Managing of screening-detected sub-solid nodules-a European perspective

Area of Science:

• Pulmonology
• Radiology
• Oncology

Background:

• The National Lung Screening Trial (2011) demonstrated a 20% reduction in lung cancer mortality with annual low-dose computed tomography (LDCT).
• Numerous European randomized controlled trials (e.g., ITALUNG, NELSON, UKLS) have since been initiated, increasing LDCT utilization.
• This has led to a higher detection rate of subsolid nodules, posing a clinical challenge.

Purpose of the Study:

• To review the current European perspective on the management of subsolid nodules detected during lung cancer screening.
• To address the controversies and provide guidance on follow-up imaging and clinical assessment.

Main Methods:

• Review of published guidelines and European lung cancer screening trial data.
• Analysis of the clinical behavior of subsolid nodules, including transient inflammatory lesions, benign conditions, and lung cancers.
• Emphasis on the role of follow-up imaging in patient management.

Main Results:

• Subsolid nodules are frequently detected in lung cancer screening programs.
• While some may represent transient or benign lesions, persistent nodules require careful monitoring.
• The majority of subsolid nodules exhibit indolent behavior over extended periods.

Conclusions:

• Optimal management strategies for screening-detected subsolid nodules are still evolving.
• Follow-up imaging is crucial for differentiating benign from malignant lesions and guiding treatment decisions.
• A European consensus on subsolid nodule management is needed to standardize care.