Predictive model for the probability of malignancy in solitary pulmonary nodules: a meta-analysis

BACKGROUND: To date, multiple predictive models have been developed with the goal of reliably differentiating between solitary pulmonary nodules (SPNs) that are malignant and those that are benign. The present meta-analysis was conducted to assess the diagnostic utility of these predictive models in the context of SPN differential diagnosis. METHODS: The PubMed, Embase, Cochrane Library, CNKI, Wanfang, and VIP databases were searched for relevant studies published through August 31, 2021. Pooled data analyses were conducted using Stata v12.0. RESULTS: In total, 20 retrospective studies that included 5171 SPNs (malignant/benign: 3662/1509) were incorporated into this meta-analysis. Respective pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic score values were 88% (95CI%: 0.84–0.91), 78% (95CI%: 0.74–0.80), 3.91 (95CI%: 3.42–4.46), 0.16 (95CI%: 0.12–0.21), and 3.21 (95CI%: 2.87–3.55), with an area under the summary receiver operating characteristic curve value of 86% (95CI%: 0.83–0.89). Significant heterogeneity among studies was detected with respect to sensitivity (I(2) = 89.07%), NLR (I(2) = 87.29%), and diagnostic score (I(2) = 72.28%). In a meta-regression analysis, sensitivity was found to be impacted by the standard reference in a given study (surgery and biopsy vs. surgery only, P = 0.02), while specificity was impacted by whether studies were blinded (yes vs. unclear, P = 0.01). Sensitivity values were higher when surgery and biopsy samples were used as a standard reference, while unclear blinding status was associated with increased specificity. No significant evidence of publication bias was detected for the present meta-analysis (P = 0.539). CONCLUSIONS: The results of this meta-analysis demonstrate that predictive models can offer significant diagnostic utility when establishing whether SPNs are malignant or benign.