Characterization of small pulmonary nodules by CT

Small pulmonary nodules with diameters ≤10 mm are very frequent findings at CT examinations. Despite the traditional opinion that every pulmonary nodule should be considered malignant until proven otherwise, the vast majority of small lesions are benign, and therefore biopsy may not be necessary in all cases. During the last few years, several CT-based methods have been developed to differentiate between benign and malignant lesions non-invasively. A negative quantitative contrast-enhanced CT is a strong predictor for benignity. Repeat nodule volume measurements at short-term follow-up CT examinations can detect growth suggesting malignancy. Limitations and potential pitfalls of these methods must be observed to avoid false negative test results leading to delayed diagnosis and treatment of malignant tumours. An algorithm for diagnostic workup of incidentally detected small pulmonary nodules in subjects without known malignancy is proposed in this article.

[1]  W. Steinbrich,et al.  Solitary pulmonary nodules: MR evaluation of enhancement patterns with contrast-enhanced dynamic snapshot gradient-echo imaging. , 1996, Radiology.

[2]  W. Heindel,et al.  Screening for early lung cancer with low-dose spiral computed tomography: results of annual follow-up examinations in asymptomatic smokers , 2004, European Radiology.

[3]  C I Henschke,et al.  Does 2-year stability imply that pulmonary nodules are benign? , 1997, AJR. American journal of roentgenology.

[4]  Feng Li,et al.  Mass screening for lung cancer with mobile spiral computed tomography scanner , 1998, The Lancet.

[5]  C I Henschke,et al.  CT-guided transthoracic needle biopsy of small solitary pulmonary nodules. , 1997, Clinical imaging.

[6]  Theresa C McLoud,et al.  Small pulmonary nodules: detection at chest CT and outcome. , 2003, Radiology.

[7]  E. Fishman,et al.  Pulmonary hamartoma: CT findings. , 1986, Radiology.

[8]  J. Erasmus,et al.  Solitary pulmonary nodules: Part II. Evaluation of the indeterminate nodule. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[9]  S J Swensen,et al.  Functional CT: lung nodule evaluation. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[10]  C. Douglas Maynard,et al.  ACR Appropriateness Criteria , 2000 .

[11]  T. McLoud,et al.  Work-up of the solitary pulmonary nodule. American College of Radiology. ACR Appropriateness Criteria. , 2000, Radiology.

[12]  C. Henschke,et al.  Bronchioloalveolar carcinoma and adenocarcinoma with bronchioloalveolar features presenting as ground-glass opacities on CT. , 2002, Clinical imaging.

[13]  H Nakata,et al.  Evolution of peripheral lung adenocarcinomas: CT findings correlated with histology and tumor doubling time. , 2000, AJR. American journal of roentgenology.

[14]  W. Black,et al.  Communicating the significance of radiologic test results: the likelihood ratio. , 1986, AJR. American journal of roentgenology.

[15]  W. Heindel,et al.  Volumetric measurements of pulmonary nodules at multi-row detector CT: in vivo reproducibility , 2003, European Radiology.

[16]  J. Gurney,et al.  Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part II. Application. , 1993, Radiology.

[17]  E. Fishman,et al.  Solitary pulmonary nodules: CT assessment. , 1986, Radiology.

[18]  Ella A Kazerooni,et al.  The solitary pulmonary nodule. , 2003, Chest.

[19]  Naofumi Matsunaga,et al.  The probability of malignancy in small pulmonary nodules coexisting with potentially operable lung cancer detected by CT , 2003, European Radiology.

[20]  Mordecai Schwartz.  A biomathematical approach to clinical tumor growth , 1961, Cancer.

[21]  C. Henschke.  Early lung cancer action project , 2000, Cancer.

[22]  R. Bhadelia,et al.  Prevalence of pathologically proven intrapulmonary lymph nodes and their appearance on CT. , 1996, AJR. American journal of roentgenology.

[23]  O S Miettinen,et al.  Early Lung Cancer Action Project , 2001, Cancer.

[24]  F. Fischbach,et al.  Detection of pulmonary nodules by multislice computed tomography: improved detection rate with reduced slice thickness , 2003, European Radiology.

[25]  Margrit Betke,et al.  Small pulmonary nodules: volume measurement at chest CT--phantom study. , 2003, Radiology.

[26]  J. Gurney.  Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part I. Theory. , 1993, Radiology.

