• Oisin J O'Connell, Francisco A Almeida, Michael J Simoff, Lonny Yarmus, Ray Lazarus, Benjamin Young, Yu Chen, Roy Semaan, Timothy M Saettele, Joseph Cicenia, Harmeet Bedi, Corrine Kliment, Liang Li, Sonali Sethi, Javier Diaz-Mendoza, David Feller-Kopman, Juhee Song, Thomas Gildea, Hans Lee, Horiana B Grosu, Michael Machuzak, Macarena Rodriguez-Vial, George A Eapen, Carlos A Jimenez, Roberto F Casal, and David E Ost.
• 1 Department of Pulmonary Medicine and.
• Am. J. Respir. Crit. Care Med. 2017 Jun 15; 195 (12): 1651-1660.

RationaleEstimating the probability of finding N2 or N3 (prN2/3) malignant nodal disease on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with non-small cell lung cancer (NSCLC) can facilitate the selection of subsequent management strategies.ObjectivesTo develop a clinical prediction model for estimating the prN2/3.MethodsWe used the AQuIRE (American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education) registry to identify patients with NSCLC with clinical radiographic stage T1-3, N0-3, M0 disease that had EBUS-TBNA for staging. The dependent variable was the presence of N2 or N3 disease (vs. N0 or N1) as assessed by EBUS-TBNA. Univariate followed by multivariable logistic regression analysis was used to develop a parsimonious clinical prediction model to estimate prN2/3. External validation was performed using data from three other hospitals.Measurements And Main ResultsThe model derivation cohort (n = 633) had a 25% prevalence of malignant N2 or N3 disease. Younger age, central location, adenocarcinoma histology, and higher positron emission tomography-computed tomography N stage were associated with a higher prN2/3. Area under the receiver operating characteristic curve was 0.85 (95% confidence interval, 0.82-0.89), model fit was acceptable (Hosmer-Lemeshow, P = 0.62; Brier score, 0.125). We externally validated the model in 722 patients. Area under the receiver operating characteristic curve was 0.88 (95% confidence interval, 0.85-0.90). Calibration using the general calibration model method resulted in acceptable goodness of fit (Hosmer-Lemeshow test, P = 0.54; Brier score, 0.132).ConclusionsOur prediction rule can be used to estimate prN2/3 in patients with NSCLC. The model has the potential to facilitate clinical decision making in the staging of NSCLC.

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