Radiologic Features of Nodules Attached to the Mediastinal or Diaphragmatic Pleura at Low-Dose CT for Lung Cancer Screening
Yeqing Zhu, Rowena Yip, J. Zhang, Qiang Cai, Qi Sun, Pengfei Li, Natela Paksashvili, Natthaya Triphuridet, Claudia I. Henschke, David F. Yankelevitz, Claudia I. Henschke, David F. Yankelevitz, Rowena Yip, Artit Jirapatnakul, Raja M. Flores, Andrew Kaufman, Andrea Wolf, Daniel Nicastri, Javier J. Zulueta, Emanuela Taioli, Anthony P. Reeves, Nasser K. Altorki, James P. Smith, Daniel M. Libby, Mark Pasmantier, Steven Markowitz, Albert Miller, José Cervera Deval, Dorith Shaham, Luis Seijó, Gorka Bastarrika, Luis M. Montuenga, Cheryl Aylesworth, Karl Klingler, Othmar Schöb, Shahriyour Andaz, Michaela Straznicka, Cynthia Chin, Todd S. Weiser, Shusuke Sone, Takaomi Hanaoka, Heidi Roberts, Demetris Patsios, M. Scopetuolo, Andrew Brown, Thomas Bauer, Stefano Canitano, Salvatore Giunta, Ning Wu, Enser Cole, Patrick Meyers, Diana Yeh, Dan W. Luedke, Xueguo Liu, Gary Herzog, Ralph W. Aye, Matthew D. Rifkin, Giulia Veronesi, Maurizio Infante, Davood Vafai, Samuel Kopel, Jana Taylor, Richard J. Thurer, Nestor Villamizar, John H. M. Austin, Gregory D. Pearson, Donald Klippenstein, Alan Litwin, Peter Loud, Leslie J. Kohman, Ernest M. Scalzetti, Arfa Khan, Rakesh Shah, William Mayfield, Carmine Frumiento, Michael V. Smith, M. Kristin Thorsen, Richard M. Hansen, David P. Naidich, Georgeann McGuinness, Mark Widmann, Robert J. Korst, J. Lowry, Mary Salvatore, James Walsh, David Bertsch, Paul Scheinberg, Barry Sheppard, G Cecchi, Michelle S. Ginsberg, Dennis Slater, Laura S. Welch, Fred Grannis, Arnold Rotter, Cliff P. Connery, Terence A.S. Matalon, Edson H. Cheung, Robert Glassberg, David K. Olsen, David Mullen
Abstract
Background Pulmonary noncalcified nodules (NCNs) attached to the fissural or costal pleura with smooth margins and triangular or lentiform, oval, or semicircular (LOS) shapes at low-dose CT are recommended for annual follow-up instead of immediate workup. Purpose To determine whether management of mediastinal or diaphragmatic pleura-attached NCNs (M/DP-NCNs) with the same features as fissural or costal pleura-attached NCNs at low-dose CT can follow the same recommendations. Materials and Methods This retrospective study reviewed chest CT examinations in participants from two databases. Group A included 1451 participants who had lung cancer that was first present as a solid nodule with an average diameter of 3.0-30.0 mm. Group B included 345 consecutive participants from a lung cancer screening program who had at least one solid nodule with a diameter of 3.0-30.0 mm at baseline CT and underwent at least three follow-up CT examinations. Radiologists reviewed CT images to identify solid M/DP-NCNs, defined as nodules 0 mm in distance from the mediastinal or diaphragmatic pleura, and recorded average diameter, margin, and shape. General descriptive statistics were used. Results Among the 1451 participants with lung cancer in group A, 163 participants (median age, 68 years [IQR, 61.5-75.0 years]; 92 male participants) had 164 malignant M/DP-NCNs 3.0-30.0 mm in average diameter. None of the 164 malignant M/DP-NCNs had smooth margins and triangular or LOS shapes (upper limit of 95% CI of proportion, 0.02). Among the 345 consecutive screening participants in group B, 146 participants (median age, 65 years [IQR, 59-71 years]; 81 female participants) had 240 M/DP-NCNs with average diameter 3.0-30.0 mm. None of the M/DP-NCNs with smooth margins and triangular or LOS shapes were malignant after a median follow-up of 57.8 months (IQR, 46.3-68.1 months). Conclusion For solid M/DP-NCNs with smooth margins and triangular or LOS shapes at low-dose CT, the risk of lung cancer is extremely low, which supports the recommendation of Lung Imaging Reporting and Data System version 2022 for annual follow-up instead of immediate workup. © RSNA, 2024 See also the editorial by Goodman and Baruah in this issue.