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Controversies on lung cancers manifesting as part-solid nodules

  • Computed Tomography
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

Summarise survival of patients with resected lung cancers manifesting as part-solid nodules (PSNs).

Methods

PubMed/MEDLINE and EMBASE databases were searched for all studies/clinical trials on CT-detected lung cancer in English before 21 December 2015 to identify surgically resected lung cancers manifesting as PSNs. Outcome measures were lung cancer-specific survival (LCS), overall survival (OS), or disease-free survival (DFS). All PSNs were classified by the percentage of solid component to the entire nodule diameter into category PSNs <80% or category PSNs ≥80%.

Results

Twenty studies reported on PSNs <80%: 7 reported DFS and 2 OS of 100%, 6 DFS 96.3-98.7%, and 11 OS 94.7-98.9% (median DFS 100% and OS 97.5%). Twenty-seven studies reported on PSNs ≥80%: 1 DFS and 2 OS of 100%, 19 DFS 48.0%-98.0% (median 82.6%), and 16 reported OS 43.0%-98.0% (median DFS 82.6%, OS 85.5%). Both DFS and OS were always higher for PSNs <80%.

Conclusion

A clear definition of the upper limit of solid component of a PSN is needed to avoid misclassification because cell-types and outcomes are different for PSN and solid nodules. The workup should be based on the size of the solid component.

Key points

• Lung cancers manifesting as PSNs are slow growing with high cure rates.

• Upper limits of the solid component are important for correct interpretation.

• Consensus definition is important for the management of PSNs.

• Median disease-free-survival (DFS) increased with decreasing size of the nodule.

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Abbreviations

AIS:

Adenocarcinoma-in-situ

DFS:

Disease-free or relapse-free survival

GGO:

Ground-glass opacities

I-ELCAP:

International Early Lung Cancer Action Program

LCS:

Lung cancer-specific survival

MIA:

Minimally invasive adenocarcinoma

NLST:

National Lung Screening Trial

NSN:

Nonsolid nodules

OS:

Overall survival

PSN:

Part-solid nodules

TDR:

Disappearance rate

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Acknowledgements

We would also like to thank Ms. Camille Chan, who provided assistance with the literature search and identification of relevant studies to be included in this review.

Author information

Authors and Affiliations

  1. Department of Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA

    Rowena Yip, Kunwei Li, Li Liu, Dongming Xu, Kathleen Tam, David F. Yankelevitz & Claudia I. Henschke

  2. Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China

    Kunwei Li

  3. Department of Diagnostic Radiology, Cancer Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China

    Li Liu

  4. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Emanuela Taioli

  5. Department of Educational Psychology and Learning Systems, College of Education, Florida State University, Tallahassee, FL, USA

    Betsy Becker

Authors
  1. Rowena Yip
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  2. Kunwei Li
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  3. Li Liu
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  4. Dongming Xu
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  5. Kathleen Tam
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  6. David F. Yankelevitz
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  7. Emanuela Taioli
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  8. Betsy Becker
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  9. Claudia I. Henschke
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Corresponding author

Correspondence to Claudia I. Henschke.

Ethics declarations

Guarantor

The scientific guarantors of this publication are Dr Claudia Henschke and Ms. Rowena Yip.

Conflict of interest

Dr Yankelevitz is a named inventor on a number of patents and patent applications relating to the evaluation of diseases of the chest including measurement of nodules. Some of these, which are owned by Cornell Research Foundation (CRF), are non-exclusively licensed to General Electric. As an inventor of these patents, Dr Yankelevitz is entitled to a share of any compensation that CRF may receive from its commercialisation of these patents. He is also an equity owner in Accumetra, a privately held technology company committed to improving the science and practice of image-based decision-making. Dr Yankelevitz also serves on the advisory board of GRAIL.

Dr Henschke is the President and serves on the board of the Early Diagnosis and Treatment Research Foundation. She receives no compensation from the Foundation. The Foundation is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases. Dr Claudia Henschke is also a named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on CT scans of the chest that are owned by Cornell Research Foundation (CRF). Since 2009, Dr Henschke has not accepted any financial benefit from these patents including royalties and any other proceeds related to the patents or patent applications owned by CRF.

Other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

Funding for this study was in part by the Flight Attendants Medical Research Institute.

Statistics and biometry

Dr. Claudia Henschke, Ms. Rowena Yip, Dr Betsy Becker and Dr Emanuela Taioli kindly provided statistical advice for this manuscript.

At least one of the authors has significant statistical expertise.

Informed consent

Written informed consent was not required for this study because this study is a review of existing literature and no human subjects were involved.

