Indeterminate pulmonary subsolid nodules in patients with no history of cancer: growing prediction, CT pattern, and pathological diagnosis

Abstract

We aimed to evaluate and compare the growth patterns among pathological types of indeterminate subsolid nodules in patients without a history of cancer as observed on computed tomography (CT). METHODSThis retrospective study included 77 consecutive patients with 80 indeterminate subsolid nodules on unenhanced thin-section CT. Subsolid nodules were classified into 2 growth pattern groups based on volume: growth (n = 35) and non-growth (n = 42). According to the pathological diagnosis, subsolid nodules were further subdivided into 3 groups: adenocarcinoma in situ (growth, n = 8 vs. non-growth, n = 22), minimally invasive adenocarcinoma (n = 14 vs. n = 15), and invasive adenocarcinoma (n = 13 vs. n = 5). Kaplan-Meier and Cox proportional hazards regression analyses were performed to identify the risk factors for subsolid nodules growth. The CT findings of the 35 subsolid nodules in the growth group were compared among the 3 pathological groups. RESULTSIn the growth group, the overall mean volume doubling time and mass doubling time (MDT) were 811.5 days and 616.5 days, respectively. Patient's age (odds ratio = 1.041, P = .045) and CT subtype of non-solid nodule and part-solid nodule (odds ratio = 3.430, P = .002) could predict subsolid nodule growth. The baseline volume, mass, and mean CT value were larger in the invasive adenocarcinoma group than in the adenocarcinoma in situ group (all P < .01). The shortest volume doubling time was observed in the invasive adenocarcinoma group, followed by the minimally invasive adenocarcinoma group and the adenocarcinoma in situ group. A shorter mass doubling time was observed in the minimally invasive adenocarcinoma group than in the adenocarcinoma in situ group (all P < .02). CONCLUSIONAs age increases, the risk of pulmonary subsolid nodule growth increases by 4% each year, and part-solid nodules have a 3 times higher risk of growth compared to non-solid nodules in patients with no history of cancer. Subsolid nodules with more aggressive pathological characteristics grow at a faster rate. I ncidentally detected pulmonary subsolid nodules (SSNs) can commonly present as indeterminate nodules on chest computed tomography (CT) in routine workflows. Pulmonary SSNs can be divided into non-solid nodules (NSNs) and part-solid nodules (PSNs) according to the absence or presence of internal solid components on thin-section CT, respectively. 1,2 Subsolid nodules can be benign or malignant; most benign SSNs can be radiologically diagnosed based on whether the lesion resolves on follow-up CT scans, while a few persistent SSNs must be surgically confirmed as focal organizing pneumonia and non-specific interstitial fibrosis. 3 Pulmonary SSNs that persist after a follow-up period of 3-6 months have a high likelihood of being premalignant or malignant lesions, and many authors consider persistent SSNs to represent early-stage adenocarcinoma or its precursor. [3][4][5] However, it is still important to determine the following: (1) the growth patterns of radiologically malignant SSNs, (2) what g...

Diagnostic challenge and survival analysis of pulmonary oligometastases and primary lung cancer in breast cancer patients

“…28 The likelihood of pathological invasiveness increases with lesion size, consolidation part, and solid proportion. 29,30 During follow-up, the solid components of numerous lung nodules grew, raising the possibility that the nodules will turn malignant. Following a puncture biopsy, pathology revealed them as early-stage lung adenocarcinoma.…”

“…Previous studies have demonstrated that ground‐glass opacity components represent lepidic growth and the solid components are related to invasion in lung cancer 28 . The likelihood of pathological invasiveness increases with lesion size, consolidation part, and solid proportion 29,30 . During follow‐up, the solid components of numerous lung nodules grew, raising the possibility that the nodules will turn malignant.…”

Letter to the Editor: Indeterminate pulmonary subsolid nodules in patients with no history of cancer

“…However, they have specified only 77 pathological diagnoses, including 29 adenocarcinomas in situ , 29 minimally invasive adenocarcinomas, 18 invasive adenocarcinomas, and one atypical adenomatous hyperplasia. 1 There is a discrepancy in the number of resected and histopathologically reported nodules in the study.…”

“…I read with interest the original article entitled “Indeterminate pulmonary subsolid nodules in patients with no history of cancer: growing prediction, CT pattern, and pathological diagnosis” by Guo et al 1 In this retrospective study, the authors assessed the growth patterns of indeterminate subsolid pulmonary nodules on computed tomography in patients without a history of malignancy. The authors reported that the risk of pulmonary subsolid nodule growth increases by 4% each year in patients without a history of malignancy.…”

Long‐term follow‐up of persistent pulmonary subsolid nodules: Natural course of pure, heterogeneous, and real part‐solid ground‐glass nodules

“…15 The clinicopathologic behaviors of rPSNs appear to be worse than those of hGGNs. 16 However, previous studies on the natural process of SSNs mainly compared pGGNs and PSNs separated by the LW, 1,[17][18][19] and did not provide enough information on the natural history with regard to the solid component on different window settings. This study aims to investigate the natural history and clinicopathological aspects of pGGNs, hGGNs, and rPSNs with long-term follow-up.…”