Towards a close computed tomography monitoring approach for screen detected subsolid pulmonary nodules?

• Published in: The European respiratory journal Vol. 45; no. 3; pp. 765 - 773
• Main Authors: Scholten, Ernst T., de Jong, Pim A., de Hoop, Bartjan, van Klaveren, Rob, van Amelsvoort-van de Vorst, Saskia, Oudkerk, Matthijs, Vliegenthart, Rozemarijn, de Koning, Harry J., van der Aalst, Carlijn M., Vernhout, René M., Groen, Harry J.M., Lammers, Jan-Willem J., van Ginneken, Bram, Jacobs, Colin, Mali, Willem P.T.M., Horeweg, Nanda, Weenink, Carla, Thunnissen, Erik, Prokop, Mathias, Gietema, Hester A.
• Format: Journal Article
• Language: English
• Published: England 01.03.2015
• Subjects: Dissection - methods; Early Detection of Cancer - methods; Female; Follow-Up Studies; Humans; Image Processing, Computer-Assisted - methods; Lung Neoplasms - diagnosis; Lung Neoplasms - surgery; Male; Middle Aged; Monitoring, Physiologic - methods; Multiple Pulmonary Nodules - diagnostic imaging; Multiple Pulmonary Nodules - pathology; Multiple Pulmonary Nodules - surgery; Netherlands; Outcome Assessment (Health Care); Predictive Value of Tests; Reproducibility of Results; Tomography, X-Ray Computed - methods
• ISSN: 0903-1936; 1399-3003; 1399-3003
• DOI: 10.1183/09031936.00005914

Pulmonary subsolid nodules (SSNs) have a high likelihood of malignancy, but are often indolent. A conservative treatment approach may therefore be suitable. The aim of the current study was to evaluate whether close follow-up of SSNs with computed tomography may be a safe approach. The study population consisted of participants of the Dutch-Belgian lung cancer screening trial (Nederlands Leuvens Longkanker Screenings Onderzoek; NELSON). All SSNs detected during the trial were included in this analysis. Retrospectively, all persistent SSNs and SSNs that were resected after first detection were segmented using dedicated software, and maximum diameter, volume and mass were measured. Mass doubling time (MDT) was calculated. In total 7135 volunteers were included in the current analysis. 264 (3.3%) SSNs in 234 participants were detected during the trial. 147 (63%) of these SSNs in 126 participants disappeared at follow-up, leaving 117 persistent or directly resected SSNs in 108 (1.5%) participants available for analysis. The median follow-up time was 95 months (range 20–110 months). 33 (28%) SSNs were resected and 28 of those were (pre-) invasive. None of the non-resected SSNs progressed into a clinically relevant malignancy. Persistent SSNs rarely developed into clinically manifest malignancies unexpectedly. Close follow-up with computed tomography may be a safe option to monitor changes.