Persistent pulmonary subsolid nodules with solid portions of 5 mm or smaller: Their natural course and predictors of interval growth
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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.
• 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.
KeywordsLung adenocarcinoma Adenocarcinoma in situ Computed tomography Portion size Follow-up studies
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.