Malignant versus benign nodules at CT screening for lung cancer: comparison of thin-section CT findings

To evaluate thin-section computed tomographic (CT) characteristics of malignant nodules on the basis of overall appearance (pure ground-glass opacity [GGO], mixed GGO, or solid opacity) in comparison with the appearance of benign nodules.

Institutional review board approval and patient consent were obtained. Follow-up diagnostic CT was performed in 747 suspicious pulmonary nodules detected at low-dose CT screening (17 892 examinations). Of 747 nodules, 222 were evaluated at thin-section CT (1-mm collimation), which included 59 cancers and 163 benign nodules (3-20 mm). Thin-section CT findings of malignant versus benign nodules with pure GGO (17 vs 12 lesions), mixed GGO (27 vs 29 lesions), or solid opacity (15 vs 122 lesions) were analyzed. Fisher exact test for independence was used to compare differences in shape, margin, and internal features between benign and malignant nodules. Positive predictive value (PPV) was analyzed when a category was significantly different from the others.

Among nodules with pure GGO, a round shape was found more frequently in malignant lesions (11 of 17, 65%) than in benign lesions (two of 12, 17%; P = .02; PPV, 85%); mixed GGO, a subtype with GGO in the periphery and a high-attenuation zone in the center, was seen much more often in malignant lesions (11 of 27, 41%) than in benign lesions (two of 29, 7%; P = .004; PPV, 85%). Among solid nodules, a polygonal shape or a smooth or somewhat smooth margin was present less frequently in malignant than in benign lesions (polygonal shape: 7% vs 38%, P = .02; smooth or somewhat smooth margin: 0% vs 63%, P < .001), and 98% (46 of 47) of polygonal nodules and 100% (77 of 77) of nodules with a smooth or somewhat smooth margin were benign.

Recognition of certain characteristics at thin-section CT can be helpful in differentiating small malignant nodules from benign nodules.