TY - JOUR
T1 - Predicting malignancy
T2 - Subsolid nodules detected on LDCT in a surgical cohort of East Asian patients
AU - Wang, Yung Hsien
AU - Chen, Chieh Feng
AU - Lin, Yen Kuang
AU - Chiang, Caleb
AU - Tzao, Ching
AU - Yen, Yun
N1 - Funding Information:
Research Center of Cancer Translational Medicine” from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan. This work was supported by Health and welfare surcharge of tobacco products grant MOHW107-TDU-B-212-114020, MOHW107-TDU-B-212-114014 and MOHW107-TDU-B-212-114026B. This work was supported by Ministry of Science and Technology grant MOST 106-3114-B-038-001, MOST 107-2321-B-038-002, MOST 108-2321-B-038-003.
Funding Information:
This work was financially supported by the "TMU Research Center of Cancer Translational Medicine" from The Featured Areas Research Center Program within the framework of the Higher Education Sprout Project by the Ministry of Education (MOE) in Taiwan. This work was supported by Health and welfare surcharge of tobacco products grant MOHW107-TDU-B-212-114020, MOHW107-TDU-B-212-114014 and MOHW107-TDUB- 212-114026B. This work was supported by Ministry of Science and Technology grant MOST 106-3114-B-038-001, MOST 107-2321-B-038-002, MOST 108-2321-B-038-003.
Funding Information:
Funding: This work was financially supported by the “TMU
Funding Information:
Peer Review File: Available at http://dx.doi.org/10.21037/jtd-20-659 Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi. org/10.21037/jtd-20-659). All authors report grants from TMU Research Center of Cancer Translational Medicine, grants from Taiwan Ministry of Health and Welfare (MOHW), grants from Taiwan Ministry of Science and Technology grant (MOST), during the conduct of the study.
Publisher Copyright:
© 2020 Journal of Thoracic Disease. All rights reserved.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Background: Due to widespread use of low-dose computed tomography (LDCT) screening, increasing number of patients are found to have subsolid nodules (SSNs). The management of SSNs is a clinical challenge and primarily depends on CT imaging. We seek to identify risk factors that may help clinicians determine an optimal course of management. Methods: We retrospectively reviewed the characteristics of 83 SSN lesions, including 48 pure groundglass nodules and 35 part-solid nodules, collected from 83 patients who underwent surgical resection. Results: Of the 83 SSNs, 16 (19.28%) were benign and 67 (80.72%) were malignant, including 23 adenocarcinomas in situ (AIS), 16 minimally invasive adenocarcinomas (MIA), and 28 invasive adenocarcinomas (IA). Malignant lesions were found to have significantly larger diameters (P<0.05) with an optimal cut-off point of 9.24 mm. Significant indicators of malignancy include female sex (P<0.05), air bronchograms (P<0.001), spiculation (P<0.05), pleural tail sign (P<0.05), and lobulation (P<0.05). When compared with AIS/MIA combined, IA lesions were found to be larger (P<0.05) with an optimal cutoff of 12 mm, and have a higher percentage of part-solid nodules (P<0.001), pleural tail sign (P<0.001), air bronchograms (P<0.05), and lobulation (P<0.05). Further multivariate analysis found that lesion size and spiculation were independent factors for malignancy while part-solid nodules were associated with IA histology. Conclusions: East Asian females are at risk of presenting with a malignant lesion even without history of heavy smoking or old age. Nodule features associated with malignancy include larger size, air bronchograms, lobulation, pleural tail sign, spiculation, and solid components. A combination of patient characteristic and LDCT features can be effectively used to guide management of patients with SSNs.
AB - Background: Due to widespread use of low-dose computed tomography (LDCT) screening, increasing number of patients are found to have subsolid nodules (SSNs). The management of SSNs is a clinical challenge and primarily depends on CT imaging. We seek to identify risk factors that may help clinicians determine an optimal course of management. Methods: We retrospectively reviewed the characteristics of 83 SSN lesions, including 48 pure groundglass nodules and 35 part-solid nodules, collected from 83 patients who underwent surgical resection. Results: Of the 83 SSNs, 16 (19.28%) were benign and 67 (80.72%) were malignant, including 23 adenocarcinomas in situ (AIS), 16 minimally invasive adenocarcinomas (MIA), and 28 invasive adenocarcinomas (IA). Malignant lesions were found to have significantly larger diameters (P<0.05) with an optimal cut-off point of 9.24 mm. Significant indicators of malignancy include female sex (P<0.05), air bronchograms (P<0.001), spiculation (P<0.05), pleural tail sign (P<0.05), and lobulation (P<0.05). When compared with AIS/MIA combined, IA lesions were found to be larger (P<0.05) with an optimal cutoff of 12 mm, and have a higher percentage of part-solid nodules (P<0.001), pleural tail sign (P<0.001), air bronchograms (P<0.05), and lobulation (P<0.05). Further multivariate analysis found that lesion size and spiculation were independent factors for malignancy while part-solid nodules were associated with IA histology. Conclusions: East Asian females are at risk of presenting with a malignant lesion even without history of heavy smoking or old age. Nodule features associated with malignancy include larger size, air bronchograms, lobulation, pleural tail sign, spiculation, and solid components. A combination of patient characteristic and LDCT features can be effectively used to guide management of patients with SSNs.
KW - Computed tomography
KW - Ground-glass opacity (GGO)
KW - Lung adenocarcinoma
KW - Subsolid nodules (SSNs)
UR - http://www.scopus.com/inward/record.url?scp=85091829561&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091829561&partnerID=8YFLogxK
U2 - 10.21037/jtd-20-659
DO - 10.21037/jtd-20-659
M3 - Article
AN - SCOPUS:85091829561
SN - 2072-1439
VL - 12
SP - 4315
EP - 4326
JO - Journal of Thoracic Disease
JF - Journal of Thoracic Disease
IS - 8
ER -