A new, large-scale study has lent support to the recommendation that nonsolid nodules identified by CT (computed tomography) scans can be managed with annual screening rather than with invasive biopsies or surgery.
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Nonsolid nodules are growths in the lung that have normal tissue visible through the nodule on a CT image, which can be caused by a number of different factors, including inflammation, infection, and fibrosis. However, they can pose a significant challenge to oncologists as they may also be a precursor to cancer. Finding NSNs has become more frequent in recent years with the advent of more sophisticated imagining procedures and since the Centers for Medicare and Medicaid Services recommended annual low-dose CT screening for longtime smokers.
In a study published in Radiology, researchers led by Rowena Yip, Mount Sinai Medical Center (New York, NY), used data from the National Lung Screening Trial, which compared low-dose CT with chest radiography for lung cancer detection, to look at patients who had at least one NSN on a CT scan and subsequently died of lung cancer.
Of the 26,722 patients who participated in the trial, 2534 (9.4%) had one or more NSNs and a total of 48 died of lung cancer. On review, 21 of those 48 patients had no NSN in the cancerous lobe. The CT scans of the remaining 27 patients where then reviewed by four oncologists who determined that death was unlikely to have been caused by NSN, so long as annual follow-up was done.
Thus, researchers concluded that cause of death from lung cancer was unlikely to be due to solitary or dominant NSN as long as patients adhered to recommended follow-up procedures.
“This report adds further support toward taking a conservative approach for annual follow-up for the management and treatment of NSNs, especially when they are solitary,” said Dr Yip. “Whereas some of these NSNs may become aggressive lung cancers over time, the changes in the nodule appearance can be documented with CT scans, which for now remains the best biomarker for cancer progression.”
