Comparison of Brock University, Mayo Clinic and Herder models for pretest probability of cancer in solid pulmonary nodules.

OBJECTIVE: Risk analysis models, which are used in the diagnostic algorithm of incidental pulmonary nodules, are based on patient data from developed countries. Mayo Clinic, Brock University and Herder are among the most known models. We aim to compare the reliability of these models in patients with indeterminate solid nodules and to investigate the contribution of the predictors used to the model. METHODS: We analysed 305 patients who performed transthoracic needle biopsy and positron emission tomography/computed tomography for solid nodules, retrospectively. For all three models, the malignancy risk probabilities of patients were calculated, and patients were classified as low (<5%), moderate (60%) and high (<60%) risk groups. Later, the malignancy rates of each model in three different risk groups were compared within each other and among the models. RESULTS: The malignancy rate is 73% in 305 patients. In the Mayo Clinic and Herder models, the difference in the low-, medium- and high-risk groups is significant (p < 0.001). In the medium-risk group, the rate of malignancy is 96.8% in the Brock model. In the high-risk group, the rate of malignancy in Herder is 88.3% and the rate of malignancy in Mayo Clinic is 28.8%. The optimal cutoff values for the Mayo Clinic, Brock University, and Herder were 29.6, 13.4 and 70 (AUC, respectively; 0.71, 0.67 and 0.73). Age, smoking, gender, size, emphysema and spiculation increase the likelihood of malignancy. CONCLUSION: Close results were obtained in all three models. In the high-risk group, the Herder model has the highest reliability rate (odds ratio 3.3, confidence interval [1.1, 10.2]). Upper lobe predilection is not a reliable predictor.

The relation between distant metastasis and genetic change type in stage IV lung adenocarcinoma patients at diagnosis.

INTRODUCTION: Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C-ROS oncogene 1 (ROS-1) fusion change in lung adenocarcinoma. OBJECTIVES: The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes. METHODS: The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS-1) and distant metastasis was analysed. RESULTS: A total of 845 patients were included in the study. The median age was 62 (28-88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032, P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02). CONCLUSION: In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma.

Diagnostic success of transthoracic needle biopsy and PET-CT for 1 to 2 cm solid indeterminate pulmonary nodules.

OBJECTIVES: Among the nodule types, the most controversial group are indeterminate solid nodules from 1 to 2 cm in size with the first choice being transthoracic needle biopsy (TTNB) or positron emission tomography (PET-CT) or both methods together. However, no single diagnostic algorithm could be applied to all cases. This research discusses the diagnostic success of PET-CT and TTNB. MATERIALS AND METHODS: 407 Patients who referred to our hospital for any reason, with solid nodules with the size from 1 to 2 cmincidentally identified on the thoracic CT tests were investigated. Among the patients who underwent biopsy, 312 cases had PET-CT, and maximum SUV (SUVmax) values of the nodules were examined. Values of ≥2.5 were accepted as hypermetabolic. RESULTS: The mean age of the patients was 61 ± 10.8 years. 84 patients were female (20.6%) and 323 were male (79.4%). For TTNB; sensitivity, specificity and accuracy rates of all cases, who were correctly diagnosed, were 76.9%, 83.3% and 78.9%, respectively (P < .001). The 2.5 SUVmax cutoff value had sensitivity of 91%, specificity of 35.6%, accuracy of 75% (P = .034). The cutoff value of 49 years of age, nodule size of 16.4 mm, gender and 2.5 SUVmax value had high accuracy for benign-malignant differentiation. No statistically significant difference was found in the upper lobe localization of nodule. CONCLUSION: A positive result from TTNB is a reliable finding; however, a negative result is not definitive. The high negative predictive value of PET-CT is effective in preventing the unnecessary biopsies and surgical procedures.

Analysis of the Role of Physicians in the Cessation of Cigarette Smoking Based on Medical Specialization.

OBJECTIVE: Physicians do not adequately use their unique professional privilege to prevent patients from smoking. The aim of this study was to investigate the type and extent of advice given to patients by physicians of different medical specialties regarding smoking cessation. METHODS: In total, 317 volunteer physicians were included in this study. The participants rated their attitudes toward the smoking habits of their patients by completing a questionnaire. The approaches used to address the smoking habits of patients significantly differed among physicians working at polyclinics, clinics and emergency service departments (p<0.001). Physicians working at clinics exhibited the highest frequency of inquiring about the smoking habits of their patients, while physicians working at emergency service departments exhibited the lowest frequency. RESULTS: Physicians from different medical specialties significantly differed in their responses. Physicians specializing in lung diseases, thoracic surgery, and cardiology were more committed to preventing their patients from cigarette smoking. CONCLUSIONS: The role of physicians, particularly pulmonologists and thoracic surgeons, is critical in the fight against cigarette smoking. Promoting physician awareness of this subject is highly important in all other branches of medicine.