Smooth or Attached Solid Indeterminate Nodules Detected at Baseline CT Screening in the NELSON Study: Cancer Risk during 1 Year Follow-up

Dong Ming Xu, Hester J. van der Zaag-Loonen, Matthijs Oudkerk*, Ying Wang, Rozemarijn Vliegenthart, Ernst T. Scholten, Johny Verschakelen, Mathias Prokop, Harry J. de Koning, Rob J. van Klaveren

*Corresponding author for this work

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Abstract

Purpose: To retrospectively determine whether baseline nodule characteristics at 3-month and 1-year volume doubling time (VDT) are predictive for lung cancer in solid indeterminate noncalcified nodules (NCNs) detected at baseline computed tomographic (CT) screening.

Materials and Methods: The study, conducted between April 2004 and May 2006, was institutional review board approved. Patient consent was waived for this retrospective evaluation. NCNs between 5 and 10 mm in diameter (n = 891) were evaluated at 3 months and 1 year to assess growth (VDT <400 days). Baseline assessments were related to growth at 3 months and 1 year by using chi(2) and Mann-Whitney U tests. Baseline assessments and growth were related to the presence of malignancy by using univariate and multivariate logistic regression analyses.

Results: At 3 months and at 1 year, 8% and 1% of NCNs had grown, of which 15% and 50% were malignant, respectively. One-year growth was related to morphology (P <.01), margin (P <.0001), location (P <.001), and size (P <.01). All cancers were nonspherical and purely intra-parenchymal, without attachment to vessels, the pleura, or fissures. In nonsmooth unattached nodules, a volume of 130 mm(3) or larger was the only predictor for malignancy (odds ratio, 6.3; 95% confidence interval [CI]: 1.7, 23.0). After the addition of information on the 3-month VDT, large volume (odds ratio, 4.9; 95% CI: 1.2, 20.1) and 3-month VDT (odds ratio, 15.6; 95% CI: 4.5, 53.5) helped predict malignancy. At 1 year, only the 1-year growth remained (odds ratio, 213.3; 95% CI: 18.7, 2430.9) as predictor for malignancy.

Conclusion: In smooth or attached solid indeterminate NCNs, no malignancies were found at 1-year follow-up. In nonsmooth purely intraparenchymal NCNs, size is the main baseline predictor for malignancy. When follow-up data are available, growth is a strong predictor for malignancy, especially at 1-year follow-up. (C) RSNA, 2008

Original languageEnglish
Pages (from-to)264-272
Number of pages9
JournalRADIOLOGY
Volume250
Issue number1
DOIs
Publication statusPublished - Jan-2009

Keywords

  • SOLITARY PULMONARY NODULES
  • INTRAPULMONARY LYMPH-NODES
  • HIGH-RESOLUTION CT
  • LUNG-CANCER
  • MALIGNANT LESIONS
  • FEATURES
  • BENIGN
  • POPULATION
  • TRIAL
  • MANAGEMENT

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