Background

Solid costal pleura–attached noncalcified nodules (CP-NCNs) less than 10.0 mm with lentiform, oval, or semicircular (LOS) or triangular shapes and smooth margins on baseline low-dose CT scans from the Mount Sinai Early Lung and Cardiac Action Program (MS-ELCAP) were reviewed, and it was determined that they can be followed up at the first annual screening rather than having a shorter-term work-up.

Purpose

To determine whether the same criteria could be used for solid CP-NCNs newly identified at annual screening examinations.

Materials and Methods

With use of the same MS-ELCAP database, all new solid CP-NCNs measuring 30.0 mm or less were identified at 4425 annual screening examinations between 2010 and 2019. In addition, to ensure that no malignant CP-NCNs met the criteria, all solid malignant CP-NCNs of 30.0 mm or less in the International Early Lung Cancer Action Program, or I-ELCAP, database of 111 102 annual screening examinations from the 76 participating institutions between 1992 and 2019 were identified; Mount Sinai is one of these institutions. All identified solid CP-NCNs were reviewed—with the radiologists blinded to diagnosis—for shape (triangular, LOS, polygonal, round, or irregular), margin (smooth or nonsmooth), pleural attachment (broad or narrow), and the presence of emphysema and/or fibrosis within 10.0 mm of each CP-NCN. Intra- and interreader readings were performed, and agreements were determined by using the B-statistic.

Results

Of the 76 new solid CP-NCNs, 21 were lung cancers. Benign CP-NCNs were smaller than malignant ones (median diameter, 4.2 mm vs 11 mm; P < .001), had a different shape distributions, more frequently had smooth margins (67% vs 14%; P < .001), and less frequently had emphysema (38% vs 81%; P = .003) or fibrosis (3.6% vs 19%; P = .045) within a 10.0 mm radius. All 22 solid CP-NCNs less than 10.0 mm in average diameter with triangular or LOS shapes and smooth margins were benign, and none of the 21 solid malignant CP-NCNs had these characteristics. Intra- and interobserver agreement for triangular or LOS-shaped CP-NCNs with smooth margins was almost perfect (0.77 and 0.69, respectively).

Conclusion

The same follow-up recommendation developed for baseline costal pleura–attached noncalcified nodules (CP-NCNs) can be used for CP-NCNs newly identified at annual screening rounds.

© RSNA, 2021

中文翻译：

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每年低剂量 CT 筛查中新发现的肋胸膜附着的非钙化结节的特征

背景

在西奈山早期肺和心脏行动计划的基线低剂量 CT 扫描中，小于 10.0 毫米的实体肋胸膜附着的非钙化结节 (CP-NCN) 呈扁豆状、椭圆形或半圆形 (LOS) 或三角形，边缘光滑（ MS-ELCAP) 进行了审查，并确定它们可以在第一次年度筛查时进行随访，而不是进行短期检查。

目的

确定相同的标准是否可用于在年度筛选检查中新发现的固体 CP-NCN。

材料和方法

使用相同的 MS-ELCAP 数据库，在 2010 年至 2019 年间的 4425 次年度筛查检查中发现了所有尺寸为 30.0 mm 或以下的新实体 CP-NCN。此外，为确保没有恶性 CP-NCN 符合标准，所有实体国际早期肺癌行动计划 (I-ELCAP) 数据库中确定了 30.0 mm 或以下的恶性 CP-NCN，该数据库包含 1992 年至 2019 年间来自 76 个参与机构的 111 102 次年度筛查检查；西奈山就是这些机构之一。对所有确定的实性 CP-NCN 进行了审查（放射科医师对诊断不知情）的形状（三角形、LOS、多边形、圆形或不规则）、边缘（光滑或不光滑）、胸膜附着（宽或窄）以及是否存在每个 CP-NCN 10.0 mm 内的肺气肿和/或纤维化。进行了阅读器内和阅读器间阅读，

结果

在 76 个新的实体 CP-NCN 中，21 个是肺癌。良性 CP-NCN 比恶性 CP-NCN 小（中位直径，4.2 毫米对 11 毫米；P < .001），具有不同的形状分布，更常见的是边缘光滑（67% 对 14%；P < .001），并且10.0 毫米半径内肺气肿（38% 对 81%；P = .003）或纤维化（3.6% 对 19%；P = .045）的频率较低。所有 22 个平均直径小于 10.0 mm、三角形或 LOS 形状、边缘光滑的实性 CP-NCN 均为良性，21 个实性恶性 CP-NCN 均不具有这些特征。具有平滑边缘的三角形或 LOS 形 CP-NCN 的观察者内和观察者间一致性几乎是完美的（分别为 0.77 和 0.69）。

结论

为基线肋胸膜附着的非钙化结节 (CP-NCN) 制定的相同后续建议可用于在年度筛查轮次中新发现的 CP-NCN。

©北美放射学会，2021