Outcome of Incidental Pulmonary Nodules in a Real-World Setting

Abstract

ObjectivesEarly diagnosis of lung cancer is imperative to improve survival. Incidental pulmonary nodules (IPN) may represent early stages of lung cancer and appropriate follow-up and management of these nodules is important, but also very resource demanding. We aim to describe the results of the CT-based follow-up on a cohort of patients with IPN in terms of detected malignancies, the proportion undergoing invasive procedures, and the subsequent outcome.Materials and methodsRetrospective cohort study of patients in a CT IPN follow-up program who underwent a needle biopsy of the lung from 2018-2021 at Aarhus University Hospital.ResultsA total of 4181 patients with IPN were followed with CT control scans. Out of these 249 (6%) were diagnosed with lung cancer of which 224 (90%) were diagnosed as a result of the IPN follow-up. Seventy-five percent of the patients were diagnosed in stages I-II and curable treatment was possible in 77.9% of the patients. In the CT IPN follow-up program 449 patients underwent a CT guided needle biopsy. Out of these 190 patients underwent biopsy without the detection of malignancy, corresponding to 4.5% of the entire IPN population.ConclusionThe cumulated incidence of lung cancer in our population in the IPN follow-up program was 6%. The probability of malignancy when undergoing an invasive procedure on an IPN was 55.7% of which lung cancer was vastly predominant. The majority of lung cancers were diagnosed in an early and potentially curable stage.Micro AbstractIncidental pulmonary nodules (IPN) may represent early stages of lung cancer. Our retrospective cohort study of 4181 patients in a CT IPN follow-up program from 2018-2021 at Aarhus University Hospital shows an incidence of lung cancer of 6%, predominantly in curable stages. Of the entire CT IPN population 4.5% underwent CT guided needle biopsy without the detection of malignancy.

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