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- Title
Incidental perifissural nodules on routine chest computed tomography: lung cancer or not?
- Authors
Mets, Onno M.; Chung, Kaman; Scholten, Ernst Th.; Veldhuis, Wouter B.; Prokop, M.; van Ginneken, Bram; Schaefer-Prokop, Cornelia M.; de Jong, Pim A.
- Abstract
<bold>Objectives: </bold>Perifissural nodules (PFNs) are a common finding on chest CT, and are thought to represent non-malignant lesions. However, data outside a lung cancer-screening setting are currently lacking.<bold>Methods: </bold>In a nested case-control design, out of a total cohort of 16,850 patients ≥ 40 years of age who underwent routine chest CT (2004-2012), 186 eligible subjects with incident lung cancer and 511 controls without were investigated. All non-calcified nodules ≥ 4 mm were semi-automatically annotated. Lung cancer location and subject characteristics were recorded.<bold>Results: </bold>Cases (56 % male) had a median age of 64 years (IQR 59-70). Controls (60 % male) were slightly younger (p<0.01), median age of 61 years (IQR 51-70). A total of 262/1,278 (21 %) unique non-calcified nodules represented a PFN. None of these were traced to a lung malignancy over a median follow-up of around 4.5 years. PFNs were most often located in the lower lung zones (72 %, p<0.001). Median diameter was 4.6 mm (range: 4.0-8.1), volume 51 mm3 (range: 32-278). Some showed growth rates < 400 days.<bold>Conclusions: </bold>Our data show that incidental PFNs do not represent lung cancer in a routine care, heterogeneous population. This confirms prior screening-based results.<bold>Key Points: </bold>• One-fifth of non-calcified nodules represented a perifissural nodule in our non-screening population. • PFNs fairly often show larger size, and can show interval growth. • When morphologically resembling a PFN, nodules are nearly certainly not a malignancy. • The assumed benign aetiology of PFNs seems valid outside the screening setting.
- Subjects
COMPUTED tomography; LUNG cancer; PULMONARY nodules; DATA; CHEST (Anatomy)
- Publication
European Radiology, 2018, Vol 28, Issue 3, p1095
- ISSN
0938-7994
- Publication type
journal article
- DOI
10.1007/s00330-017-5055-x