{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T04:26:52Z","timestamp":1787372812587,"version":"build-2736575974"},"reference-count":38,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Curr. Oncol.","Current Oncology"],"abstract":"<jats:p>Background: Distinguishing organizing pneumonia from recurrent malignancy in patients undergoing cancer surveillance remains a major clinical challenge. Although inflammatory biomarkers have emerged as potential diagnostic tools, their incremental value beyond imaging-based assessment remains uncertain. Methods: In this retrospective single-center study, we evaluated 170 patients with prior malignancy who underwent surgical assessment for suspicious lung-only pulmonary lesions between 2013 and 2023. Histopathology confirmed organizing pneumonia in 61 patients and malignancy in 109 patients. Preoperative clinical, radiologic, Positron emission tomography\/computed tomography (PET\/CT), and inflammatory biomarker variables were incorporated into predefined clinical, radiology-PET\/CT, biomarker, and integrated models using Least absolute shrinkage and selection operator (LASSO)-penalized logistic regression with internal cross-validation. Results: The radiology\/PET model demonstrated excellent discrimination (AUC 0.927), closely approximating the performance of the integrated model (AUC 0.935). The clinical and biomarker-only models showed moderate discrimination (AUC 0.764 and 0.778, respectively). Adding inflammatory biomarkers to imaging-derived features resulted in only a minimal improvement in diagnostic performance (\u0394AUC = 0.009, 95% CI \u22120.019 to 0.037), indicating no statistically significant incremental benefit. Calibration, decision curve, and predictor stability analyses consistently identified radiologic and PET\/CT-derived variables as the principal sources of predictive information. Conclusions: In patients with suspicious pulmonary lesions during cancer surveillance, diagnostic discrimination was driven predominantly by imaging-derived features, whereas conventional inflammatory biomarkers provided limited incremental value. These findings support an imaging-centered approach to preoperative risk stratification and multidisciplinary decision-making.<\/jats:p>","DOI":"10.3390\/curroncol33080491","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:05:19Z","timestamp":1787241919000},"page":"491","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Distinguishing Organizing Pneumonia from Malignancy During Cancer Surveillance: Predominant Diagnostic Value of Imaging over Systemic Inflammatory Biomarkers"],"prefix":"10.3390","volume":"33","author":[{"given":"Hacer Boztepe","family":"Yesilcay","sequence":"first","affiliation":[{"name":"Department of Thoracic Surgery, Antalya Training and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8749-9825","authenticated-orcid":false,"given":"Asim Armagan","family":"Aydin","sequence":"additional","affiliation":[{"name":"Department of Clinical Oncology, Antalya Training and Research Hospital, University of Health Sciences, 07100 Antalya, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Boccatonda, A., Guagnano, M.T., D\u2019Ardes, D., Cipollone, F., Vetrugno, L., Schiavone, C., Piscaglia, F., and Serra, C. (2024). The Role of Contrast-Enhanced Ultrasound in the Differential Diagnosis of Malignant and Benign Subpleural Lung Lesions. J. Clin. Med., 13.","DOI":"10.3390\/jcm13082302"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Xu, H., Zhu, N., Yue, Y., Guo, Y., Wen, Q., Gao, L., Hou, Y., and Shang, J. (2023). Spectral CT-Based Radiomics Signature for Distinguishing Malignant Pulmonary Nodules from Benign. BMC Cancer, 23.","DOI":"10.1186\/s12885-023-10572-4"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Chen, H., Stoltzfus, K.C., Lehrer, E.J., Horn, S.R., Siva, S., Trifiletti, D.M., Meng, M.-B., Verma, V., Louie, A.V., and Zaorsky, N.G. (2021). The Epidemiology of Lung Metastases. Front. Med., 8.","DOI":"10.3389\/fmed.2021.723396"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1007\/s11748-017-0825-6","article-title":"Predictors of Primary Lung Cancer in a Solitary Pulmonary Lesion after a Previous Malignancy","volume":"65","author":"Nakadate","year":"2017","journal-title":"Gen. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1016\/j.chest.2022.12.044","article-title":"Guided Bronchoscopy for the Evaluation of Pulmonary Lesions","volume":"163","author":"Nadig","year":"2023","journal-title":"Chest"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5271","DOI":"10.21037\/qims-22-309","article-title":"Intraoperative Identification of Pulmonary Nodules during Minimally Invasive Thoracic Surgery: A Narrative Review","volume":"12","author":"Tang","year":"2022","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1016\/j.rxeng.2022.08.002","article-title":"Organizing Pneumonia","volume":"64","year":"2022","journal-title":"Radiolog\u00eda (Engl. Ed.)"