Abstract
BACKGROUND: To develop and validate an (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and clinico-biological features-based nomogram for distinguishing solid benign pulmonary nodules (BPNs) from malignant pulmonary nodules (MPNs). METHODS: A total of 280 patients with BPN (n=128) or MPN (n=152) were collected retrospectively and randomized into the training set (n=196) and validation set (n=84). Pretherapeutic clinicobiological markers, PET/CT metabolic features and radiomic features were analyzed and selected to develop prediction models by the machine-learning method [Least Absolute Shrinkage and Selection Operator (LASSO) regression]. These prediction models were validated using the area under the curve (AUC) of the receiver-operator characteristic (ROC) analysis and decision curve analysis (DCA). Then, the factors of the model with the optimal predictive efficiency were used to constructed a nomogram to provide a visually quantitative tool for distinguishing BPN from MPN patients. RESULTS: We developed 3 independent models (Clinical Model, Radiomics Model and Combined Model) to distinguish patients with BPN from those with MPN in the training set. The Combined Model was validated to hold the optimal efficiency and clinical utility with the lowest false positive rate (FPR) in classifying the solid pulmonary nodules in two sets (AUCs of 0.91 and 0.94, FPRs of 18.68% and 5.41%, respectively; P<0.05). Thus, the quantitative nomogram was developed based on the Combined Model, and a good consistency between the predictions and the actual observations was validated by the calibration curves. CONCLUSIONS: This study presents a machine-learning nomogram integrated clinico-biologico-radiological features that can improve the efficiency and reduce the FPR in the noninvasive differentiation of BPN from MPN.