Understanding East-West differences in subsolid nodules: prevalence and overdiagnosis implications in lung cancer...

Area of Science:

• Pulmonology
• Radiology
• Oncology
• Epidemiology

Background:

• Opportunistic low-dose computed tomography (LDCT) screening for lung cancer has increased overdiagnosis in Asian countries.
• Substantial divergence in subsolid nodule (SSN) prevalence exists between Eastern and Western nations.
• The influence of SSNs on overdiagnosis trends, particularly in females, warrants investigation.

Purpose of the Study:

• To analyze the prevalence of subsolid nodules (SSNs) in Eastern versus Western countries.
• To investigate the sex-specific prevalence of SSNs.
• To explore the contribution of SSNs to overdiagnosis in lung cancer screening.

Main Methods:

• Retrospective analysis of 4166 participants undergoing baseline LDCT from January 2014 to August 2021.
• Extraction of clinical parameters including age, sex, Lung-RADS categories, smoking history, and SSN characteristics.
• Narrative review and pooled analysis of published studies on SSN prevalence and sex disparities.

Main Results:

• A total of 4166 participants (49.3% female) with a mean age of 53.38 years were included.
• SSN prevalence was significantly higher in females (20.1%) than males (12.6%).
• Pooled analysis revealed higher SSN prevalence in Eastern (12.6%) vs. Western countries (3.6%), with a significant sex difference (risk ratio = 0.489).

Conclusions:

• High SSN prevalence in Asian nations, especially among females, contributes significantly to overdiagnosis in lung cancer screening.
• Differences in clinical management and health literacy regarding SSNs exist between Eastern and Western countries.
• Tailored sex-specific strategies and risk prediction models are essential for optimizing lung cancer screening.