Proposal of Modified Lung-RADS in Assessing Pulmonary Nodules of Patients with Previous Malignancies: A Primary Study

Abstract

Background: In addition to the diameters of pulmonary nodules, the number and morphology of blood vessels in pure ground-glass nodules (pGGNs) were closely related to the occurrence of lung cancer. Moreover, the benign and malignant signs of nodules were also valuable for the identification of nodules. Based on these two points, we tried to revise Lung-RADS 2022 and proposed our Modified Lung-RADS. The aim of the study was to verify the diagnostic performance of Modified Lung-RADS for pulmonary solid nodules (SNs) and pure ground-glass nodules (pGGNs) in patients with previous malignancies. Methods: The chest CT and clinical data of patients with prior cancer who underwent pulmonary nodulectomies from 1 January 2018 to 30 November 2021 were enrolled according to inclusion and exclusion criteria. A total of 240 patients with 293 pulmonary nodules were included in this study. In contrast with the original version, the risk classification of pGGNs based on the GGN–vascular relationships (GVRs), and the SNs without burrs and with benign signs, could be downgraded to category 2. The sensitivity, specificity, and agreement rate of the original Lung-RADS 2022 and Modified Lung-RADS for pGGNs and SNs were calculated and compared. Results: Compared with the original version, the sensitivity and agreement rate of the Modified version for pGGNs increased from 0 and 23.33% to 97.10% and 92.22%, respectively, while the specificity decreased from 100% to 76.19%. As regards SNs, the specificity and agreement rate of the Modified version increased from 44.44% to 75.00% (p < 0.05) and 88.67% to 94.09% (p = 0.052), respectively, while the sensitivity was unchanged (98.20%). Conclusions: In general, the diagnostic efficiency of Modified Lung-RADS was superior to that of the original version, and Modified Lung-RADS could be a preliminary attempt to improve Lung-RADS 2022.

Subpleural pulmonary nodule marking with patent blue V dye prior to surgical resection

“…The recommendations based on the Fleischner classification ( 3 ) and BTS guidelines ( 4 ) have been recently updated based on the insights from large screening studies ( 5 ). They play a crucial role in the assessment of the malignant potential of lesions, risk evaluation, and recommendation of the further management of the pulmonary nodules in daily clinical practice ( 6 ).…”