University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands; Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands.
University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
Lung Cancer. 2017 Nov;113:45-50. doi: 10.1016/j.lungcan.2017.08.023. Epub 2017 Sep 1.
To explore the relationship between nodule count and lung cancer probability in baseline low-dose CT lung cancer screening.
Included were participants from the NELSON trial with at least one baseline nodule (3392 participants [45% of screen-group], 7258 nodules). We determined nodule count per participant. Malignancy was confirmed by histology. Nodules not diagnosed as screen-detected or interval cancer until the end of the fourth screening round were regarded as benign. We compared lung cancer probability per nodule count category.
1746 (51.5%) participants had one nodule, 800 (23.6%) had two nodules, 354 (10.4%) had three nodules, 191 (5.6%) had four nodules, and 301 (8.9%) had>4 nodules. Lung cancer in a baseline nodule was diagnosed in 134 participants (139 cancers; 4.0%). Median nodule count in participants with only benign nodules was 1 (Inter-quartile range [IQR]: 1-2), and 2 (IQR 1-3) in participants with lung cancer (p=NS). At baseline, malignancy was detected mostly in the largest nodule (64/66 cancers). Lung cancer probability was 62/1746 (3.6%) in case a participant had one nodule, 33/800 (4.1%) for two nodules, 17/354 (4.8%) for three nodules, 12/191 (6.3%) for four nodules and 10/301 (3.3%) for>4 nodules (p=NS).
In baseline lung cancer CT screening, half of participants with lung nodules have more than one nodule. Lung cancer probability does not significantly change with the number of nodules. Baseline nodule count will not help to differentiate between benign and malignant nodules. Each nodule found in lung cancer screening should be assessed separately independent of the presence of other nodules.
探讨基线低剂量 CT 肺癌筛查中结节数量与肺癌概率的关系。
本研究纳入了 NELSON 试验中的至少有一个基线结节的参与者（3392 名参与者[占筛查组的 45%]，7258 个结节）。我们确定了每个参与者的结节数量。通过组织学确定恶性肿瘤。直至第四次筛查结束仍未被诊断为筛查检出癌或间期癌的结节被视为良性。我们比较了每个结节数量类别中的肺癌概率。
1746 名（51.5%）参与者有一个结节，800 名（23.6%）有两个结节，354 名（10.4%）有三个结节，191 名（5.6%）有四个结节，301 名（8.9%）有>4 个结节。在基线结节中诊断出 134 名参与者（139 例癌症）患有肺癌。仅有良性结节的参与者的中位结节数为 1（四分位距[IQR]：1-2），而患有肺癌的参与者的中位结节数为 2（IQR 1-3）（p=NS）。在基线时，恶性肿瘤主要在最大的结节中被发现（66 例癌症中的 64 例）。如果一个参与者有一个结节，则肺癌的概率为 62/1746（3.6%）；有两个结节的概率为 33/800（4.1%）；有三个结节的概率为 17/354（4.8%）；有四个结节的概率为 12/191（6.3%）；有>4 个结节的概率为 10/301（3.3%）（p=NS）。
在基线肺癌 CT 筛查中，一半有肺结节的参与者有多个结节。结节数量与肺癌概率无显著相关性。基线结节数量无助于区分良性和恶性结节。在肺癌筛查中发现的每个结节都应单独评估，而不考虑其他结节的存在。
