Indeterminate solitary pulmonary nodules revealed at population-based CT screening of the lung: using first follow-up diagnostic CT to differentiate benign and malignant lesions.

Abstract

We studied the role of the first follow-up diagnostic CT for differentiating benign and malignant lesions in indeterminate solitary pulmonary nodules revealed at CT screening for lung cancer in which a total of 13,786 CT examinations (46% in women and 54% in men; 46% were smokers; mean age, 62 years) were performed. We reviewed thin-section CT findings on the initial diagnostic CT (lesion size; percentages of ground-glass-opacity areas of lesion; and presence or absence of lobulation, spiculation, air bronchogram, cavity, satellite lesions, pleural tag, concave margins, polygonal shape, and peripheral subpleural lesion) in 80 pulmonary nodules (36 malignancies and 44 benign lesions) of 80 patients. We evaluated changes in size (regression, no change, or growth) on the first follow-up CT performed 42-120 days (mean, 93 days) after the initial CT. The greatest accuracy (81%) with 89% sensitivity and 75% specificity for determining malignancy was attained with a combined criterion of growth of lesions or predominantly ground-glass-opacity lesions. Of all criteria that were specific to malignancy, the greatest sensitivity (50%) was achieved with a combination of growth or no change in size of lesions and predominantly ground-glass opacity and no concave margins. Of all criteria that were specific to benign lesions, the greatest sensitivity (45%) was attained with a combination of lesion regression or polygonal shape. Follow-up CT findings were useful, and a combination of findings on initial CT and follow-up CT was optimal for differentiating benign and malignant pulmonary nodules.