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Pediatric Radiology

, Volume 45, Issue 12, pp 1753–1760 | Cite as

Clinical significance of pulmonary nodules detected on abdominal CT in pediatric patients

  • Micheál Breen
  • David Zurakowski
  • Edward Y. LeeEmail author
Original Article

Abstract

Background

The clinical significance of a pulmonary nodule that is detected incidentally on CT studies in children is unknown. In addition, there is limited information regarding the management of incidentally detected pulmonary nodules discovered on abdominal CT studies in children.

Objective

The purpose of this study was to investigate the clinical significance of incidental pulmonary nodules detected on abdominal CT studies in children.

Materials and methods

This was a retrospective study performed following institutional review board approval. Abdominal CT reports in patients younger than 18 years of age from July 2004 to June 2011 were reviewed for the terms “nodule,” “nodular” or “mass” in reference to the lung bases. The study population included those pediatric patients in whom pulmonary nodules were initially detected on abdominal CT studies. The largest pulmonary nodules detected on CT studies were evaluated for their features (size, shape, margin, attenuation, location, and presence of calcification and cavitation). Follow-up CT studies and clinical records were reviewed for demographic information, history of underlying malignancies and the clinical outcome of the incidental pulmonary nodules. Comparison of malignant versus benign pulmonary nodules was performed with respect to the size of the nodule, imaging features on CT, and patient history of malignancy using the Student’s t-test and Fisher exact test. Youden J-index in receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off size for suggesting a high risk of malignancy of incidentally detected pulmonary nodules.

Results

Pulmonary nodules meeting inclusion criteria were detected in 62 (1.2%) of 5,234 patients. The mean age of patients with nodules was 11.2 years (range: 5 months-18 years). Thirty-one patients (50%) had follow-up CT studies and two of these patients (6%) were subsequently found to have malignant pulmonary nodules. Both of these patients had a history of malignancy. Of the remaining 31 patients without follow-up CT studies, none had a history of malignancy. Clinical follow-up data was available in 26 of these 31 patients (84%) and none had any evidence of malignant pulmonary nodule development. There was a significant association between history of malignancy and incidentally detected pulmonary nodules on abdominal CT studies subsequently found to be malignant (P = 0.036). The size was significantly larger for the malignant pulmonary nodules compared to the benign pulmonary nodules with a size ≥7 mm in diameter being the optimal cut-off for suggesting a high risk of malignancy (11.5 ± 6.4 mm vs. 4.7 ± 3.0 mm, P = 0.003).

Conclusion

The incidence of pulmonary nodules found on pediatric abdominal CT studies is 1.2%. The incidence of malignancy in such pulmonary nodules is low (3%) and only seen in the setting of pulmonary nodules ≥7 mm in diameter in children with a history of malignancy. Therefore, further investigation is warranted for pulmonary nodules that are ≥7 mm in children with a history of malignancy while further imaging work-up may not be necessary in the remaining patients in this pediatric patient population.

Keywords

Abdomen Children Computed tomography Incidental findings Lung Pulmonary nodules 

Notes

Conflicts of interest

None

References

  1. 1.
    Strouse PJ (2014) The incidental pulmonary nodule in a child: a conundrum. Pediatr Radiol 45:627CrossRefPubMedGoogle Scholar
  2. 2.
    Westra SJ, Brody AS, Mahani MG et al (2015) The incidental pulmonary nodule in a child: part 1: recommenations from the SPR thoracic imaging committee regarding characterization, signifiance, and follow-up. Pediatr Radiol 45:628–633CrossRefPubMedGoogle Scholar
  3. 3.
    Westra SJ, Thacker PG, Podberesky DJ et al (2015) The incidental pulmonary nodule in a child: part 2: commentary and suggestions for clinical management, risk communication and prevention. Pediatr Radiol 45:634–639CrossRefPubMedGoogle Scholar
  4. 4.
    Thacker PG (2013) The incidental pulmonary nodule: an impetus for guidelines. Pediatr Radiol 45:777CrossRefPubMedGoogle Scholar
  5. 5.
    MacMahon H, Austin JH, Gamsu G et al (2005) Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the fleischner society. Radiology 237:395–400CrossRefPubMedGoogle Scholar
  6. 6.
    Alpert JB, Fantauzzi JP, Melamud K et al (2012) Clinical significance of lung nodules reported on abdominal CT. AJR Am J Roentgenol 198:793–799CrossRefPubMedGoogle Scholar
  7. 7.
    Newcombe RG (1998) Two-sided confidence intervals for the single proportion: comparison of seven methods. Stat Med 17:857–872CrossRefPubMedGoogle Scholar
  8. 8.
    Zhou XH, Obuchowski NA, McClish DK (2011) Statistical methods in diagnostic medicine, 2nd edn. Wiley, New York, pp 48–55CrossRefGoogle Scholar
  9. 9.
    Silva CT, Amaral JG, Moineddin R et al (2010) CT characteristics of lung nodules present at diagnosis of extrapulmonary malignancy in children. AJR Am J Roentgenol 194:772–778CrossRefPubMedGoogle Scholar
  10. 10.
    McCarville MB, Lederman HM, Santana VM et al (2006) Distinguishing benign from malignant pulmonary nodules with helical chest CT in children with malignant solid tumors. Radiology 239:514–520CrossRefPubMedGoogle Scholar
  11. 11.
    McCarville MB, Billups C, Wu J et al (2013) The role of PET/CT in assessing pulmonary nodules in children with solid malignancies. AJR Am J Roentgenol 201:W900–W905PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Goske MJ, Applegate KE, Bulas D et al (2011) Image Gently: progress and challenges in CT education and advocacy. Pediatr Radiol 41:461–466CrossRefPubMedGoogle Scholar
  13. 13.
    Macdougall RD, Strauss KJ, Lee EY (2013) Managing radiation dose from thoracic multidetector computed tomography in pediatric patients: background, current issues, and recommendations. Radiol Clin N Am 51:743–760CrossRefPubMedGoogle Scholar
  14. 14.
    Sodhi KS, Lee EY (2014) What all physicians should know about the potential radiation risk that computed tomography poses for paediatric patients. Acta Paediatr 103:807–811CrossRefPubMedGoogle Scholar
  15. 15.
    Takashima S, Sone S, Li F et al (2003) Small solitary pulmonary nodules (< or =1 cm) detected at population-based CT screening for lung cancer: reliable high-resolution CT features of benign lesions. AJR Am J Roentgenol 180:955–964CrossRefPubMedGoogle Scholar
  16. 16.
    Edey AJ, Hansell DM (2009) Incidentally detected small pulmonary nodules on CT. Clin Radiol 64:872–884CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Micheál Breen
    • 1
  • David Zurakowski
    • 2
  • Edward Y. Lee
    • 1
    Email author
  1. 1.Department of RadiologyBoston Children’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Departments of Anesthesiology and SurgeryBoston Children’s Hospital and Harvard Medical SchoolBostonUSA

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