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.chest.2021.12.659","article-title":"Algorithmic Approach to the Diagnosis of Organizing Pneumonia","volume":"162","author":"Cherian","year":"2022","journal-title":"Chest"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Vedachalam, S., Freihat, M., Alomari, A.K., Sears, C.R., and Al Nasrallah, N. (2026). The Concurrence of Lung Malignancies and Organizing Pneumonia. Front. Oncol., 15.","DOI":"10.3389\/fonc.2025.1733651"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Radzikowska, E., and Fijolek, J. (2023). Update on Cryptogenic Organizing Pneumonia. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1146782"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"150956","DOI":"10.1053\/j.ro.2025.08.007","article-title":"Organizing Pneumonia Phenotype","volume":"61","author":"Sakthivel","year":"2026","journal-title":"Semin. Roentgenol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1007\/s00261-025-05048-x","article-title":"Incidence of Malignancy in Lung Lesions Initially Classified as Organizing Pneumonia on CT-Guided Biopsies","volume":"51","author":"Kim","year":"2025","journal-title":"Abdom. Radiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1097\/RLU.0000000000003855","article-title":"Organizing Pneumonia With Intense 68Ga-FAPI Uptake Mimicking Lung Cancer on 68Ga-FAPI PET\/CT","volume":"47","author":"Tang","year":"2022","journal-title":"Clin. Nucl. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1053\/j.ro.2021.10.005","article-title":"Imaging Patterns of Pneumonia","volume":"57","author":"Cook","year":"2022","journal-title":"Semin. Roentgenol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1080\/14737159.2023.2215928","article-title":"Blood-Based Biomarkers of Chronic Inflammation","volume":"23","author":"Pritzker","year":"2023","journal-title":"Expert Rev. Mol. Diagn."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.2217\/imt-2022-0133","article-title":"Systemic Immune\u2013Inflammation Index Predicts Prognosis of Cancer Immunotherapy: Systemic Review and Meta-Analysis","volume":"14","author":"Tian","year":"2022","journal-title":"Immunotherapy"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Leng, J., Wu, F., and Zhang, L. (2022). Prognostic Significance of Pretreatment Neutrophil-to-Lymphocyte Ratio, Platelet\u2212to\u2212Lymphocyte Ratio, or Monocyte-to-Lymphocyte Ratio in Endometrial Neoplasms: A Systematic Review and Meta\u2212analysis. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.734948"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Hajibandeh, S., Hajibandeh, S., Romman, S., Parente, A., Laing, R.W., Satyadas, T., Subar, D., Aroori, S., Bhatt, A., and Durkin, D. (2023). Preoperative C-Reactive Protein-to-Albumin Ratio and Its Ability to Predict Outcomes of Pancreatic Cancer Resection: A Systematic Review. Biomedicines, 11.","DOI":"10.3390\/biomedicines11071983"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Cetintepe, T., Cetintepe, L., Guc, Z., Ertekin, I., Karaalp, O., and Alacacioglu, A. (2025). LDH-to-Albumin Ratio (LAR) in Solid Tumor Patients with Cytopenia: A Simple Biomarker to Predict Bone Marrow Metastasis. J. Clin. Med., 14.","DOI":"10.3390\/jcm14207379"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"5027","DOI":"10.3390\/curroncol31090372","article-title":"Unraveling the Predictive Value of the Novel Global Immune-Nutrition-Inflammation Index (GINI) on Survival Outcomes in Patients with Grade 4 Adult-Type Diffuse Gliomas","volume":"31","author":"Aydin","year":"2024","journal-title":"Curr. Oncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"12782","DOI":"10.1038\/s41598-025-97641-9","article-title":"Identification of Serum Metabolite Biomarkers and Metabolic Reprogramming Mechanisms to Predict Recurrence in Cholangiocarcinoma","volume":"15","author":"Prajumwongs","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e1048","DOI":"10.1097\/LBR.0000000000001048","article-title":"Blood-Based Biomarkers for Pulmonary Nodule Risk Stratification","volume":"33","author":"Perwaiz","year":"2026","journal-title":"J. Bronchol. Interv. Pulmonol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"110931","DOI":"10.1016\/j.ejrad.2023.110931","article-title":"Three Dimensional Computed Tomography Texture Analysis of Pulmonary Lesions: Does Radiomics Allow Differentiation between Carcinoma, Neuroendocrine Tumor and Organizing Pneumonia?","volume":"165","author":"Adelsmayr","year":"2023","journal-title":"Eur. J. Radiol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Gong, J., Zhang, Z., Luo, T., Huang, X., Zhu, C., Lv, J., and