Abstract
Purpose
The aims of this study were to evaluate the high-resolution computed tomography (HRCT) features of subsolid pulmonary nodules (SSN) detected in cancer patients to differentiate between benign and malignant lesions, to assess their evolution during the follow-up, and to determine which neoplastic diseases are most frequently associated with the growth in size and/or density of SSN.
Materials and methods
Ninety-seven patients with a total of 146 subsolid nodules [140 pure ground-glass opacities (pGGOs) and six mixed ground-glass opacities (mGGOs)] were retrospectively recruited. Two chest radiologists independently reviewed the HRCT features of the nodules (location, shape, size, density) and the patients’ clinical characteristics (sex, age, smoking and cancer history). Mean duration of follow-up was more than 2 years.
Results
During follow-up, 58% of SSN remained stable, 10% disappeared. An increase in size and/or density was seen in 32% of SSN, and in particular in partly solid (mGGOs), large (≥10 mm) and irregular nodules. The majority of small-size (<5 mm) rounded SSN remained stable. SSN growth was more frequent in patients with advanced age and a history of smoking, and occurred even after a long period of stability (39% of pGGOs “changed” over 3 years). The neoplastic diseases most frequently associated with SSN growth were cancers of lung (34%), breast (15%), colon (15%) and bladder (10%).
Conclusions
The observation of a sample of cancer patients has shown that SSN may frequently grow in size and/or density in these patients, especially if associated powith cancers of lung, breast, colon and bladder. As the majority of SSN showed a very slow development time, a follow-up period longer than 3 years is warranted even in cancer patients.
Riassunto
Obiettivo
Scopo del presente lavoro è valutare le caratteristiche alla tomogracfia computerizzata ad alta risoluzione (HRCT) dei noduli polmonari subsolidi (NSS) in pazienti oncologici, per differenziare NSS benigni e maligni, valutare la loro evoluzione durante il follow-up e determinare quali patologie neoplastiche più frequentemente si associano a crescita dimensionale e/o densitometrica delle lesioni.
Materiali e metodi
Sono stati reclutati in maniera retrospettiva 97 pazienti, per un totale di 146 NSS (140 ground glass “puri” — pGGO, e 6 ground glass “misti” — mGGO). Le caratteristiche HRCT dei noduli (localizzazione, forma, dimensioni, densità) e quelle cliniche dei pazienti (sesso, età, abitudine al fumo e anamnesi oncologica) sono state valutate indipendentemente da due radiologi toracici. La durata media del follow-up è stata superiore ai 2 anni. Risultati. Durante il follow-up il 58% dei NSS è rimasto invariato, il 10% è scomparso, mentre in circa un terzo dei casi (32%) si è verificato un aumento di dimensioni e/o densità, specialmente in caso di noduli parzialmente solidi (mGGO), di grandi dimensioni (≥10 mm) e irregolari. La maggior parte dei NSS rotondeggianti e di piccole dimensioni (<5 mm) è rimasto invariato. La crescita è stata più frequente in soggetti di età avanzata e con storia di fumo e si è verificata anche dopo un lungo periodo di stabilità (39% di pGGO “modificati” oltre i 3 anni). Le patologie oncologiche più frequentemente associate a crescita dei NSS sono risultate i tumori del polmone (34%), della mammella (15%), del colon (15%) e della vescica (10%).
Conclusioni
L’osservazione di un campione di pazienti oncologici ha dimostrato come i NSS frequentemente possono crescere di dimensioni e/o densità in questi pazienti, soprattutto se associati a tumori del polmone, della mammella, del colon e della vescica. La maggioranza di essi ha mostrato un tempo di sviluppo estremamente lento, perciò, un follow-up superiore ai 3 anni appare giustificato anche nei pazienti oncologici.
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Attinà, D., Niro, F., Stellino, M. et al. Evolution of the subsolid pulmonary nodule: a retrospective study in patients with different neoplastic diseases in a nonscreening clinical context. Radiol med 118, 1269–1280 (2013). https://doi.org/10.1007/s11547-013-0926-y
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DOI: https://doi.org/10.1007/s11547-013-0926-y