Diagnostic Performance of the Herder Model in Veterans Undergoing PET Scans for Pulmonary Nodule Evaluation

British Thoracic Society (BTS) guidelines recommend using the Herder model to risk-stratify lung nodules after positron emission tomography (PET). However, this approach has not been adequately evaluated, particularly among Veterans. A single-center retrospective cohort study was carried out in U.S. Veterans with pulmonary nodules assessed by PET to validate the Herder model; decision analysis using risk thresholds from the BTS guidelines was performed. One hundred subjects met inclusion criteria. Area under the curve of the Herder model for predicting malignancy was 0.87 for all lung nodules and 0.90 for newly discovered nodules. For low- and high-risk lung nodules, BTS guidelines would have recommended appropriate care in this patient cohort.