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Characterization of Newly Detected Costal Pleura–attached Noncalcified Nodules at Annual Low-Dose CT Screenings

2021; Radiological Society of North America; Volume: 301; Issue: 3 Linguagem: Inglês

10.1148/radiol.2021210807

1527-1315

Yeqing Zhu, Rowena Yip, Nan You, Qiang Cai, Claudia I. Henschke, David F. Yankelevitz, Claudia I. Henschke, David F. Yankelevitz, Rowena Yip, Dongming Xu, Mary M. Salvatore, Raja M. Flores, Andrea Wolf, David S. Mendelson, Dorothy I. McCauley, Mildred Chen, Daniel M. Libby, Olli S. Miettinen, James P. Smith, Mark Pasmantier, Anthony P. Reeves, Steven Markowitz, Albert Miller, José Cervera Deval, Heidi Roberts, Demetris Patsios, Shusuke Sone, Takaomi Hanaoka, Javier J. Zulueta, Luis M. Montuenga, María D. Lozano, Ralph W. Aye, Thomas W. Bauer, Stefano Canitano, Salvatore Giunta, Enser Cole, Karl Klingler, John H. M. Austin, Gregory D. Pearson, Dorith Shaham, Cheryl Aylesworth, Patrick Meyers, Shahriyour Andaz, Davood Vafai, David P. Naidich, Georgeann McGuinness, Barry Sheppard, Matthew D. Rifkin, M. Kristin Thorsen, Richard M. Hansen, Samuel Kopel, William Mayfield, Dan W. Luedke, Donald Klippenstein, Alan Litwin, Peter Loud, Leslie J. Kohman, Ernest M. Scalzetti, Richard J. Thurer, Arfa Khan, Rakesh Shah, Xueguo Liu, Gary Herzog, Diane Yeh, Ning Wu, J. Lowry, Mary M. Salvatore, Carmine Frumiento, Michael V. Smith, Robert J. Korst, Jana Taylor, Robert T. Heelan, Michelle S. Ginsberg, Michaela Straznicka, Mark Widmann, G Cecchi, Terence A.S. Matalon, Paul Scheinberg, Shari-Lynn Odzer, David R. Olsen, Fred Grannis, A Rotter, Daniel Ray, David Mullen, Peter H. Wiernik, Edson H. Cheung, Melissa Lim, Louis DeCunzo, Robert Glassberg, Harvey I. Pass, Carmen Endress, Mark Yoder, Palmi Shah, Laura S. Welch, Michael Kalafer, Jeremy Green, James Walsh, David Bertsch, Elmer Camacho, Cynthia Chin, James O’Brien, D. Lee Gorden, Albert Koch, James Wiley,

Ultrasound in Clinical Applications

Background Solid costal pleura-attached noncalcified nodules (CP-NCNs) less than 10.0 mm with lentiform, oval, or semicircular (LOS) or triangular shapes and smooth margins on baseline low-dose CT scans from the Mount Sinai Early Lung and Cardiac Action Program (MS-ELCAP) were reviewed, and it was determined that they can be followed up at the first annual screening rather than having a shorter-term work-up. Purpose To determine whether the same criteria could be used for solid CP-NCNs newly identified at annual screening examinations. Materials and Methods With use of the same MS-ELCAP database, all new solid CP-NCNs measuring 30.0 mm or less were identified at 4425 annual screening examinations between 2010 and 2019. In addition, to ensure that no malignant CP-NCNs met the criteria, all solid malignant CP-NCNs of 30.0 mm or less in the International Early Lung Cancer Action Program, or I-ELCAP, database of 111 102 annual screening examinations from the 76 participating institutions between 1992 and 2019 were identified; Mount Sinai is one of these institutions. All identified solid CP-NCNs were reviewed-with the radiologists blinded to diagnosis-for shape (triangular, LOS, polygonal, round, or irregular), margin (smooth or nonsmooth), pleural attachment (broad or narrow), and the presence of emphysema and/or fibrosis within 10.0 mm of each CP-NCN. Intra- and interreader readings were performed, and agreements were determined by using the B-statistic. Results Of the 76 new solid CP-NCNs, 21 were lung cancers. Benign CP-NCNs were smaller than malignant ones (median diameter, 4.2 mm vs 11 mm; P < .001), had a different shape distributions, more frequently had smooth margins (67% vs 14%; P < .001), and less frequently had emphysema (38% vs 81%; P = .003) or fibrosis (3.6% vs 19%; P = .045) within a 10.0 mm radius. All 22 solid CP-NCNs less than 10.0 mm in average diameter with triangular or LOS shapes and smooth margins were benign, and none of the 21 solid malignant CP-NCNs had these characteristics. Intra- and interobserver agreement for triangular or LOS-shaped CP-NCNs with smooth margins was almost perfect (0.77 and 0.69, respectively). Conclusion The same follow-up recommendation developed for baseline costal pleura-attached noncalcified nodules (CP-NCNs) can be used for CP-NCNs newly identified at annual screening rounds. © RSNA, 2021.