Indeterminate pulmonary subsolid nodules in patients with no history of cancer: growing prediction, CT pattern, and pathological diagnosis

Abstract

PURPOSE We aimed to evaluate and compare the growth patterns among pathological types of indeterminate subsolid nodules in patients without a history of cancer as observed on computed tomography (CT). METHODS This retrospective study included 77 consecutive patients with 80 indeterminate subsolid nodules on unenhanced thin-section CT. Subsolid nodules were classified into 2 growth pattern groups based on volume: growth (n = 35) and non-growth (n = 42). According to the pathological diagnosis, subsolid nodules were further subdivided into 3 groups: adenocarcinoma in situ (growth, n = 8 vs. non-growth, n = 22), minimally invasive adenocarcinoma (n = 14 vs. n = 15), and invasive adenocarcinoma (n = 13 vs. n = 5). Kaplan–Meier and Cox proportional hazards regression analyses were performed to identify the risk factors for subsolid nodules growth. The CT findings of the 35 subsolid nodules in the growth group were compared among the 3 pathological groups. RESULTS In the growth group, the overall mean volume doubling time and mass doubling time (MDT) were 811.5 days and 616.5 days, respectively. Patient’s age (odds ratio = 1.041, P = .045) and CT subtype of non-solid nodule and part-solid nodule (odds ratio = 3.430, P = .002) could predict subsolid nodule growth. The baseline volume, mass, and mean CT value were larger in the invasive adenocarcinoma group than in the adenocarcinoma in situ group (all P < .01). The shortest volume doubling time was observed in the invasive adenocarcinoma group, followed by the minimally invasive adenocarcinoma group and the adenocarcinoma in situ group. A shorter mass doubling time was observed in the minimally invasive adenocarcinoma group than in the adenocarcinoma in situ group (all P < .02). CONCLUSION As age increases, the risk of pulmonary subsolid nodule growth increases by 4% each year, and part-solid nodules have a 3 times higher risk of growth compared to non-solid nodules in patients with no history of cancer. Subsolid nodules with more aggressive pathological characteristics grow at a faster rate.