European Radiology

, Volume 26, Issue 6, pp 1529–1537 | Cite as

Persistent pulmonary subsolid nodules with solid portions of 5 mm or smaller: Their natural course and predictors of interval growth

  • Jong Hyuk Lee
  • Chang Min ParkEmail author
  • Sang Min Lee
  • Hyungjin Kim
  • H. Page McAdams
  • Jin Mo Goo



To investigate the natural course of persistent pulmonary subsolid nodules (SSNs) with solid portions ≤5 mm and the clinico-radiological features that influence interval growth over follow-ups.


From 2005 to 2013, the natural courses of 213 persistent SSNs in 213 patients were evaluated. To identify significant predictors of interval growth, Kaplan-Meier analysis and Cox proportional hazard regression analysis were performed.


Among the 213 nodules, 136 were pure ground-glass nodules (GGNs; growth, 18; stable, 118) and 77 were part-solid GGNs with solid portions ≤5 mm (growth, 24; stable, 53). For all SSNs, lung cancer history (p = 0.001), part-solid GGNs (p < 0.001), and nodule diameter (p < 0.001) were significant predictors for interval growth. On subgroup analysis, nodule diameter was an independent predictor for the interval growth of both pure GGNs (p < 0.001), and part-solid GGNs (p = 0.037). For part-solid GGNs, lung cancer history (p = 0.002) was another significant predictor of the interval growth. Interval growth of pure GGNs ≥10 mm and part-solid GGNs ≥8 mm were significantly more frequent than in pure GGNs <10 mm (p < 0.001) and part-solid GGNs <8 mm (p = 0.003), respectively.


The natural course of SSNs with solid portions ≤5 mm differed significantly according to their nodule type and nodule diameters, with which their management can be subdivided.

Key Points

Pure GGNs ≥10 mm have significantly more frequent interval growth than those <10 mm.

Part-solid GGNs ≥8 mm have significantly more frequent interval growth than those <8 mm.

Management of SSNs with solid portions ≤5 mm can be subdivided by diameter.


Lung adenocarcinoma Adenocarcinoma in situ Computed tomography Portion size Follow-up studies 



Subsolid nodule


Ground-glass nodule


Atypical adenomatous hyperplasia





This study was supported by a research grant from the Korean Foundation for Cancer Research (grant number: CB-2011-02-01). The scientific guarantor of this publication is Prof. Dr. Chang Min Park. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by the Research of the Korean Foundation for Cancer Research (grant number: CB-2011-02-01).One of the authors has significant statistical expertise: Chang Min Park, MD (Seoul National University Hospital). Institutional review board approval was obtained. Requirement of written informed consent was waived by the institutional review board. The study population of the present study was extracted from our ground-glass nodule registry of Seoul National University Hospital. Thus, of the 213 subsolid nodules (SSNs) in 213 patients in this study, some had been reported in our previous studies [17, 18, 19, 20]. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.


