Lung Nodule Malignancy Risk Panel

Clinical Context & Background

This panel aggregates the three most widely used prediction models for solitary pulmonary nodules (SPN).

1. Mayo Clinic Model:

Classic logistic regression model. Best suited for incidentally detected solid nodules. Relies heavily on smoking history and extrathoracic cancer history.

2. Brock (PanCan) Model:

Derived from lung cancer screening cohorts. Superior for sub-solid (ground-glass/part-solid) nodules and screening-detected lesions.

3. Herder Model:

Refinement of the Mayo model incorporating FDG-PET metabolic activity. Essential if a PET scan has been performed.

Guidelines (BTS/Fleischner):

A risk > 10% typically warrants further investigation (PET-CT or Tissue Sampling).

Primary Source EvidenceMacMahon H, et al. Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017. Radiology. 2017;284(1):228-243.

Formula Logic

Mayo Model (Solid Nodules)

Step 1: Logit = -6.8238 + (0.0391 × Age) + (0.7917 × Smoker) + (1.3388 × CancerHx) + (0.1274 × Diameter) + (1.0407 × Spiculation) + (0.7838 × UpperLobe)

Step 2: Probability = e^Logit / (1 + e^Logit)

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Brock (PanCan) Model

Step 1: Logit calculation using Age, Sex, Family Hx, Emphysema, Nodule Size, Type, Location, Count, and Spiculation.

Step 2: Probability = e^Logit / (1 + e^Logit)

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Herder Model (with PET)

Step 1: Calculate Mayo Logit (as above).

Step 2: Herder Logit = 0.04 + (0.78 × Mayo_Logit) + PET_Avidity_Score (where PET Score ranges from -2.33 to +1.05).

Step 3: Probability = e^Herder_Logit / (1 + e^Herder_Logit)

Reference Data

Model	Risk Category	Probability	Typical Management
Panel Synthesis	Very Low	< 1%	No routine follow-up
Panel Synthesis	Low/Interm.	1 - 10%	Surveillance CT
Panel Synthesis	High	> 10%	PET-CT / Biopsy
---	---	---	---
Mayo (Solid)	Low	< 5%	Surveillance
Mayo (Solid)	Intermediate	5 - 65%	Investigation
Mayo (Solid)	High	> 65%	Resection
---	---	---	---
Brock (PanCan)	Very Low	< 1%	No routine follow-up
Brock (PanCan)	Low/Interm.	1 - 10%	Surveillance CT
Brock (PanCan)	High	> 10%	Investigation
---	---	---	---
Herder (PET)	Low	< 10%	Surveillance likely
Herder (PET)	Intermediate	10 - 70%	Biopsy / Resection
Herder (PET)	High	> 70%	Resection

Clinical Workflow

Use, Interpret, And Continue The Patient Pathway

Expand for workflow guidance, limitations, examples, and related next steps.

When To Use

Use Lung Nodule Malignancy Risk Panel when comparison of Mayo, Brock (PanCan), and Herder models for pulmonary nodules.
Confirm that the patient, diagnosis, disease phase, and available inputs match the cited model before calculation.

How To Interpret

Interpret the displayed result using the calculator-specific formula and reference table, spanning Panel Synthesis through Herder (PET).
A boundary result should prompt input verification and clinical review rather than false precision.

What To Do Next

Review every component result separately; if models disagree, verify inputs and follow the more cautious disease-specific pathway rather than averaging scores.
Document the inputs, result, timing, and clinical context so the assessment can be reproduced.

Limitations

A panel improves comparison but does not make component models interchangeable or create a new validated composite score.
The result supports clinician judgment and does not independently determine treatment.

Validated Population

patients whose clinical question requires the component models displayed in the combined panel

How to apply this result

For a representative case, verify Age, Sex, Smoking History, calculate the result, and confirm that its classification matches the highlighted reference band before continuing the disease-specific pathway.

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Frequently Asked Questions

When should Lung Nodule Malignancy Risk Panel be used?

Use it for patients whose clinical question requires the component models displayed in the combined panel when all required inputs and the intended clinical setting are confirmed.

Can Lung Nodule Malignancy Risk Panel determine treatment by itself?

No. Interpret the result with the cited evidence, complete clinical assessment, current guidelines, and patient-specific goals.

Evidence-based oncology decision support. Verify with clinical guidelines.

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