Towards a close computed tomography monitoring approach for screen detected subsolid pulmonary nodules?

Scholten, Ernst Th.; Jong, Pim A. de; Hoop, Bartjan de; Klaveren, R. van; Vorst, Saskia van Amelsvoort-van de; Oudkerk, Matthijs; Vliegenthart, Rozemarijn; Koning, Harry J. de; Aalst, Carlijn M. van der; Vernhout, René M.; Groen, Harry J.M.; Lammers, Jan‐Willem J.; Ginneken, Bram van; Jacobs, Colin; Mali, Willem P.Th.M.; Horeweg, Nanda; Weenink, Carla; Thunnissen, Erik; Prokop, Mathias; Gietema, Hester A.

doi:10.1183/09031936.00005914

Cited by 100 publications

(82 citation statements)

References 34 publications

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“…Furthermore, subsolid lung cancers were excluded, since the Syngo LungCARE© software package was not able to calculate the volume of sub-solid nodules (1.9% of all non-calcified nodules). Growth curves of nineteen subsolid NELSON lung cancers have been published elsewhere [33].…”

Section: Participantsmentioning

confidence: 99%

Quantification of growth patterns of screen-detected lung cancers: The NELSON study

et al. 2017

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a b s t r a c tObjectives: Although exponential growth is assumed for lung cancer, this has never been quantified in vivo. Aim of this study was to evaluate and quantify growth patterns of lung cancers detected in the Dutch-Belgian low-dose computed tomography (CT) lung cancer screening trial (NELSON), in order to elucidate the development and progression of early lung cancer. Materials and methods: Solid lung nodules found at ≥3 CT examinations before lung cancer diagnosis were included. Lung cancer volume (V) growth curves were fitted with a single exponential, expressed as V = V 1 exp(t/ ), with t time from baseline (days), V 1 estimated baseline volume (mm 3 ), and estimated time constant. The R 2 coefficient of determination was used to evaluate goodness of fit. Overall volumedoubling time for the individual lung cancer is given by * log(2). Results: Forty-seven lung cancers in 46 participants were included. Forty participants were male (87.0%); mean age was 61.7 years (standard deviation, 6.2 years). Median nodule size at baseline was 99.5 mm 3 (IQR: 46.8-261.8 mm 3 ). Nodules were followed for a median of 770 days (inter-quartile range: 383-1102 days) before lung cancer diagnosis. One cancer (2.1%) was diagnosed after six CT examinations, six cancers (12.8%) were diagnosed after five CTs, 14 (29.8%) after four CTs, and 26 cancers (55.3%) after three CTs. Lung cancer growth could be described by an exponential function with excellent goodness of fit (R 2 0.98). Median overall volume-doubling time was 348 days (inter-quartile range: 222-492 days). Conclusion: This study based on CT lung cancer screening provides in vivo evidence that growth of cancerous small-to-intermediate sized lung nodules detected at low-dose CT lung cancer screening can be described by an exponential function such as volume-doubling time.© 2017 Elsevier B.V. All rights reserved.

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Section: Participantsmentioning

confidence: 99%

Quantification of growth patterns of screen-detected lung cancers: The NELSON study

et al. 2017

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“…In the report by SCHOLTEN et al [8] in this issue of the ERJ shows that volume and mass doubling times of SSNs tend to be very long, and that a cut-off of <400 days would be unable to discriminate malignant from benign SSNs. The performance of volumetric software for subsolid nodules is less than ideal.…”

Section: @Erspublicationsmentioning

confidence: 99%

“…The performance of volumetric software for subsolid nodules is less than ideal. In fact, SCHOLTEN et al [8] resorted to manual determinations to obtain diameter, then volume and, hence, mass measurements, and moreover, one-third of their patients were ultimately referred for further workup based on a visual impression of growth. KIM et al [31] reported an error margin of -18% to +19% for automated mass measurements of SSNs, which is comparable with the results of SCHOLTEN et al [8].…”

Section: @Erspublicationsmentioning

confidence: 99%

“…For this reason, they are often considered for immediate resection. Nonetheless, recent reports [6,7] suggest that long-term observation of these patients may be appropriate.In this issue of the European Respiratory Journal (ERJ), the clinical course of 108 patients with persistent SSNs detected in the NELSON trial is reported [8], and a long-term follow-up approach is proposed on the grounds that the risk of progression of SSNs towards clinically significant lung cancer is extremely low. In principle, despite the high probability of SSNs being histologically malignant, their clinical behaviour tends to be indolent and surgical resection of all of them would therefore lead to a great number of lung resections with little real benefit, i.e.…”

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A conservative approach for subsolid lung nodules: is it safe enough?

