Derivation and Validation of a CT Scan Scoring System for Discriminating Malignant From Benign Pleural Effusions

作者：Porcel Jose M^*; Pardina Marina; Bielsa Silvia; Gonzalez Antonio; Light Richard W

来源：Chest, 2015, 147(2): 513-519.

DOI：10.1378/chest.14-0013

BACKGROUND: Chest CT scanning has become an integral part of the workup for undiagnosed pleural effusions. We aimed to develop a CT scan-based scoring system for differentiating between benign and malignant pleural effusions.
METHODS: A number of chest CT scan abnormalities were compared between 228 patients with benign and 115 with malignant effusions (derivation cohort). A logistic regression analysis was used to identify the independent predictors of malignancy and generate CT scan scores, with more points assigned to those findings associated with higher beta-coefficient values. The diagnostic accuracy of the CT scan scoring system was calculated for the derivation cohort and further evaluated in two independent populations (n = 80 and 42, respectively) by two radiologists.
RESULTS: CT scan scores predicting malignancy included any pleural lesion (ie, nodule, mass, or thickening) >= 1 cm (5 points); the presence of liver metastases, an abdominal mass, or a lung mass or nodule >= 1 cm (3 points each); and the absence of either pleural loculations, pericardial effusions, or cardiomegaly (2 points each). In the first validation cohort, a sum score of >= 7 yielded a sensitivity of 88% (95% CI, 73%-95%), specificity of 94% (95% CI, 83%-98%), likelihood ratio positive of 13.8 (95% CI, 4.6-41.5), likelihood ratio negative of 0.13 (95% CI, 0.05-0.33), and area under the receiver operating characteristics curve of 0.919 (95% CI, 0.849-0.990). Moreover, 69% of 42 patients with pathologically unconfirmed malignant effusions from a second independent cohort would have been correctly labeled by the predictive score.
CONCLUSIONS: A simple CT scan-based scoring system can help physicians to separate malignant from benign pleural effusions.

• 出版日期2015-2