Claudia I. Henschke MD, PhD, Presenter: Nothing to Disclose

Rowena Yip MPH, Abstract Co-Author: Nothing to Disclose

James Smith MD, Abstract Co-Author: Nothing to Disclose

Mingzhu Liang MD, Abstract Co-Author: Nothing to Disclose

Dongming Xu MD, PhD, Abstract Co-Author: Nothing to Disclose

David F. Yankelevitz MD, Abstract Co-Author: Research Grant, AstraZeneca PLC Royalties, General Electric Company

The diagnostic workup of nonsolid pulmonary nodules remains controversial. We address the frequency of identifying such nodules, the frequency of resolution or growth,  the frequency and stage of lung cancer diagnoses, and long-term survival of those diagnosed with lung cancer.

Using the screenings in the database, we identified participants with one or more nonsolid nodules identified in the first, baseline round to determine whether the nodule resolved, decreased in size, remained unchanged, or increased in size or CT attenuation. Nodule size was based on the average nodule diameter. Follow-up time for the diagnosed cases of lung cancer was from the date of diagnosis to April 1, 2014 or death, whichever came first.

Among the 58,062 participants who underwent baseline CT screening, the prevalence of at least one nonsolid nodule was 4% (2,383). The frequency was: 1060 (45%) for those largest nodule < 5 mm in diameter, 956 (40%) for 5-9 mm, 231 (8%) for 10-14 mm, and 136 (7%) for 15+ mm. The nonsolid nodule resolved in 20% (N = 466), decreased in size in 7% (N = 174), was unchanged in 54% (N = 1,281), or increased in size or HU attenuation in 19% (N =462) on annual repeat scans.  A diagnosis of lung cancer was made in 65 (3%) of the 2,383 participants,3 (0.3%) for those < 5 mm, 26 (2.7%) for those 5-9 mm, 22 (9.5%) for those 10-14 mm, and 14 (10%) for those 15+ mm. Median time to diagnosis was 34 months (range: 1-125).  No malignancy was diagnosed in those whose nodule resolved or decreased, 2% (N = 27) in those whose nodule did not change and 8% (N = 20) among the 462 whose nodule increased in size. All were adenocarcinoma, clinical and pathologic Stage I.  There were no lung cancer deaths in the 62 who underwent resection, regardless of whether resection was lobar (N = 37) or sublobar (N = 25).  None of the 3 unresected patients with a cytologic diganosis of malignancy died of lung cancer.  Median follow-up time from diagnosis was 80 months (range: 4-161 months).     

Nonsolid nodules, regardless of size, can be followed annually as survival is 100% even when resected years later. 

Nonsolid nodules of any size can be followed by annual scans to assess growth.   

Henschke, C, Yip, R, Smith, J, Liang, M, Xu, D, Yankelevitz, D, CT Screening for Lung Cancer: The Frequency of Nonsolid Nodules, Rate of Malignancy, and Long-term Survival in a Large, Long-term Database.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004179.html