Annual CT, Not Biopsy for Nonsolid Nodules in Lung Cancer Screening

Lung cancers that manifest as nonsolid nodules (NSNs) as seen on CT lung cancer screening have an indolent course and can be managed with annual CT follow-up, according to a study published in Radiology.

Researchers from Mount Sinai Medical Center in New York City, NY, sought to validate the recommendation of annual follow-up examinations following identification of NSNs by CT lung cancer screening.         

The researchers searched the National Lung Screening Trial (NLST) and identified 2,534 patients who had one or more NSNs detected by CT, out of 26,722 participants (9.4%). Lung cancer was cause of death (COD) for 48 participants.

The researchers found that 21 of the 48 patients had no NSN in the cancerous lobe. Radiologists reviewed CT scans of the remaining 27 patients. Diagnosis was listed as adenocarcinoma for 12 patients (Group A) and 15 were cases of lung cancer from other cell types (Group B). The frequency of lung cancer as the COD because of NSN and the time from randomization to diagnosis within these groups was determined.

The results showed that six of the 12 patients in group A had no NSN in the cancerous lobe whereas the remaining six patients had a dominant solid or part-solid nodule in the lobe that rapidly grew in four patients, was multifocal in one patient, and had a growing NSN in one patient in whom diagnosis was delayed for over three years. Five of the 15 patients in group B had no NSN, and for the remaining 10 patients, lung cancer as the COD was not because of NSN.[[{"type":"media","view_mode":"media_crop","fid":"50331","attributes":{"alt":"Rowena Yip, MPH","class":"media-image media-image-right","id":"media_crop_6190767232021","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6133","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 215px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Rowena Yip, MPH","typeof":"foaf:Image"}}]]

“The causes of death in this group were likely due to another solid or part-solid nodule in the same lobe of the lung,” lead author Rowena Yip, MPH, senior biostatistician at Icahn School of Medicine at Mount Sinai, said in a release. “In the one death related to a growing nonsolid nodule, the time from prior CT to diagnosis was greater than three years.”

The researchers concluded that it seemed unlikely that patients with lung cancer as the COD occurred with solitary or dominant NSN as long as annual follow-up was performed.

“We think that we have enough data now to say that these nodules can safely be followed by annual CT scans and do not have to be biopsied or treated right away,” co-author Claudia I. Henschke, MD, PhD, said the same release. “Survival remains 100 percent as long as the nodules remain nonsolid, and for those that ultimately do progress, the one-year follow-up interval is short enough that they still remain entirely curable.”