Byrne Suzanne C, Hunsaker Andetta R, Hammer Mark M
Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115.
Harvard Medical School, Boston, Mass.
Radiology. 2025 May;315(2):e243166. doi: 10.1148/radiol.243166.
Background There is currently a lack of consensus regarding the risk of malignancy and the natural history of cystic lung lesions. Purpose To evaluate imaging characteristics associated with the risk of malignancy of cystic lung lesions in a lung cancer screening program. Materials and Methods This retrospective study included all CT lung cancer screening examinations performed from January 2015 to July 2023 in a large health care network. Radiology reports were queried for cystic lesions. Baseline CT images were reviewed, and lesion morphologic characteristics and size were recorded. All follow-up CT scans were evaluated for changes in the lesion. The risk of growth and diagnosis of cancer over time were analyzed with Kaplan-Meier curves. Results Among 15 762 patients, 235 were found to have cystic lung lesions; 33 (14%) of these patients were diagnosed with lung cancer arising from the cystic lesion. Increased risk of cancer was associated with nodular wall thickening (odds ratio [OR], 11; = .002) and presence of a solid nodule (OR, 5.3; < .001) alone or in combination with a ground-glass component (OR, 24; < .001). Multilocularity was not associated with an increased risk of cancer (OR, 1.7; > .2). There were no cases of malignancy in unilocular cystic lesions without wall thickening ( = 46). Lesion growth or increase in complexity over time was associated with an increased risk of malignancy ( < .001). The median time to lesion growth was 636 days. The median time to cancer diagnosis was 482 days, and 28 (85%) of the cancers were stage 0 or I. Conclusion Cystic lung lesions with nodular wall thickening had an increased risk of malignancy. Conversely, unilocular lesions without wall thickening had essentially no risk of malignancy. Most malignant cystic lung lesions exhibited indolent behavior, with slow growth and diagnosis at early stages. © RSNA, 2025 See also the editorial by Zagurovskaya in this issue.
背景 目前关于肺囊性病变的恶性风险及自然病程尚无共识。目的 评估肺癌筛查项目中与肺囊性病变恶性风险相关的影像特征。材料与方法 这项回顾性研究纳入了2015年1月至2023年7月在一个大型医疗网络中进行的所有CT肺癌筛查检查。从放射学报告中查询囊性病变。回顾基线CT图像，记录病变的形态特征和大小。对所有随访CT扫描评估病变的变化。采用Kaplan-Meier曲线分析随时间推移病变生长及癌症诊断的风险。结果 在15762例患者中，发现235例有肺囊性病变；其中33例（14%）患者被诊断为源自囊性病变的肺癌。癌症风险增加与结节壁增厚（比值比[OR]，11；P = .002）、实性结节的存在（OR，5.3；P < .001）单独或与磨玻璃成分联合存在（OR，24；P < .001）相关。多房性与癌症风险增加无关（OR，1.7；P > .2）。无壁增厚的单房囊性病变无恶性病例（n = 46）。随时间推移病变生长或复杂性增加与恶性风险增加相关（P < .001）。病变生长的中位时间为636天。癌症诊断的中位时间为482天，28例（85%）癌症为0期或I期。结论 有结节壁增厚的肺囊性病变恶性风险增加。相反，无壁增厚的单房性病变基本无恶性风险。大多数恶性肺囊性病变表现为惰性行为，生长缓慢且早期诊断。© RSNA，2025 另见本期Zagurovskaya的社论。
