Annual Follow-up With Low-Dose CT Is Sufficient for Some Lung Nodules

For nonsolid nodules identified by computed tomography (CT) screening for lung cancer, annual screening with low-dose CT can eliminate the need for biopsy or surgery.¹

Nonsolid nodules (NSNs) are growths in the lung that are usually asymptomatic and that have normal lung tissue visible through the nodule on a CT image. Finding NSNs has become more common since recent guidelines from the Centers for Medicare and Medicaid Services (CMS) recommend annual low-dose CT screening for longtime smokers.

“When you biopsy a nonsolid nodule, it’s usually premalignant, noninvasive, or due to some other cause like infection or fibrosis,” said Claudia I. Henschke, MD, PhD, the Department of Radiology at Icahn School of Medicine at Mount Sinai, New York City, and co-author of the study. Henschke was an author on an earlier study that examined data from more than 57,000 patients and found that NSNs of any size could be followed with annual repeat CT scans.

This new study looked at data from the National Lung Screening Trial (NLST), a large trial that compared low-dose CT with chest radiography for lung cancer detection. In this study, the researchers searched the NLST database and identified all participants who had at least one NSN on a CT scan and subsequently died of lung cancer.

The researchers found that, among the 26,722 participants, 2534 (9.4%) had one or more NSNs. Of those, 48 died of lung cancer, yet 21 of those 48 had no NSNs in the cancerous lobe of the lung. A review of the remaining 27 cases found that death was unlikely to be caused by the NSN, as long as annual follow-up was done.

“The causes of death in this group were likely due to another solid or part-solid nodule in the same lobe of the lung,” said Rowena Yip, MPH, senior biostatistician at Icahn School of Medicine at Mount Sinai, and lead author. “In the one death related to a growing nonsolid nodule, the time from prior CT to diagnosis was greater than 3 years.”

The new findings add further support to the previous research. Together, they could help spare patients from the costs, complications, and stress of unnecessary biopsy and surgery.

“We think that we have enough data now to say that these nodules can safely be followed by annual CT scans and do not have to be biopsied or treated right away,” Henschke said. “Survival remains 100% as long as the nodules remain nonsolid, and for those that ultimately do progress, the 1-year follow-up interval is short enough that they still remain entirely curable.”

Reference

1. Yip R, Yankelevitz DF, Hu M, et al. Lung cancer deaths in the National Lung Screening Trial attributed to nonsolid nodules. Radiology. 2016 Jul 5. doi:10.1148/radiol.2016152333. [Epub ahead of print]