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Lung Nodule Malignancy Risk Panel
years
mm
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).
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 |
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