Learning objectives
To describe the features of subsolid nodules (SSNs) in terms of prevalence,
growth rate,
predictors of malignancy and prognosis,
analysing in particular results from lung cancer screening studies.
To evaluate the updated proper management of SSNs,
distinguishing between lung cancer screening setting and everyday clinical practice,
describing respectively the ACR Lung-RADS and the new Fleischner Society Guidelines.
Background
As everybody knows,
a pulmonary nodule is a rounded opacity,
well or poorly defined,
measuring up to 3cm in diameter.
In this definition are included both solid nodules and SSNs.
However,
this poster is focused on SSNs and solid nodules will not be discussed.
SSNs can be distinguished into two main categories:
pure ground-glass nodules (GGNs),which are nodules characterized by hazy increased lung attenuation,
that does not obliterate the bronchial and vascular margins;
part-solid nodules (PSNs),
which contain both ground-glass and solid soft-tissue attenuation components(Fig....
Findings and procedure details
Part I.
SSNs features
I.1 Prevalence
The real prevalence of SSNs it is not directly reported in most of the studies,
therefore is difficult to extract.
As reported in the British Thoracic Society (BTS) Guidelines for the investigation and management of pulmonary nodules,
the PanCan dataset showed that between all the detected nodules the 15.9% were GGNs and the 4.4% were PSNs,
while the BCCA dataset demonstrated a prevalence (between all nodules) of 9.3% and only 0.9% for GGNs andPSNs,
respectively.
By the contrary the...
Conclusion
For SSNs,
lung cancer screening setting differs from everyday clinical practice.
For this reason different and specific guidelines are needed.
Uniform application of international guidelines may sensibly reduce overmanagement of these nodules.
Personal information
Dr.
Giuseppe Cicchetti
Resident doctor in Radiology
Department of Radiology - Catholic University of Sacred Heart - Policlinico “A.
Gemelli” Foundation – Rome,
Italy
[email protected]
References
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(2008) Fleischner Society: glossary of terms for thoracic imaging.
Radiology 246:697–722.
MacMahon H et al.
(2017) Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017.
Radiology 284:228–243.
Callister ME et al.
(2015) British Thoracic Society guidelines for the investigation and management of pulmonary nodules.
Thorax 70: Suppl.
ii1–ii54.
Yankelevitz DF et al.
(2015) CT screening for lung cancer: nonsolid nodules in baseline and annual repeat rounds.
Radiology 277:555–564.
Henschke CI et al.
(2016) CT...