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Visual discrimination of screen-detected persistent from transient subsolid nodules: An observer study.

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Experienced radiologists have moderate ability to distinguish transient from persistent subsolid nodules on CT scans alone. Visual assessment of CT morphology is insufficient to replace short-term follow-up for these lung nodules.

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Area of Science:

  • Radiology
  • Pulmonology
  • Medical Imaging

Background:

  • Subsolid nodules on CT scans can be transient or persistent.
  • Differentiating these types is crucial for patient management.
  • Current methods may require follow-up CT examinations.

Purpose of the Study:

  • To assess radiologists' ability to differentiate transient from persistent subsolid nodules using CT alone.
  • To identify CT morphological features aiding this differentiation.

Main Methods:

  • Analysis of 172 subsolid nodules (86 transient, 135 persistent) from the National Lung Screening Trial (NLST).
  • Four experienced radiologists assessed morphological features and provided a differentiation score.
  • Receiver operating characteristic (ROC) curve analysis evaluated observer performance.

Main Results:

  • Radiologists achieved an area under the curve (AUC) of 0.75 for nodules ≥ 10 mm.
  • Significant differentiating features included nodule type, margin, border definition, and pleural retraction.
  • Inter-observer agreement varied for different features, with some reaching high consensus.

Conclusions:

  • Radiologists' visual differentiation of transient vs. persistent subsolid nodules (≥ 10 mm) is only moderately accurate.
  • CT morphology assessment alone is not adequate to eliminate the need for short-term follow-up.