Creation of nomograms that combine clinical, CT, and radiographic features to separate benign from malignant diseases using spiculation or (and) lobulation signs

Background: Distinguishing between benign and malignant pulmonary nodules based on CT imaging features such as the spiculation sign and/or lobulation sign remains challenging and these nodules are often misinterpreted as malignant tumors. this retrospective study aimed to develop a prediction model to estimate the likelihood of benign and malignant lung nodules exhibiting spiculation and/or lobulation signs.

Methods: A total of 500 patients with pulmonary nodules from June 2022 to August 2024 were retrospectively analyzed. Among them, 190 patients with spiculation sign and lobar sign or both on CT scan were included in this study. This investigation collected the clinical information, preoperative chest CT imaging characteristics, and postoperative histopathologic results from patients.Univariate and multivariate logistic regression analyses were employed to identify independent risk factors, from which a prediction model and nomogram were developed. In addition, The model performance was assessed through receiver operating characteristic(ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA).

Results: In our study, 190 patients with pulmonary nodules underwent lung biopsy in 10 patients and surgical resection in 180 patients, of whom 53 were benign nodules and 137 were malignant nodules. When combined with the spiculation sign or (and) the lobulation sign, the vascular cluster sign, bronchial architectural distortion, bubble-like translucent area, nodule density, and CEA were found to be significant independent predictors for determining the benignity and malignancy of pulmonary nodules. The nomogram prediction model demonstrated high predictive accuracy with an area under the ROC curve (AUC) of 0.904. Furthermore, the model's calibration curve demonstrated adequate calibration. DCA confirmed the prediction model's validity.

Conclusion: The model can assist clinicians in making more accurate preoperative diagnoses and in guiding clinical decision-making regarding treatment, potentially reducing unnecessary surgical interventions.