Letters Solitary pulmonary nodule

Authors’ reply to Llewellyn

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e3663 (Published 28 May 2012) Cite this as: BMJ 2012;344:e3663
  1. William McNulty, specialist registrar1,
  2. Giles Cox, consultant respiratory physician1,
  3. Iain Au-Yong, consultant radiologist1
  1. 1King’s Mill Hospital, Sutton-in-Ashfield NG17 4JL, UK
  1. iauyong{at}doctors.org.uk

Llewellyn gives an interesting insight into the intricacies of likelihood ratios.1 2 Investigating solitary pulmonary nodules may require multiple, invasive investigations with a significant burden on the patient. The probability of malignancy varies widely, depending on patient and radiological factors. The concept of risk assessment of malignancy taking into account patient and radiographic factors in solitary pulmonary nodules has been well documented and is in widespread clinical use, and we were asked specifically by an expert reviewer to include it in our review.

The paper whose data we quoted details an algorithm for such assessment,3 and this model has been validated by the same authors against histological diagnoses,4 as well as by others,5 along the lines suggested by Llewellyn.1 These principles are also detailed in the appropriateness criteria of the American College of Radiogy.6 Risk calculators for solitary pulmonary nodules are further useful tools that have been developed to incorporate patient and nodule factors into clinical decision making.3 They may help clinicians decide between a watch and wait approach and invasive investigation, ultimately providing a safer and more efficient use of resources.


Cite this as: BMJ 2012;344:e3663


  • Competing interests: None declared.


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