Outcome of Solitary Pulmonary Nodules Discovered in an X-Ray Screening Program

Comstock, George W.; Vaughan, Robert H.; Montgomery, G. L.

doi:10.1056/nejm195605312542202

Cited by 43 publications

(13 citation statements)

References 8 publications

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“…Factors such as age, location in endemic areas for fungal disease, special study groups such as veterans, or screening studies affect the probability of malignancy in an SPN. Most of the studies show that the incidence of malignant SPN ranges between 5–69% (average of 40%) 1 11 – 15. When lung cancer is the cause of SPN, adenocarcinoma is the most common pathology; on the other hand, small cell carcinoma is a rare cause of SPN 16 17.…”

Section: Aetiology Of Solitary Pulmonary Nodulementioning

confidence: 99%

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The evaluation and management of the solitary pulmonary nodule

Soubani

2008

Postgraduate Medical Journal

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Solitary pulmonary nodules (SPNs) are increasingly detected with the widespread use of chest computed tomography (CT) scans. The primary goal of the evaluation of these nodules is to determine whether they are malignant or benign. Clinical factors such as older age, tobacco smoking and current or remote history of malignancy increase the pre-test likelihood of malignancy. Radiological features of the SPN based on chest CT with high resolution cuts are critical in differentiating between benign or malignant lesions. These features include size, change in size, the presence and pattern of calcification, edge characteristics, attenuation, and contrast enhancement. SPNs that are stable in size for >2 years and those with benign pattern of calcification do not need further studies. Lesions with clear change in size are malignant until proven otherwise and require tissue diagnosis. Frequently, the aetiology of the SPN following chest CT scan remains indeterminate and requires further evaluation. The approach to the management of indeterminate SPN ranges between observation with repeat chest CT scan, further diagnostic studies such as positron emission tomography (PET) scan, or invasive procedures to obtain tissue diagnosis. These procedures include bronchoscopy, transthoracic needle aspirate, and resection by video assisted thoracoscopy or thoracotomy. Determination of which approach to follow depends on the pre-test probability of malignancy, whether the patient is a surgical candidate, and the patient's informed preferences. This article reviews the radiological features of the SPN and their value in differentiating between benign and malignant lesions. This is followed by discussion of the different approaches to the management of the SPN after initial characterisation by chest CT scan, including the benefits and limitations of the different diagnostic studies.

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Section: Aetiology Of Solitary Pulmonary Nodulementioning

confidence: 99%

“…Solitary pulmonary nodules (SPNs) are detected in 0.2% of chest radiographs 1. It is estimated that around 150 000 lung nodules are detected annually in the USA, and more than 90% of these are incidental 2.…”

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confidence: 99%

The evaluation and management of the solitary pulmonary nodule

Soubani

2008

Postgraduate Medical Journal

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“…These nodules are caused by a variety of disorders including neoplasms, infection, inflammation, vascular, and congenital abnormalities. Although most solitary pulmonary nodules have benign causes, 30-40 % of these nodules are malignant [4,5]. Ideally, the goals of diagnosis and management are to perform surgery promptly in all patients with operable malignant nodules and to avoid unnecessary thoracotomy in those patients with benign lesions.…”

Section: Introductionmentioning

confidence: 99%

Characterization of solitary pulmonary nodules with 18F-FDG PET/CT relative activity distribution analysis

Zhao

Lin

et al. 2015

Eur Radiol

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“…Despite several studies on the frequency of SPN discovered on imaging exams, incidence data (number of new cases of SPN occurring within a specified period of time among person-time at risk in the population) are still scarce, especially in a general population. In the 1950s, one SPN was found for every 500 to 1000 chest radiographs in the USA, depending on the population studied [4–6]. Since the 1990s, CT screening programs for lung cancer have been providing estimates of the prevalence of non-calcified nodules discovered in high-risk participants, but data on the incidence of nodules, and especially SPNs, are neither detailed enough nor even provided [7–11].…”

Section: Introductionmentioning

confidence: 99%

Incidence of solitary pulmonary nodules in Northeastern France: a population-based study in five regions

Marrer¹,

Jolly²,

Arveux³

et al. 2017

BMC Cancer

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BackgroundThe discovery of a solitary pulmonary nodule (SPN) on a chest imaging exam is of major clinical concern. However, the incidence rates of SPNs in a general population have not been estimated. The objective of this study was to provide incidence estimates of SPNs in a general population in 5 northeastern regions of France.MethodsThis population-based study was undertaken in 5 regions of northeastern France in May 2002-March 2003 and May 2004-June 2005. SPNs were identified by chest CT reports collected from all radiology centres in the study area by trained readers using a standardised procedure. All reports for patients at least 18 years old, without a previous history of cancer and showing an SPN between 1 and 3 cm, were included.ResultsA total of 11,705 and 20,075 chest CT reports were collected for the 2002–2003 and 2004–2005 periods, respectively. Among them, 154 and 297 reports showing a SPN were included, respectively for each period. The age-standardised incidence rate (IR) was 10.2 per 100,000 person-years (95% confidence interval 8.5–11.9) for 2002–2003 and 12.6 (11.0–14.2) for 2004–2005. From 2002 to 2005, the age-standardised IR evolved for men from 16.4 (13.2–19.6) to 17.7 (15.0–20.4) and for women from 4.9 (3.2–6.6) to 8.2 (6.4–10.0). In multivariate Poisson regression analysis, gender, age, region and period were significantly associated with incidence variation.ConclusionsThis study provides reference incidence rates of SPN in France. Incidence was higher for men than women, increased with age for both gender and with time for women. Trends in smoking prevalence and improvement in radiological equipment may be related to incidence variations.

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Outcome of Solitary Pulmonary Nodules Discovered in an X-Ray Screening Program

Cited by 43 publications

References 8 publications

The evaluation and management of the solitary pulmonary nodule

The evaluation and management of the solitary pulmonary nodule

Characterization of solitary pulmonary nodules with 18F-FDG PET/CT relative activity distribution analysis

Incidence of solitary pulmonary nodules in Northeastern France: a population-based study in five regions

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