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Updated: Jun 14, 2025

Electromagnetic Navigation Transthoracic Nodule Localization for Minimally Invasive Thoracic Surgery

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Published on: May 4, 2022

Pulmonary Subsolid Nodules: Upfront Surgery or Watchful Waiting?

Fenglan Li¹, Linlin Qi¹, Changfa Xia²

¹Department of Diagnostic Radiology, National Cancer Center/National, Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

|January 6, 2025

Summary

This summary is machine-generated.

For small pulmonary subsolid nodules (SSNs) with a consolidation to tumor ratio (CTR) of ≤ 0.25, watchful waiting is as effective as surgery. This approach offers comparable survival outcomes for patients with SSNs, reducing the need for immediate surgical intervention.

Keywords:

follow-up lung cancer prognosis pulmonary subsolid nodules surgery

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Area of Science:

Pulmonology
Thoracic Surgery
Oncology

Background:

Management of small pulmonary subsolid nodules (SSNs) with diameter ≤ 2 cm and consolidation to tumor ratio (CTR) ≤ 0.25 remains controversial despite good prognoses.
These SSNs often exhibit slow growth and low malignancy potential, prompting investigation into less invasive management strategies.

Purpose of the Study:

To compare the efficacy of upfront surgical intervention versus watchful waiting in patients with SSNs (≤ 2 cm diameter, CTR ≤ 0.25).
To determine if surgical intervention offers superior survival outcomes compared to non-operative management in this specific patient cohort.

Main Methods:

Retrospective analysis of 1,676 patients with SSNs who underwent thin-section CT scans.
Patients were categorized into observation and surgery groups based on management strategy.
Event-free survival (EFS) was evaluated using Kaplan-Meier analysis, Cox proportional hazards modeling, and propensity score matching.

Main Results:

The observation group demonstrated noninferiority to the surgery group in 5-year EFS across all evaluated SSN categories (P < .001).
Specific categories (A, A1, A2) showed 5-year EFS rates of 100% vs. 99.0%, 100% vs. 99.6%, and 100% vs. 98.6% for observation vs. surgery, respectively.
Category A2 (1 cm < diameter ≤ 2 cm, CTR ≤ 0.25) showed 100% EFS for observation versus 93.3% for surgery, with a hazard ratio of 0.0668.

Conclusions:

Watchful waiting is a suitable and effective management strategy for patients with SSNs of ≤ 2 cm in diameter and CTR ≤ 0.25.
Upfront surgical intervention is not superior to watchful waiting in this patient group, suggesting a less invasive approach may be preferred.