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Validation of prediction models for risk stratification of incidentally detected pulmonary subsolid nodules: a retrospective cohort study in a Korean tertiary medical centre
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  • Published on:
    Comment on, “Validation of prediction models for risk stratification of incidentally detected pulmonary subsolid nodules: a retrospective cohort study in a Korean tertiary medical center”
    • Nobuko Wada, MD Hyogo Prefectural Amagasaki General Medical Center
    • Other Contributors:
      • Yuki Kataoka, MD/MPH

    To the Editor:
    We read the recent articles from Kim et al. with great interest and appreciate the authors’ efforts to evaluate the suitability of the two models regarding the prediction of incidentally-detected pulmonary subsolid nodules (SSNs), as well as their reports that there were substantial differences. However, we would like to highlight two concerns that we have regarding their study.

    First, there is a lack of description regarding whether an adequate pathological diagnosis was performed. We would like to know who performed the diagnosis and how it was made. In predictive model research, it is preferable that outcomes are evaluated with masked predictors, as there might be bias in estimating associations between predictors and outcomes. [1]

    Secondly, there might have been a sampling bias before surgery selection. Among patients with SSNs, surgery might be preferentially performed, especially for patients who show a high possibility of lung cancer. Further, additional upper lobes and peripheral nodules, which were difficult to diagnose by bronchoscopy examination, might be selected and resected. Thus, cases of atypical adenomatous hyperplasia (AAH)/ adenocarcinoma in situ (AIS) might comprise a smaller portion of the study cohort, and minimally invasive adenocarcinoma (MIA)/ invasive pulmonary adenocarcinoma (IPA) might be diagnosed more frequently. Clinically, we often struggle to decide whether the nodule is malignant in a case where surgery c...

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    Conflict of Interest:
    None declared.