From the Departments of Epidemiology (D.Z., G.S., G.H.d.B., M.A.H.), Radiology (G.S., M.P., R.V.), and Pulmonary Disease (H.J.M.G.), University of Groningen, University Medical Center Groningen, Hanzeplein 1, Postbus 30.001, 9700RB Groningen, the Netherlands; Department of Medical Imaging, Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands (C.J., M.P.); Department of Radiology, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.d.J.); Department of Radiology and Nuclear Medicine, Maastricht University, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (H.A.G.); Department of Pulmonary Medicine, University of Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands (R.S., J.G.A.); Department of Respiratory Oncology, University Hospitals Leuven, Leuven, Belgium (K.N.); Institute for Diagnostic Accuracy, Groningen, the Netherlands (M.A.H.); and Department of Respiratory Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (M.A.H.).
Radiology. 2024 Oct;313(1):e240535. doi: 10.1148/radiol.240535.
Screening with low-dose CT (LDCT) in a high-risk population, as defined by age and smoking behavior, reduces lung cancer-related mortality. However, LDCT screening presents a major challenge. Numerous, mostly benign, nodules are seen in the lungs during screening. The question is how to distinguish the malignant from the benign nodules. Various studies use different protocols for nodule management. The Dutch-Belgian NELSON (Nederlands-Leuvens Longkanker Screenings Onderzoek) trial, the largest European lung cancer screening trial, used distinctions based on nodule volumetric assessment and growth rate. This review discusses key findings from the NELSON study regarding the characteristics of screening-detected nodules, including nodule size and its volumetric assessment, growth rate, subtype, and their associated malignancy risk. These results are compared with findings from other screening studies and current recommendations for lung nodule management. By examining differences in nodule management strategies and providing a comprehensive overview of outcomes specific to lung cancer screening, this review aims to contribute to the broader discussion on optimizing lung nodule management in screening programs.
低剂量 CT（LDCT）筛查在年龄和吸烟行为定义的高危人群中可降低肺癌相关死亡率。然而，LDCT 筛查带来了重大挑战。在筛查期间，肺部会出现许多大多为良性的结节。问题是如何将恶性结节与良性结节区分开来。各种研究使用不同的结节管理方案。荷兰-比利时 NELSON（Nederlands-Leuvens Longkanker Screenings Onderzoek）试验是欧洲最大的肺癌筛查试验，使用了基于结节体积评估和生长速度的区分方法。本综述讨论了 NELSON 研究中关于筛查发现的结节特征的关键发现，包括结节大小及其体积评估、生长速度、亚型以及它们与恶性肿瘤风险的关联。这些结果与其他筛查研究的结果和当前的肺结节管理建议进行了比较。通过检查结节管理策略的差异，并提供针对肺癌筛查的具体结果的全面概述，本综述旨在为优化筛查计划中的肺结节管理的更广泛讨论做出贡献。
