciplinary team between January 2013 and December 2020. Availability of pathological results after resection or CT-/EBUS-guided sampling was mandatory for study inclusion. Two groups were formed: Group A (malignant nodule; n = 238) and Group B (benign nodule; n = 148). Initially, 22 potential score parameters were derived from the patients’ medical histories. Results: After uni- and multivariate analysis, we identified the following eight parameters that were integrated into a scoring system: (1) age (Group A: 64.5 ± 10.2 years vs. Group B: 61.6 ± 13.8 years; multivariate p-value: 0.054); (2) nodule size (21.8 ± 7.5 mm vs. 18.3 ± 7.9 mm; p = 0.051); (3) spiculation (73.1% vs. 41.9%; p = 0.024); (4) solidity (84.9% vs. 62.8%; p = 0.004); (5) size dynamics (6.4 ± 7.7 mm/3 months vs. 0.2 ± 0.9 mm/3 months; p p p = 0.079); and (8) cancer history (34.9% vs. 24.3%; p = 0.052). Our model demonstrated superior precision to that of the Mayo score (p = 0.013) with an overall correct classification of 96.0%, a calibration (observed/expected-ratio) of 1.1, and a discrimination (ROC analysis) of AUC (95% CI) 0.94 (0.92–0.97). Conclusions: Focusing on essential parameters, LIONS PREY can be easily and reproducibly applied based on computed tomography (CT) scans. Multidisciplinary team members could use it to facilitate decision making. Patients may find it easier to consent to surgery knowing the likelihood of pulmonary malignancy. The LIONS PREY app is available for free on Android and iOS devices.

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