CT Screening for Lung Cancer: Part-Solid Nodules in Baseline and Annual Repeat Rounds

• Published in: American journal of roentgenology (1976) Vol. 207; no. 6; pp. 1176 - 1184
• Main Authors: Henschke, Claudia I, Yip, Rowena, Smith, James P, Wolf, Andrea S, Flores, Raja M, Liang, Mingzhu, Salvatore, Mary M, Liu, Ying, Xu, Dong Ming, Yankelevitz, David F
• Format: Journal Article
• Language: English
• Published: United States 01.12.2016
• Subjects: Aged; Early Detection of Cancer - utilization; Female; Follow-Up Studies; Humans; Incidence; Longitudinal Studies; Lung Neoplasms - diagnostic imaging; Lung Neoplasms - mortality; Male; Middle Aged; Risk Factors; Solitary Pulmonary Nodule - diagnostic imaging; Solitary Pulmonary Nodule - mortality; Tomography, X-Ray Computed - utilization; United States - epidemiology; opacities; lung cancer–specific survival; CT screening; lung neoplasm; ground-glass nodules
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/AJR.16.16043

The purpose of this study was to assess the frequencies of identifying participants with part-solid nodules, of diagnostic pursuit, of diagnoses of lung cancer, and long-term lung cancer survival in baseline and annual repeat rounds of CT screening in the International Early Lung Cancer Action Project. Screenings were performed under a common protocol. Participants with solid, nonsolid, and part-solid nodules and the diagnoses of lung cancer were documented. Part-solid nodules were identified in 2892 of 57,496 (5.0%) baseline screening studies; 567 (19.6%) of these nodules resolved or decreased in size. Diagnostic pursuit led to the diagnosis of adenocarcinoma in 79 cases, all clinical stage I. At resection, one nodule (12-mm solid component) had a single N2 metastasis. A new part-solid nodule was identified in 541 of 64,677 (0.8%) annual repeat screenings; 377 (69.7%) of these nodules resolved or decreased in size. In eight cases among the 541, the diagnosis of adenocarcinoma manifesting as a part solid nodule was made; on retrospective review the nodule originally had been a nonsolid nodule. In another 20 cases, the cancer originally had manifested as a nonsolid nodule but had progressed to become part-solid at annual repeat screening before any diagnosis was pursued. These 28 annual repeat cases of lung cancer were all pathologic stage IA. Of the 107 cases of lung cancer (79 baseline cases and 28 annual repeat cases), 106 were surgically resected, and one baseline case was followed up with imaging for 4 years. The lung cancer survival rate was 100% with a median follow-up period from diagnosis of 89 months (interquartile range, 52-134 months). Lung cancers manifesting as part-solid nodules at repeat screening studies all started as nonsolid nodules. Among 107 cases of adenocarcinoma manifesting as a part-solid nodule, a single lymph node metastasis was found in a single case (solid component, 12 mm).