Spectrum of early lung cancer presentation in low-dose screening CT: a pictorial review

Abstract

The typical presentation of early stage lung cancers on low-dose CT screening are non-calcified pulmonary nodules. However, there is a wide spectrum of unusual focal abnormalities that can be early presentations of lung cancer. These abnormalities include, for example, cancers associated with ‘cystic airspaces’ or scar-like cancers. The detection of lung cancer with low-dose CT can be affected by the absence of intravenous contrast medium. As a consequence, endobronchial and central lesions can be difficult to recognize, raising the potential for missed cancers. Focal lesions arising within pre-existing lung disease, such as lung fibrosis or apical scars, can also be early lung cancer manifestations and deserve particular consideration as recognition of these lesions may be hindered by the underlying disease. Furthermore, the unpredictable growth rate of lung cancer, which ranges from indolent to aggressive cancers, necessitates attention to the wide spectrum of progression in lung cancer appearance on serial low-dose CT scans. In this pictorial review we discuss the spectrum of early lung cancer presentation in low-dose CT screening, highlighting typical as well as unusual radiological features and the varied growth rates of early lung cancer.Teaching Points• There is a wide spectrum of early presentations of lung cancer on LDCT.• Low radiation dose and the absence of contrast medium injection can affect lung cancer detection.• Lung cancer growth shows various behaviours, ranging from indolent to aggressive cancers.• Familiarity with LDCT technique can improve CT screening effectiveness and avoid missed diagnosis.

Emphysema affects the number and appearance of solitary pulmonary nodules identified in chest low-dose computed tomography: a study on high risk lung cancer screenees recruited in Silesian District

“…38 It was reported that nonsolid SPNs are malignant in 63% of cases, while pure ground glass and solid nodules in 18% and 7% of cases, respectively. [39][40][41][42] In our cohort, over half of diagnosed nodules were solid, followed by nonsolid and part--solid. However, the limitation of this study is the lack of central reading of CT scans.…”

Solid Indeterminate Pulmonary Nodules Less Than or Equal to 250 mm3: Application of the Updated Fleischner Society Guidelines in Clinical Practice

“…According to the literature [9, 10, 15–19, 21], we found that the patient risk status, nodule margins, and nodule size (for the high-risk group only) were significantly related to the nodule outcome. In contrast to many studies [5, 6, 8–10, 15, 16, 18, 19], no significant relationships were found between the nodule outcome and nodule location; however, we found that 80% of malignant nodules were located in the upper lobes (Table 4).…”

ESR/ERS statement paper on lung cancer screening

“…Furthermore, perifissural nodules, which correspond to intrapulmonary lymph nodes, require a less aggressive approach [79,80]. Knowledge of early lung cancer morphology and uncommon manifestations is vital given that these lesions may go unnoticed by CAD systems [81,82].…”