RT Journal Article
SR Electronic
T1 Lung cancer probability and clinical outcomes of baseline and new subsolid nodules detected on low-dose CT screening
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 980
OP 988
DO 10.1136/thoraxjnl-2020-215107
VO 76
IS 10
A1 Yeon Wook Kim
A1 Byoung Soo Kwon
A1 Sung Yoon Lim
A1 Yeon Joo Lee
A1 Jong Sun Park
A1 Young-Jae Cho
A1 Ho Il Yoon
A1 Kyung Won Lee
A1 Jae Ho Lee
A1 Jin-Haeng Chung
A1 Eunjeong Ji
A1 Choon-Taek Lee
YR 2021
UL http://thorax.bmj.com/content/76/10/980.abstract
AB Background Limited data are available regarding the management of subsolid nodules detected on lung cancer screening with low-dose CT (LDCT). We aimed to determine the characteristics of screen-detected subsolid nodules, and to evaluate the probability of lung cancer and the clinical course of subsolid nodules detected at baseline and during follow-up screening.Methods We evaluated 50 132 asymptomatic adults (22 631 never-smokers and 27 501 ever-smokers) who underwent LDCT screening for lung cancer between May 2003 and June 2019 at a tertiary centre in South Korea. The incidence, characteristics and clinical outcomes of the baseline and new screen-detected subsolid nodules were determined.Results A total of 6725 subsolid nodules (5116 pure ground glass opacity nodules and 1609 part-solid nodules) were detected in 4545 participants (1484 new subsolid nodules detected in 937 (1.9%) participants; the overall incidence of subsolid nodules: 10.7% in never-smokers and 7.7% in ever-smokers, p<0.001). Among 4918 subsolid nodules that underwent follow-up with CT scans (the mean number of CT scans, including the baseline LDCT scan: 4.6), 2116 nodules (30.0% of baseline subsolid nodules and 78.9% of new subsolid nodules) resolved spontaneously. Among 293 biopsied subsolid nodules, 227 (77.5%) nodules were diagnosed as lung cancer, of which 226 (99.6%) were adenocarcinomas. No significant difference was observed in pathological invasiveness or the initial stage between the baseline and new cancerous subsolid nodules. Multivariable analyses revealed that new detection at follow-up screening was significantly associated with a lower probability of lung cancer (OR 0.26, 95% CI 0.14 to 0.49) and overall growth (OR 0.39, 95% CI 0.26 to 0.59), but with a higher probability of resolution (OR 6.30, 95% CI 5.09 to 7.81).Conclusions LDCT screening led to a considerably high rate of subsolid nodule detection, particularly in never-smokers. Compared with the baseline subsolid nodules, the new subsolid nodules were associated with a lower probability of lung cancer and higher probability of spontaneous resolution, indicating their more inflammatory nature. Less aggressive follow-up may be allowed for new subsolid nodules, particularly in screening programmes for Asian populations.Data are available on reasonable request.