University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands.
University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Groningen, The Netherlands; Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands.
Lung Cancer. 2018 Nov;125:103-108. doi: 10.1016/j.lungcan.2018.05.007. Epub 2018 May 14.
New nodules are regularly found after the baseline round of low-dose computed tomography (LDCT) lung cancer screening. The relationship between a participant's number of new nodules and lung cancer probability is unknown.
Participants of the ongoing Dutch-Belgian Randomized Lung Cancer Screening (NELSON) Trial with (sub)solid nodules detected after baseline and registered as new by the NELSON radiologists were included. The correlation between a participant's new nodule count and the largest new nodule size was assessed using Spearman's rank correlation. To evaluate the new nodule count as predictor for new nodule lung cancer together with largest new nodule size, a multivariable logistic regression analysis was performed.
In total, 705 participants with 964 new nodules were included. In 48% (336/705) of participants no nodule had been found previously during baseline screening and in 22% (154/705) of participants >1 new nodule was detected (range 1-12 new nodules). Eventually, 9% (65/705) of the participants had lung cancer in a new nodule. In 100% (65/65) of participants with new nodule lung cancer, the lung cancer was the largest or only new nodule at initial detection. The new nodule lung cancer probability did not differ significantly between participants with 1 (10% [56/551], 95%CI 8-13%) or >1 new nodule (6% [9/154], 95%CI 3-11%, P = .116). An increased number of new nodules positively correlated with a participant's largest nodule size (P < 0.001, Spearman's rho 0.177). When adjusted for largest new nodule size, the new nodule count had a significant negative association with lung cancer (odds ratio 0.59, 0.37-0.95, P = .03).
A participant's new nodule count alone only has limited association with lung cancer. However, a higher new nodule count correlates with an increased largest new nodule size, while the lung cancer probability remains equivalent, and may improve lung cancer risk prediction by size only.
在低剂量计算机断层扫描（LDCT）肺癌筛查的基线一轮后，经常会发现新的结节。参与者新结节的数量与肺癌概率之间的关系尚不清楚。
本研究纳入了正在进行的荷兰-比利时随机肺癌筛查（NELSON）试验中的参与者，这些参与者在基线后检测到（亚）实性结节，并由 NELSON 放射科医生登记为新结节。使用 Spearman 秩相关评估参与者新结节数量与最大新结节大小之间的相关性。为了评估新结节计数作为与最大新结节大小一起预测新结节肺癌的指标，进行了多变量逻辑回归分析。
共纳入 705 名参与者，其中 964 个新结节。在 48%（336/705）的参与者中，基线筛查时未发现结节，22%（154/705）的参与者检测到 >1 个新结节（范围为 1-12 个新结节）。最终，9%（65/705）的参与者在新结节中发现了肺癌。在 100%（65/65）有新结节肺癌的参与者中，肺癌是初始检测时最大或唯一的新结节。有 1 个新结节（10%[56/551]，95%CI 8-13%）或 >1 个新结节（6%[9/154]，95%CI 3-11%，P=0.116）的参与者之间的新结节肺癌概率无显著差异。新结节数量的增加与参与者的最大结节大小呈正相关（P<0.001，Spearman 的 rho 0.177）。当调整最大新结节大小时，新结节计数与肺癌呈显著负相关（比值比 0.59，0.37-0.95，P=0.03）。
仅参与者的新结节数量与肺癌的相关性有限。然而，较高的新结节数量与较大的最大新结节大小相关，而肺癌的概率保持不变，仅通过大小可能会提高肺癌风险预测。