Infante

2015

Eur Respir J

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@ERSpublicationsA long-term follow-up strategy may be reasonable for subsolid nodules at low risk of progression based on CT features http://ow.ly/HasGFWith the foreseen dissemination of lung cancer screening with low-dose spiral computed tomography (LDCT), a great number of subjects will come to medical attention harbouring small, indeterminate pulmonary nodules [1]. Subsolid lung nodules (SSNs), also called ground-glass opacities or ground-glass nodules (GGNs), are identified in 2-3% of subjects receiving a screening LDCT [2,3]. Many of them have a benign aetiology and resolve spontaneously over time. However, unlike solid nodules that represent true lung cancer in a tiny fraction of patients, nonresolving SSNs are found to be histologically malignant in 30-70% of the cases [4,5]. For this reason, they are often considered for immediate resection. Nonetheless, recent reports [6,7] suggest that long-term observation of these patients may be appropriate.In this issue of the European Respiratory Journal (ERJ), the clinical course of 108 patients with persistent SSNs detected in the NELSON trial is reported [8], and a long-term follow-up approach is proposed on the grounds that the risk of progression of SSNs towards clinically significant lung cancer is extremely low. In principle, despite the high probability of SSNs being histologically malignant, their clinical behaviour tends to be indolent and surgical resection of all of them would therefore lead to a great number of lung resections with little real benefit, i.e. to overdiagnosis and overtreatment. However, given that progression may actually occur over time, a management plan should be devised and discussed on a case by case basis.Since the mid-1990s, when the association of subsolid nodules with early-stage bronchioloalveolar carcinoma was first reported [9,10], numerous publications have addressed the clinical significance of SSNs and their relationship with the spectrum of lung adenocarcinoma [11]. A good correlation between the aspect of SSNs on computed tomography (CT), their histological features of malignancy and clinical aggressiveness was observed in Japan a long time ago [12,13] and still has practical value today, although the pathology terms have been changed for the spectrum of lung adenocarcinoma.Pure GGNs of <10 mm are most likely benign atypical adenomatous hyperplasia or, more rarely, adenocarcinoma in situ (AIS). Pure GGNs measuring 10-30 mm reflect AIS or minimally invasive lepidic adenocarcinoma. A solid component in a GGN often reflects tumour invasion of the interstitium; the larger the solid part on CT, the larger the area of invasion [14,15]. The relative and absolute sizes of the solid component are also known to correlate with the probability of nodal metastasis, recurrence after surgery and death. Pure GGNs have virtually no probability of nodal involvement, whereas for part-solid nodules, the risk rises to about 15%, and to ∼30% for solid nodules [15,16].In a recent report on 145 patients with resected stage I lung adenocarcinom...

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“…The reports from lung cancer screening trials showed that conservative management of pGGN provides optimal balance between risk and benefits. In asymptomatic subjects at high risk of lung cancer, pGGN did not progress to advanced stage lung cancer in several years after first documentation on CT (29)(30)(31)(32). Therefore, long-term active surveillance by low-dose CT (LDCT) is encouraged until the evidence of nodule progression.…”

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Adenocarcinoma in pure ground glass nodules: histological evidence of invasion and open debate on optimal management

et al. 2017

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Towards a close computed tomography monitoring approach for screen detected subsolid pulmonary nodules?

Cited by 100 publications

References 34 publications

Quantification of growth patterns of screen-detected lung cancers: The NELSON study

Quantification of growth patterns of screen-detected lung cancers: The NELSON study

A conservative approach for subsolid lung nodules: is it safe enough?

Adenocarcinoma in pure ground glass nodules: histological evidence of invasion and open debate on optimal management

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