[27]  P C Goodman,et al.  Correlation of tumor size and survival in patients with stage IA non-small cell lung cancer. , 2000, Chest.

[28]  N. Müller,et al.  Lung nodule enhancement at CT: multicenter study. , 2000, Radiology.

[29]  M. McNitt-Gray,et al.  A pattern classification approach to characterizing solitary pulmonary nodules imaged on high resolution CT: preliminary results. , 1999, Medical physics.

[30]  S. Swensen,et al.  Screening for lung cancer with low-dose spiral computed tomography. , 2000, American journal of respiratory and critical care medicine.

[31]  L. Quint.  Work-up of the solitary pulmonary nodule , 2003, Cancer Imaging.

[32]  K. Naunheim,et al.  Incidence of lung nodules found in patients undergoing lung volume reduction. , 1997, The Annals of thoracic surgery.

[33]  S J Swensen,et al.  Solitary pulmonary nodule: CT evaluation of enhancement with iodinated contrast material--a preliminary report. , 1992, Radiology.

[34]  Masumi Kadoya,et al.  Indeterminate solitary pulmonary nodules revealed at population-based CT screening of the lung: using first follow-up diagnostic CT to differentiate benign and malignant lesions. , 2003, AJR. American journal of roentgenology.

[35]  Mark Tann,et al.  Volumetric growth rate of stage I lung cancer prior to treatment: serial CT scanning. , 2002, Radiology.

[36]  A. Sakurada,et al.  Tumor doubling time and prognostic assessment of patients with primary lung cancer , 1994, Cancer.

[37]  S. Sone,et al.  Prognostic significance of high-resolution CT findings in small peripheral adenocarcinoma of the lung: a retrospective study on 64 patients. , 2002, Lung cancer.

[38]  Binsheng Zhao,et al.  Small pulmonary nodules: volumetrically determined growth rates based on CT evaluation. , 2000, Radiology.

[39]  Margrit Betke,et al.  Chest CT: automated nodule detection and assessment of change over time--preliminary experience. , 2001, Radiology.

[40]  M Kono,et al.  Solitary pulmonary nodules: evaluation of blood flow patterns with dynamic CT. , 1997, Radiology.

[41]  S. Primack,et al.  Small Pulmonary Nodules on CT Accompanying Surgically Resectable Lung Cancer: Likelihood of Malignancy , 2002, Journal of thoracic imaging.

[42]  C. Henschke,et al.  Neural networks for the analysis of small pulmonary nodules. , 1997, Clinical imaging.

[43]  W. Heindel,et al.  Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers. , 2002, Radiology.

[44]  Hiroto Hatabu,et al.  Solitary pulmonary nodules: potential role of dynamic MR imaging in management initial experience. , 2002, Radiology.

[45]  H. Ohmatsu,et al.  Peripheral lung cancer: screening and detection with low-dose spiral CT versus radiography. , 1996, Radiology.

[46]  Fast-growing squamous cell lung cancer. , 2002, Lung cancer.

[47]  Ernst Klotz,et al.  Enhancement measurement of pulmonary nodules with multirow detector CT: precision assessment of a 3D algorithm compared to the standard procedure , 2003, SPIE Medical Imaging.

[48]  D. Hansell,et al.  The significance of pulmonary nodules detected on CT staging for lung cancer. , 1993, Clinical radiology.

[49]  A. Bankier,et al.  Spiral CT of the lung in children with malignant extra-thoracic tumors: distribution of benign vs malignant pulmonary nodules , 2000, European Radiology.

[50]  W. J. Tuddenham,et al.  Glossary of terms for thoracic radiology: recommendations of the Nomenclature Committee of the Fleischner Society. , 1984, AJR. American journal of roentgenology.

[51]  W J Kostis,et al.  Computer-aided diagnosis of small pulmonary nodules. , 2000, Seminars in ultrasound, CT, and MR.

[52]  D. Naidich,et al.  Solitary Pulmonary Nodules: CT-Bronchoscopic Correlation , 1988 .

[53]  F. Fazio,et al.  Early lung-cancer detection with spiral CT and positron emission tomography in heavy smokers: 2-year results , 2003, The Lancet.

[54]  D K Owens,et al.  Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. , 2001, JAMA.

[55]  S Sone,et al.  Growth rate of small lung cancers detected on mass CT screening. , 2000, The British journal of radiology.