Risk Stratification of Incidental Pulmonary Nodules: A Fully Automated Approach to CT Imaging Analysis.

Authors

Hongli Liu, Himmat Grewal, Joshua Reicher, Michael Muelly, Angad Kalra, Don Bigler, Omid T Omran, Hitesh Batra

Published in

Journal of bronchology & interventional pulmonology. Volume 33. Issue 4. Oct 01, 2026. Epub Sep 03, 2026.

Abstract

Incidental detection is the most common pathway through which pulmonary nodules are identified. With the advancement of navigational and robotic-assisted bronchoscopy, existing risk stratification models often lack sufficient discrimination power, particularly for intermediate-risk nodules. Bronchosolve is a fully automated, imaging-only risk stratification tool that was previously validated in lung cancer screening cohorts.
We applied Bronchosolve to a cohort of adults with incidentally detected pulmonary nodules identified from registries at 2 large health care systems between 2006 and 2019. Nodules were classified as malignant or benign based on biopsy or extended clinical follow-up. Discrimination was assessed and compared with the VA Model. Sensitivity and specificity were reported at the Youden and high-sensitivity operating points. Additional analysis was performed in cases with nodule diameter 8 to 15 mm.
Among 187 patients, malignancy prevalence was 70%. Bronchosolve achieved an AUC of 0.895 versus 0.870 for the VA model. Among nodules 8 to 15 mm, discrimination differences were larger (AUC 0.808 vs. 0.701). In nodules of 8 to 15 mm in diameter with an intermediate risk for malignancy by the VA model, Bronchosolve reclassified 51 patients to high risk and 23 to low risk; 33/37 (89%) malignancies were up-classified and 19/37 (51%) benign nodules were down-classified.
In a nonscreening setting, Bronchosolve demonstrated robust discrimination for lung nodule malignancy risk using imaging alone compared with a widely used clinical risk model, with more pronounced separation in intermediate-sized nodules. In this subgroup, Bronchosolve also yielded clinically meaningful risk reclassification, with potential implications for downstream management.

PMID:
42689326
Bibliographic data and abstract were imported from PubMed on 03 Sep 2026.

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