ArticleChest2014
When is a biopsy-proven diagnosis necessary before stereotactic ablative radiotherapy for lung cancer?: A decision analysis.
Article in Chest, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
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Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it, 65 citations in OpenAlex.
- Markov models for clinical decision-making in radiation oncology: A systematic review.Journal of medical imaging and radiation oncology · 2024Pooled it
- Survival in early lung cancer patients treated with high dose radiotherapy is independent of pathological confirmation.Thoracic cancer · 2019Trial
- A feasibility trial of delayed resection for brain metastases following pre-operative stereotactic radiosurgery.Journal of neuro-oncology · 2025Article
- Cone-beam CT in lung biopsy: a clinical practice review on lessons learned and future perspectives.Annals of translational medicine · 2023Review
- The lung cancers: staging and response, CT,The British journal of radiology · 2023Review
- Outcomes for Elective Open and Thoracoscopic Surgical Lung Biopsies in the United States and Temporal Trends.Mayo Clinic proceedings. Innovations, quality & outcomes · 2022Article
- Incidence of Radiation Therapy Among Patients Enrolled in a Multidisciplinary Pulmonary Nodule and Lung Cancer Screening Clinic.JAMA network open · 2022Article
- Cone-beam CT and Augmented Fluoroscopy-guided Navigation Bronchoscopy: Radiation Exposure and Diagnostic Accuracy Learning Curves.Journal of bronchology & interventional pulmonology · 2021Observational
- A Prediction Model to Help with Oncologic Mediastinal Evaluation for Radiation: HOMER.American journal of respiratory and critical care medicine · 2020Article
- Empiric Radiotherapy for Lung Cancer Collaborative Group multi-institutional evidence-based guidelines for the use of empiric stereotactic body radiation therapy for non-small cell lung cancer without pathologic confirmation.Translational lung cancer research · 2019Review
- Image-based management of empiric lung stereotactic body radiotherapy (SBRT) without biopsy: Predictors from a 10-year single institution experience.Thoracic cancer · 2018Article
- Hypo-fractionated stereotactic radiation therapy for lung malignancies by means of helical tomotherapy: report of feasibility by a single-center experience.La Radiologia medica · 2018Article
- Observational
- Solid pulmonary nodule risk assessment and decision analysis: comparison of four prediction models in 285 cases.European radiology · 2016Observational
- Absence of Pathological Proof of Cancer Associated with Improved Outcomes in Early-Stage Lung Cancer.Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer · 2016Article
- SABR vs. Limited Resection for Non-small Cell Lung Cancer: Are We Closer to an Answer?Current treatment options in oncology · 2016Review
- Primary Treatment Options for High-Risk/Medically Inoperable Early Stage NSCLC Patients.Clinical lung cancer · 2015Review
- An Official American Thoracic Society Research Statement: A Research Framework for Pulmonary Nodule Evaluation and Management.American journal of respiratory and critical care medicine · 2015Article
- Is surgery still the best management option for early stage NSCLC?Translational lung cancer research · 2014Review
- Stereotactic body radiotherapy in lung cancer: an update.Jornal brasileiro de pneumologia : publicacao oficial da Sociedade Brasileira de Pneumologia e TisilogiaReview
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Authors and funding
10 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 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.
methodsA 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.
resultsIn 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%).
conclusionsThis 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%.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.