Pulmonary Perifissural Nodules on CT Scans: Rapid Growth Is Not a Predictor of Malignancy

Hoop, Bartjan de; Ginneken, Bram van; Gietema, Hester A.; Prokop, Mathias

doi:10.1148/radiol.12112351

Cited by 157 publications

(155 citation statements)

References 16 publications

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“…n.m. not measured nodules have very low probability of malignancy [16,25]. De Hoop et al showed that perifissural nodules are rarely malignant, even in case of rapid growth [26]. In this study, we also found that in 2 years after baseline, none of the downward adjusted nodules turned out to be lung cancer.…”

Section: Discussionsupporting

confidence: 66%

The impact of radiologists’ expertise on screen results decisions in a CT lung cancer screening trial

et al. 2014

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Objective To evaluate the impact of radiological expertise on screen result decisions in a CT lung cancer screening trial. Methods In the NELSON lung cancer screening trial, the baseline CT result was based on the largest lung nodule's volume. The protocol allowed radiologists to manually adjust screen results in cases of high suspicion of benign or malignant nodule nature. Participants whose baseline CT result was based on a solid or part-solid nodule were included in this study. Adjustments by radiologists at baseline were evaluated. Histology was the reference for diagnosis or to confirm benignity and stability on subsequent CT examinations. Results A total of 3,318 participants (2,796 male, median age 58.0 years) were included. In 195 participants (5.9 %) the initial baseline screen result was adjusted by the radiologist. Adjustment was downwards from positive or indeterminate to negative in two and 119 participants, respectively, and from positive to indeterminate in 65 participants. None of these nodules turned out to be malignant. In 9/195 participants (4.6 %) the screen result was adjusted upwards from negative to indeterminate or indeterminate to positive; two nodules were malignant. Conclusion In one in 20 cases of baseline lung cancer screening, nodules were reclassified by the radiologist, leading to a reduction of false-positive screen results. Key Points • The NELSON study allowed radiologists to manually adjust the screen result • At baseline, radiologists adjusted the result in about one in 20 cases (95.4 % downwards) • Radiologists' adjustments led to a 22 % reduction of falsepositive screen results • Radiologists' expertise can improve nodule classification in addition to a nodule protocol

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Section: Discussionsupporting

confidence: 66%

The impact of radiologists’ expertise on screen results decisions in a CT lung cancer screening trial

et al. 2014

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“…When small nodules have a perifissural or other juxtapleural location and a morphology consistent with an intrapulmonary lymph node, follow-up CT is not recommended, even if the average dimension exceeds 6 mm. In one study of patients in the NELSON Lung Cancer Screening Trial, 20% of nodules were classified as perifissural, and 16% of these grew during the study; however, none were malignant (94). However, perifissural or juxtapleural location does not in itself reliably indicate benignancy, and the specific nodule morphology must be considered (95,96).…”

Section: Perifissural Nodulesmentioning

confidence: 99%

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

et al. 2017

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The Fleischner Society Guidelines for management of solid nodules were published in 2005, and separate guidelines for subsolid nodules were issued in 2013. Since then, new information has become available; therefore, the guidelines have been revised to reflect current thinking on nodule management. The revised guidelines incorporate several substantive changes that reflect current thinking on the management of small nodules. The minimum threshold size for routine follow-up has been increased, and recommended follow-up intervals are now given as a range rather than as a precise time period to give radiologists, clinicians, and patients greater discretion to accommodate individual risk factors and preferences. The guidelines for solid and subsolid nodules have been combined in one simplified table, and specific recommendations have been included for multiple nodules. These guidelines represent the consensus of the Fleischner Society, and as such, they incorporate the opinions of a multidisciplinary international group of thoracic radiologists, pulmonologists, surgeons, pathologists, and other specialists. Changes from the previous guidelines issued by the Fleischner Society are based on new data and accumulated experience. Table. These are followed by graded ratings of each recommendation using the American College of Chest Physicians recommendations for evidence grading in clinical guidelines (9). Additional explanations are provided regarding the rationale for each recommendation, which is based on the consensus of a multidisciplinary team and a systematic review of the literature, further details of which are included in Appendix E1 [online]. The minimum threshold size for recommending follow-up is based on an estimated cancer risk in a nodule on the order of 1% or greater. This criterion is necessarily arbitrary, and we recognize that a higher threshold may be considered appropriate in some environments and that this threshold will ultimately depend on social and economic factors. Several general considerations regarding technical aspects of using these recommendations are also presented. Finally, in Appendix E1 (online), additional information regarding methods and risk factors is given. detected at CT in adult patients who are at least 35 years old. Separate guidelines have been issued for lung cancer screening, such as those from the American College of Radiology (ACR), and we support the use of those guidelines when interpreting the results of CT screening (8). Specific recommendations are provided for patients with multiple solid and subsolid nodules, and several other commonly encountered clinical situations are addressed.These guidelines are not intended for use in patients with known primary cancers who are at risk for metastases, nor are they intended for use in immunocompromised patients who are at risk for infection; in these patients, treatment should be based on the specific clinical situation. Also, because lung cancer is rare in children and adults younger than 35 years, these guidelines are no...

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“…These nodules probably correspond to perifissural lymph nodes and represented 20% of the nodules found at baseline screening in the NELSON study, a result that is far from insignificant [21].…”

Section: How To Reduce False-positive Computed Tomography Resultsmentioning

confidence: 91%

“…Nodules classified as perifissural can be considered benign, as proven by long term follow-up, even in the case of rapid growth in high-risk patients [20,21]. These nodules probably correspond to perifissural lymph nodes and represented 20% of the nodules found at baseline screening in the NELSON study, a result that is far from insignificant [21].…”

Section: How To Reduce False-positive Computed Tomography Resultsmentioning

confidence: 93%

Avoiding overdiagnosis in lung cancer screening: the volume doubling time strategy

Revel

2013

Eur Respir J

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Pulmonary Perifissural Nodules on CT Scans: Rapid Growth Is Not a Predictor of Malignancy

Cited by 157 publications

References 16 publications

The impact of radiologists’ expertise on screen results decisions in a CT lung cancer screening trial

The impact of radiologists’ expertise on screen results decisions in a CT lung cancer screening trial

Guidelines for Management of Incidental Pulmonary Nodules Detected on CT Images: From the Fleischner Society 2017

Avoiding overdiagnosis in lung cancer screening: the volume doubling time strategy

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