Ethical approval

Institutional Review Board approval was not required because this study is a review of existing literature and no human subjects were involved.

Methodology

• prospective

• observational

• multi-centre study

Appendix A

Appendix A

Part Solid - All Concept

Embase

  1. 1.

    part-solid.mp.

  2. 2.

    partsolid.mp.

  3. 3.

    semi-solid.mp.

  4. 4.

    semisolid.mp.

  5. 5.

    subsolid.mp.

  6. 6.

    ground glass.mp.

  7. 7.

    1 or 2 or 3 or 4 or 5 or 6

  8. 8.

    lung cancer/

  9. 9.

    lung tumor/

  10. 10.

    ((lung or pulmonary) and (cancer or cancers or tumor or tumors or carcinoma or carcinomas or neoplasm or neoplasms)).mp. [mp = title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

  11. 11.

    8 or 9 or 10

  12. 12.

    mortality/or cancer mortality/

  13. 13.

    disease free survival/or cancer survival/or disease specific survival/or event free survival/or cancer specific survival/or long term survival/or metastasis free survival/or survival/or overall survival/

  14. 14.

    recurrent disease/

  15. 15.

    metastasis/or lung metastasis/

  16. 16.

    (mortality or survival or recurrence or metastasis or metastases or death rate or relapsing disease or relapse).mp. [mp = title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

  17. 17.

    12 or 13 or 14 or 15 or 16

  18. 18.

    computer assisted tomography/

  19. 19.

    (CT scan or CT scans or CAT scan or cat scans).mp. [mp = title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

  20. 20.

    (Comput$ adj3 Tomography).mp. [mp = title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword]

  21. 21.

    18 or 19 or 20

  22. 22.

    7 and 11 and 17 and 21

PS all concept

Medline

  1. 1.

    Solitary Pulmonary Nodule/or part-solid.mp.

  2. 2.

    part solid.mp.

  3. 3.

    semi-solid.mp.

  4. 4.

    semisolid.mp.

  5. 5.

    subsolid.mp. or Solitary Pulmonary Nodule/

  6. 6.

    ground glass.mp.

  7. 7.

    ground-glass.mp.

  8. 8.

    1 or 2 or 3 or 4 or 5 or 6 or 7

  9. 9.

    Disease-Free Survival/or Survival Analysis/or Survival/or Survival Rate/or survival.mp.

  10. 10.

    Hospital Mortality/or Mortality/or mortality.mp.

  11. 11.

    Recurrence/or Neoplasm Recurrence, Local/or recurrence.mp.

  12. 12.

    metastasis.mp. or Neoplasm Metastasis/

  13. 13.

    metastases.mp. or Neoplasm Metastasis/

  14. 14.

    fatality.mp.

  15. 15.

    fatalities.mp.

  16. 16.

    9 or 10 or 11 or 12 or 13 or 14 or 15

  17. 17.

    cancer.mp. or Neoplasms/

  18. 18.

    cancers.mp. or Neoplasms/

  19. 19.

    carcinoma.mp. or Carcinoma/or Carcinoma, Small Cell/or Carcinoma, Non-Small-Cell Lung/or Carcinoma, Squamous Cell/or Carcinoma, Adenosquamous/

  20. 20.

    carcinomas.mp. or Carcinoma/

  21. 21.

    tumor.mp. or Neoplasms/

  22. 22.

    tumors.mp. or Neoplasms/

  23. 23.

    17 or 18 or 19 or 20 or 21 or 22

  24. 24.

    lung.mp. or Lung/

  25. 25.

    pulmonary.mp.

  26. 26.

    24 or 25

  27. 27.

    23 and 26

  28. 28.

    Lung Neoplasms.mp. or Lung Neoplasms/

  29. 29.

    27 or 28

  30. 30.

    CT scan.mp.

  31. 31.

    CT scans.mp.

  32. 32.

    CAT scan.mp.

  33. 33.

    CAT scans.mp.

  34. 34.

    Tomography, X-Ray Computed/or computed scan.mp.

  35. 35.

    Tomography, X-Ray Computed/or computed scans.mp.

  36. 36.

    Tomography, X-Ray Computed/or computed assisted tomography.mp.

  37. 37.

    computerized scan.mp.

  38. 38.

    computerized scans.mp.

  39. 39.

    30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38

  40. 40.

    8 and 16 and 29 and 39

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Yip, R., Li, K., Liu, L. et al. Controversies on lung cancers manifesting as part-solid nodules. Eur Radiol 28, 747–759 (2018). https://doi.org/10.1007/s00330-017-4975-9

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  • DOI: https://doi.org/10.1007/s00330-017-4975-9

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