Li, Q. (2022). Combined Model of Radiomics, Clinical, and Imaging Features for Differentiating Focal Pneumonia-like Lung Cancer from Pulmonary Inflammatory Lesions: An Exploratory Study. BMC Med. Imaging, 22.","DOI":"10.1186\/s12880-022-00822-5"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e70103","DOI":"10.1111\/apm.70103","article-title":"Role of Systemic Inflammatory Markers in the Differential Diagnosis of Organizing Pneumonia and Lung Cancer","volume":"133","author":"Erinanc","year":"2025","journal-title":"APMIS"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Aminu, M., Daver, N., Godoy, M.C.B., Shroff, G., Wu, C., Torre-Sada, L.F., Goizueta, A., Shannon, V.R., Faiz, S.A., and Altan, M. (2023). Heterogenous Lung Inflammation CT Patterns Distinguish Pneumonia and Immune Checkpoint Inhibitor Pneumonitis and Complement Blood Biomarkers in Acute Myeloid Leukemia: Proof of Concept. Front. Immunol., 14.","DOI":"10.3389\/fimmu.2023.1249511"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Hai-Jing, Y., Shan, R., and Jie-Qiong, X. (2023). Prognostic Significance of the Pretreatment Pan-Immune-Inflammation Value in Cancer Patients: An Updated Meta-Analysis of 30 Studies. Front. Nutr., 10.","DOI":"10.3389\/fnut.2023.1259929"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"2337729","DOI":"10.1080\/07853890.2024.2337729","article-title":"Prognostic and Clinicopathological Value of Systemic Inflammation Response Index (SIRI) in Patients with Breast Cancer: A Meta-Analysis","volume":"56","author":"Zhang","year":"2024","journal-title":"Ann. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"555","DOI":"10.6061\/clinics\/2016(10)01","article-title":"Differential Diagnosis of Solitary Pulmonary Inflammatory Lesions and Peripheral Lung Cancers with Contrast-Enhanced Computed Tomography","volume":"71","author":"Chu","year":"2016","journal-title":"Clinics"},{"key":"ref_30","first-page":"100605","article-title":"Surgical Resection of Benign Nodules in Lung Cancer Screening: Incidence and Features","volume":"4","author":"Archer","year":"2023","journal-title":"JTO Clin. Res. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1007\/s00330-023-10208-y","article-title":"Value of [18F]AlF-NOTA-FAPI-04 PET\/CT for Differential Diagnosis of Malignant and Various Inflammatory Lung Lesions: Comparison with [18F]FDG PET\/CT","volume":"34","author":"Qiao","year":"2023","journal-title":"Eur. Radiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13550-022-00892-0","article-title":"PET-CT Imaging of Pulmonary Inflammation Using [68Ga]Ga-DOTA-TATE","volume":"12","author":"Puuvuori","year":"2022","journal-title":"EJNMMI Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s41479-023-00106-8","article-title":"Innate Immune Responses in Pneumonia","volume":"15","author":"Korkmaz","year":"2023","journal-title":"Pneumonia"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Van Calster, B., Steyerberg, E.W., Wynants, L., and van Smeden, M. (2023). There Is No Such Thing as a Validated Prediction Model. BMC Med., 21.","DOI":"10.1186\/s12916-023-02779-w"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"103109","DOI":"10.1016\/j.critrevonc.2020.103109","article-title":"CtDNA as a Cancer Biomarker: A Broad Overview","volume":"155","author":"Pessoa","year":"2020","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3629","DOI":"10.21037\/qims-20-1314","article-title":"Assessing the Predictive Accuracy of Lung Cancer, Metastases, and Benign Lesions Using an Artificial Intelligence-Driven Computer Aided Diagnosis System","volume":"11","author":"Li","year":"2021","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Russo, A., Patan\u00e8, V., Oliva, A., Viglione, V., Franzese, L., Forte, G., Liakouli, V., Perrotta, F., and Reginelli, A. (2025). AI-Based HRCT Quantification in Connective Tissue Disease-Associated Interstitial Lung Disease. Diagnostics, 15.","DOI":"10.3390\/diagnostics15172179"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Russo, A., Patan\u00e8, V., Ruotolo, F., Brunese, M.C., Del Canto, M., Alessio, L., Monari, C., Coppola, N., and Reginelli, A. (2026). Artificial Intelligence-Assisted Quantification of Longitudinal HRCT Changes During Treatment of Pulmonary Tuberculosis: An Exploratory Proof-of-Concept Study. Diagnostics, 16.","DOI":"10.3390\/diagnostics16121822"}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/8\/491\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T04:13:34Z","timestamp":1787372014000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/8\/491"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":38,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["curroncol33080491"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33080491","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]}}}