  1. 1.
    Naidich DP, Bankier AA, MacMahon H et al (2013) Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the Fleischner Society. Radiology 266:304–317CrossRefPubMedGoogle Scholar
  2. 2.
    Kobayashi Y, Sakao Y, Deshpande GA et al (2014) The association between baseline clinical–radiological characteristics and growth of pulmonary nodules with ground-glass opacity. Lung Cancer 83:61–66CrossRefPubMedGoogle Scholar
  3. 3.
    Kim H, Park CM, Koh JM, Lee SM, Goo JM (2014) Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy. Diagn Interv Radiol 20:47–57CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Sawada S, Komori E, Nogami N, Segawa Y, Shinkai T, Yamashita M (2009) Evaluation of lesions corresponding to ground-glass opacities that were resected after computed tomography follow-up examination. Lung Cancer 65:176–179CrossRefPubMedGoogle Scholar
  5. 5.
    Lee SW, Leem CS, Kim TJ et al (2013) The long-term course of ground-glass opacities detected on thin-section computed tomography. Respir Med 107:904–910CrossRefPubMedGoogle Scholar
  6. 6.
    Kobayashi Y, Fukui T, Ito S et al (2013) How long should small lung lesions of ground-glass opacity be followed? J Thorac Oncol 8:309–314CrossRefPubMedGoogle Scholar
  7. 7.
    Chang B, Hwang JH, Choi Y-H et al (2013) Natural history of pure ground-glass opacity lung nodules detected by low-dose CT scan. Chest 143:172–178CrossRefPubMedGoogle Scholar
  8. 8.
    Matsuguma H, Mori K, Nakahara R et al (2013) Characteristics of subsolid pulmonary nodules showing growth during follow-up with CT scanning. Chest 143:436–443CrossRefPubMedGoogle Scholar
  9. 9.
    Hiramatsu M, Inagaki T, Inagaki T et al (2008) Pulmonary ground-glass opacity (GGO) lesions–large size and a history of lung cancer are risk factors for growth. J Thorac Oncol 3:1245–1250CrossRefPubMedGoogle Scholar
  10. 10.
    Park CM, Goo JM, Kim TJ et al (2008) Pulmonary nodular ground-glass opacities in patients with extrapulmonary cancers: what is their clinical significance and how can we determine whether they are malignant or benign lesions? Chest 133:1402–1409CrossRefPubMedGoogle Scholar
  11. 11.
    Henschke CI, Yankelevitz DF, Mirtcheva R, McGuinness G, McCauley D, Miettinen OS (2002) CT screening for lung cancer: frequency and significance of part-solid and nonsolid nodules. AJR Am J Roentgenol 178:1053–1057CrossRefPubMedGoogle Scholar
  12. 12.
    Kim HK, Choi YS, Kim J, Shim YM, Lee KS, Kim K (2010) Management of multiple pure ground-glass opacity lesions in patients with bronchioloalveolar carcinoma. J Thorac Oncol 5:206–210CrossRefPubMedGoogle Scholar
  13. 13.
    Kim HK, Choi YS, Kim K et al (2009) Management of ground-glass opacity lesions detected in patients with otherwise operable non-small cell lung cancer. J Thorac Oncol 4:1242–1246CrossRefPubMedGoogle Scholar
  14. 14.
    Ohde Y, Nagai K, Yoshida J et al (2003) The proportion of consolidation to ground-glass opacity on high resolution CT is a good predictor for distinguishing the population of non-invasive peripheral adenocarcinoma. Lung Cancer 42:303–310CrossRefPubMedGoogle Scholar
  15. 15.
    Aoki T, Tomoda Y, Watanabe H et al (2001) Peripheral lung adenocarcinoma: correlation of thin-section CT findings with histologic prognostic factors and survival. Radiology 220:803–809CrossRefPubMedGoogle Scholar
  16. 16.
    Lee HJ, Goo JM, Lee CH, Yoo C-G, Kim YT, Im J-G (2007) Nodular ground-glass opacities on thin-section CT: size change during follow-up and pathological results. Korean J Radiol 8:22–31CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Song YS, Park CM, Park SJ, Lee SM, Jeon YK, Goo JM (2014) Volume and mass doubling times of persistent pulmonary subsolid nodules detected in patients without known malignancy. Radiology 273:276–284CrossRefPubMedGoogle Scholar
  18. 18.
    Lee SM, Park CM, Goo JM et al (2010) Transient part-solid nodules detected at screening thin-section CT for lung cancer: comparison with persistent part-solid nodules. Radiology 255:242–251CrossRefPubMedGoogle Scholar
  19. 19.
    Lee SM, Park CM, Goo JM, Lee H-J, Wi JY, Kang CH (2013) Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features. Radiology 268:265–273CrossRefPubMedGoogle Scholar
  20. 20.
    Chae H-D, Park CM, Park SJ, Lee SM, Kim KG, Goo JM (2014) Computerized texture analysis of persistent part-solid ground-glass nodules: differentiation of preinvasive lesions from invasive pulmonary adenocarcinomas. Radiology 273:285–293CrossRefPubMedGoogle Scholar
  21. 21.
    Kakinuma R, Ashizawa K, Kuriyama K et al (2012) Measurement of focal ground-glass opacity diameters on CT images: interobserver agreement in regard to identifying increases in the size of ground-glass opacities. Acad Radiol 19:389–394CrossRefPubMedGoogle Scholar
  22. 22.
    Oda S, Awai K, Murao K et al (2011) Volume-doubling time of pulmonary nodules with ground glass opacity at multidetector CT: assessment with computer-aided three-dimensional volumetry. Acad Radiol 18:63–69CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Jong Hyuk Lee
    • 1
  • Chang Min Park
    • 1
    • 2
    • 3
    Email author
  • Sang Min Lee
    • 4
  • Hyungjin Kim
    • 1
    • 5
  • H. Page McAdams
    • 3
  • Jin Mo Goo
    • 1
    • 2
  1. 1.Department of RadiologySeoul National University College of Medicine, and Institute of Radiation Medicine, Seoul National University Medical Research CenterSeoulKorea
  2. 2.Cancer Research InstituteSeoul National UniversitySeoulKorea
  3. 3.Department of RadiologyDuke University Medical CenterDurhamUSA
  4. 4.Department of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  5. 5.Aerospace Medical GroupAir Force Education and Training CommandJinjuKorea

Personalised recommendations