Lung Cancers Manifesting as Part-Solid Nodules in the National Lung Screening Trial

The objective of our study was to determine how often death occurred from lung cancers that manifested as part-solid nodules in the National Lung Screening Trial (NLST).

NLST radiologists classified nodules as solid, ground-glass, or mixed. All lung cancers classified as mixed nodules by NLST radiologists were reviewed by four experienced radiologists and reclassified as solid, nonsolid, or part-solid nodules. When possible, volume doubling times (VDTs) were calculated separately for the entire nodule and for the solid component of the nodule.

Of 88 screening-diagnosed lung cancer cases identified by the NLST radiologists as mixed nodules, study radiologists confirmed that 19 were part-solid nodules. All the part-solid nodules were present at baseline (time 0), and none of the patients with a part-solid nodule had lymph node enlargement at CT before diagnosis or metastases at resection. Multilobar stage IV (T4N0M1) bronchioloalveolar carcinoma was diagnosed in one patient 25.0 months after study randomization, and the patient died 67.9 months after randomization. All 18 patients with a solitary or dominant part-solid nodule underwent surgery, and none died of lung cancer. From randomization, the average time to diagnosis was 18.6 months and the average time of follow-up was 79.2 months. On the last CT examination performed before diagnosis, the average size of the solid component of the part-solid nodules was 9.2 mm (SD, 4.9); the solid component was larger than 10 mm in five patients. The median VDT based on the entire nodule was 476 days, and the median VDT based on the solid component alone was 240 days.

None of the patients with lung cancer manifesting as a solitary or dominant part-solid nodule had lymph node enlargement or metastases at pathology, and none died of lung cancer within the follow-up time of the NLST.