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When is a biopsy-proven diagnosis necessary before stereotactic ablative radiotherapy for lung cancer?: A decision analysis.

Publication ,  Journal Article
Louie, AV; Senan, S; Patel, P; Ferket, BS; Lagerwaard, FJ; Rodrigues, GB; Salama, JK; Kelsey, C; Palma, DA; Hunink, MG
Published in: Chest
October 2014

BACKGROUND: The practice of treating a solitary pulmonary nodule (SPN) suspicious for stage I non-small cell lung cancer (NSCLC) with stereotactic ablative radiotherapy (SABR) in the absence of pathology is growing. In the absence of randomized evidence, the appropriate prior probability threshold of lung cancer of when such a strategy is warranted can be informed using decision analysis. METHODS: A decision tree and Markov model were constructed to evaluate the relative merits of surveillance, a PET scan-directed SABR strategy (without pathology), or a PET scan-biopsy-SABR strategy, when faced with an SPN at different prior probabilities for lung cancer. Diagnostic characteristics, as well as disease, treatment, and toxicity parameters, were extracted from the literature. Deterministic analysis and probabilistic sensitivity analyses were performed to inform the appropriate lung cancer prior probability threshold between treatment strategies. RESULTS: In the reference case analysis, the prior probability threshold between surveillance and PET scan-biopsy-SABR was 17.0%; between PET scan-directed SABR and PET scan-biopsy-SABR, the threshold was 85.0%. The latter finding was confirmed on probabilistic sensitivity analysis (85.2%; 95% CI, 80.0% to 87.2%). This predicted lung cancer prior probability threshold was most sensitive to the diagnostic sensitivity of transthoracic biopsy (range, 77.2% to 94.0%) and the detection rate of false negatives on CT scan surveillance (range, 82.4% to 92.3%). CONCLUSIONS: This model suggests that if there are concerns about morbidity related to biopsy for an SPN, a PET scan-directed SABR strategy is warranted when the prior probability of lung cancer exceeds a point estimate of 85%.

Duke Scholars

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Published In

Chest

DOI

EISSN

1931-3543

Publication Date

October 2014

Volume

146

Issue

4

Start / End Page

1021 / 1028

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Solitary Pulmonary Nodule
  • Sensitivity and Specificity
  • Respiratory System
  • Radiosurgery
  • Positron-Emission Tomography
  • Lung Neoplasms
  • Humans
  • Decision Support Techniques
  • Carcinoma, Non-Small-Cell Lung
 

Citation

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Louie, A. V., Senan, S., Patel, P., Ferket, B. S., Lagerwaard, F. J., Rodrigues, G. B., … Hunink, M. G. (2014). When is a biopsy-proven diagnosis necessary before stereotactic ablative radiotherapy for lung cancer?: A decision analysis. Chest, 146(4), 1021–1028. https://doi.org/10.1378/chest.13-2924
Louie, Alexander V., Suresh Senan, Pretesh Patel, Bart S. Ferket, Frank J. Lagerwaard, George B. Rodrigues, Joseph K. Salama, Christopher Kelsey, David A. Palma, and Myriam G. Hunink. “When is a biopsy-proven diagnosis necessary before stereotactic ablative radiotherapy for lung cancer?: A decision analysis.Chest 146, no. 4 (October 2014): 1021–28. https://doi.org/10.1378/chest.13-2924.
Louie AV, Senan S, Patel P, Ferket BS, Lagerwaard FJ, Rodrigues GB, et al. When is a biopsy-proven diagnosis necessary before stereotactic ablative radiotherapy for lung cancer?: A decision analysis. Chest. 2014 Oct;146(4):1021–8.
Louie, Alexander V., et al. “When is a biopsy-proven diagnosis necessary before stereotactic ablative radiotherapy for lung cancer?: A decision analysis.Chest, vol. 146, no. 4, Oct. 2014, pp. 1021–28. Pubmed, doi:10.1378/chest.13-2924.
Louie AV, Senan S, Patel P, Ferket BS, Lagerwaard FJ, Rodrigues GB, Salama JK, Kelsey C, Palma DA, Hunink MG. When is a biopsy-proven diagnosis necessary before stereotactic ablative radiotherapy for lung cancer?: A decision analysis. Chest. 2014 Oct;146(4):1021–1028.

Published In

Chest

DOI

EISSN

1931-3543

Publication Date

October 2014

Volume

146

Issue

4

Start / End Page

1021 / 1028

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Solitary Pulmonary Nodule
  • Sensitivity and Specificity
  • Respiratory System
  • Radiosurgery
  • Positron-Emission Tomography
  • Lung Neoplasms
  • Humans
  • Decision Support Techniques
  • Carcinoma, Non-Small-Cell Lung