Byrne Suzanne C, Peers Caroline, Gargan Mary Louise, Lacson Ronilda, Khorasani Ramin, Hammer Mark M
Department of Radiology, Center for Evidence-Based Imaging.
J Comput Assist Tomogr. 2024;48(5):770-773. doi: 10.1097/RCT.0000000000001592. Epub 2024 Feb 27.
The risk of malignancy in pulmonary nodules incidentally detected on computed tomography (CT) in patients who are aged younger than 35 years is unclear.
The aim of this study was to evaluate the incidence of lung cancer in incidental pulmonary nodules in patients who are 15-34 years old.
This retrospective study included patients aged 15-34 years who had an incidental pulmonary nodule on chest CT from 2010 to 2018 at our hospital. Patients with prior, current, or suspected malignancy were excluded. A chart review identified patients with diagnosis of malignancy. Incidental pulmonary nodule was deemed benign if stable or resolved on a follow-up CT at least 2 years after initial or if there was a medical visit in our health care network at least 2 years after initial CT without diagnosis of malignancy.Receiver operating characteristic curve analysis was performed with nodule size. Association of categorical variables with lung cancer diagnosis was performed with Fisher exact test, and association of continuous variables was performed with logistic regression.
Five thousand three hundred fifty-five chest CTs performed on patients aged 15-34 years between January 2010 and December 2018. After excluding patients without a reported pulmonary nodule and prior or current malignancy, there were a total of 779 patients. Of these, 690 (89%) had clinical or imaging follow-up after initial imaging. Of these, 545 (70% of total patients) patients had imaging or clinical follow-up greater than 2 years after their initial imaging.A malignant diagnosis was established in 2/779 patients (0.3%; 95% confidence interval, 0.1%-0.9%). Nodule size was strongly associated with malignancy ( P = 0.007), with area under the receiver operating characteristic curve of 0.97. There were no malignant nodules that were less than 10 mm in size. Smoking history, number of nodules, and nodule density were not associated with malignancy.
Risk of malignancy for incidentally detected pulmonary nodules in patients aged 15-34 years is extremely small (0.3%). There were no malignant nodules that were less than 10 mm in size. Routine follow-up of subcentimeter pulmonary nodules should be carefully weighed against the risks.
在35岁以下患者中，计算机断层扫描（CT）偶然发现的肺结节发生恶性病变的风险尚不清楚。
本研究旨在评估15 - 34岁患者偶然发现的肺结节中肺癌的发病率。
这项回顾性研究纳入了2010年至2018年在我院因胸部CT偶然发现肺结节的15 - 34岁患者。排除既往有、目前患有或疑似患有恶性肿瘤的患者。通过查阅病历确定诊断为恶性肿瘤的患者。如果在初次检查后至少2年的随访CT中肺结节稳定或消失，或者在初次CT检查后至少2年在我们的医疗保健网络中有就诊记录且未诊断为恶性肿瘤，则偶然发现的肺结节被视为良性。对结节大小进行受试者操作特征曲线分析。使用Fisher精确检验分析分类变量与肺癌诊断的相关性，使用逻辑回归分析连续变量的相关性。
2010年1月至2018年12月期间，对15 - 34岁患者进行了5355次胸部CT检查。在排除未报告肺结节以及既往或目前患有恶性肿瘤的患者后，共有779例患者。其中，690例（89%）在初次成像后进行了临床或影像学随访。其中，545例（占总患者的70%）在初次成像后2年以上进行了影像学或临床随访。779例患者中有2例（0.3%；95%置信区间，0.1% - 0.9%）确诊为恶性肿瘤。结节大小与恶性肿瘤密切相关（P = 0.007），受试者操作特征曲线下面积为0.97。大小小于10 mm的结节均无恶性病变。吸烟史、结节数量和结节密度与恶性肿瘤无关。
15 - 34岁患者偶然发现的肺结节发生恶性病变的风险极低（0.3%）。大小小于10 mm的结节均无恶性病变。对于亚厘米级肺结节的常规随访应仔细权衡风险。
