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To compare the Vancouver risk calculator (VRC) with American College of Radiology (ACR) Lung Imaging Reporting and Data System (Lung-RADS) in predicting the risk of malignancy in the National Lung Screening Trial (NLST).

A total of 2813 patients with 4408 nodules (4078 solid, 330 subsolid) were available from the NLST for evaluation. Nodules were scored by using VRC with nine parameters (output was the percentage likelihood of malignancy; VRC threshold for malignancy likelihood set as greater than 5%) and Lung-RADS (output was category 2–4B; malignancy defined as category 4A or 4B; malignancy likelihood greater than 5%). Lung-RADS and VRC were compared for sensitivity, specificity, and accuracy for malignancy on a per-nodule and per-patient basis.

Of 4408 total nodules, 100 of 4078 (2.5%) solid nodules were malignant and 10 of 330 (3%) subsolid …