Clinical characteristics and work-up of small to intermediate-sized pulmonary nodules in a Chinese dedicated cancer hospital

• Published in: Cancer biology & medicine Vol. 17; no. 1; pp. 199 - 207
• Main Authors: Cui, Xiaonan, Han, Daiwei, Heuvelmans, Marjolein A, Du, Yihui, Zhao, Yingru, Zhang, Lei, Groen, Harry J M, de Bock, Geertruida H, Dorrius, Monique D, Oudkerk, Matthijs, Vliegenthart, Rozemarijn, Ye, Zhaoxiang
• Format: Journal Article
• Language: English
• Published: China Chinese Anti-Cancer Association (CACA), Cancer Biology & Medicine 15.02.2020; Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands%Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands%Department of Epidemiology, University of Groningen, University Medical Center Groningen,Groningen 9713 GZ, The Netherlands; Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China; Medisch Spectrum Twente, Department of Pulmonology, Enschede 7512 KZ, The Netherlands%Department of Epidemiology, University of Groningen, University Medical Center Groningen,Groningen 9713 GZ, The Netherlands%Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China%Department of Thoracic Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China%Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands%University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands; Compuscript; China Anti-Cancer Association
• Subjects: Adult; Aged; Benign; Biopsy; Cancer Care Facilities - statistics & numerical data; China; Computed tomography; Contrast Media - administration & dosage; Diagnosis; Diagnosis, Differential; Epidermal growth factor receptors; Female; Follow-Up Studies; Histology; Humans; Iodine; Lung - diagnostic imaging; Lung - pathology; Lung - surgery; Lung cancer; Lung Neoplasms - diagnosis; Lung Neoplasms - pathology; Lung Neoplasms - surgery; lung nodule; Lung nodules; Male; Medical screening; Middle Aged; Mutation; Neoplasm Staging; Original; pathology; Patients; Pneumonectomy; Positron emission tomography; Practice Patterns, Physicians' - statistics & numerical data; Retrospective Studies; Solitary Pulmonary Nodule - diagnosis; Solitary Pulmonary Nodule - pathology; Solitary Pulmonary Nodule - surgery; Standard deviation; Surgery; Tomography, X-Ray Computed - statistics & numerical data; Tumor Burden; China; computed tomography; diagnosis; pathology; China; Lung nodule
• ISSN: 2095-3941
• DOI: 10.20892/j.issn.2095-3941.2019.0028

To evaluate the characteristics and work-up of small to intermediate-sized pulmonary nodules in a Chinese dedicated cancer hospital. Patients with pulmonary nodules 4-25 mm in diameter detected computed tomography (CT) in 2013 were consecutively included. The analysis was restricted to patients with a histological nodule diagnosis or a 2-year follow-up period without nodule growth confirming benign disease. Patient information was collected from hospital records. Among the 314 nodules examined in 299 patients, 212 (67.5%) nodules in 206 (68.9%) patients were malignant. Compared to benign nodules, malignant nodules were larger (18.0 mm 12.5 mm, 0.001), more often partly solid (16.0% 4.7%, 0.001) and more often spiculated (72.2% 41.2%, 0.001), with higher density in contrast-enhanced CT (67.0 HU . 57.5 HU, = 0.015). Final diagnosis was based on surgery in 232 out of 314 (73.9%) nodules, 166 of which were identified as malignant [30 (18.1%) stage III or IV] and 66 as benign. In 36 nodules (11.5%), diagnosis was confirmed by biopsy and the remainder verified based on stability of nodule size at follow-up imaging ( = 46, 14.6%). Among 65 nodules subjected to gene (EGFR) mutation analyses, 28 (43.1%) cases (EGFR19 = 13; EGFR21 = 15) were identified as EGFR mutant and 37 (56.9%) as EGFR wild-type. Prior to surgery, the majority of patients [ = 194 (83.6%)] received a contrast-enhanced CT scan for staging of both malignant [ = 140 (84.3%)] and benign [ = 54 (81.8%)] nodules. Usage of positron emission tomography (PET)-CT was relatively uncommon [ = 38 (16.4%)]. CT-derived nodule assessment assists in diagnosis of small to intermediate- sized malignant pulmonary nodules. Currently, contrast-enhanced CT is commonly used as the sole diagnostic confirmation technique for pre-surgical staging, often resulting in surgery for late-stage disease and unnecessary surgery in cases of benign nodules.