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Natural progression of persistent pure ground-glass nodules 10 mm or smaller: long-term observation and risk factor assessment

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Japanese Journal of Radiology Aims and scope Submit manuscript

Abstract

Purpose

Semi-automatic segmentation was used to investigate the natural progression of pure ground-glass nodules (pGGNs) of 5–10 mm in long-term follow-up and to analyze independent risk factors for subsequent growth.

Materials and Methods

A total of 154 pGGNs of 5–10 mm from 132 patients with 698 follow-up CT scans were retrospectively identified. Subsequently, enrolled pGGNs were semiautomatically segmented on initial and follow-up CT to obtain diameter, density and volume, thus calculating mass, volume doubling time (VDT), and mass doubling time (MDT). Kaplan‒Meier analysis and multivariate Cox proportional risk regression were performed to explore independent predictors of pGGN growth. We analyzed growth differences among different pathological results of pGGNs confirmed by surgery. The prognosis was analyzed using the total diameter or solid size of the nodules on the last preoperative CT.

Results

Among the 85 (55.2%) pGGNs with growth, 5.9%, 51.8%, and 80.0% showed growth within 1, 3, and 5 years, respectively. The median VDT and MDT were 1206.4 (range 349.8–5134.4) days and 1161.3 (range 339.4–6630.4) days, respectively. The multivariate Cox risk regression analysis showed that mean CT attenuation (m-CTA) [hazard ratio (HR) = 2.098, p = 0.010] and roundness index (HR = 1.892, p = 0.021) were independent risk factors for pGGN growth. In total, 67.6% of surgically resected and growing pGGNs were invasive non-mucinous adenocarcinoma (IA), including 2 cases of endpoint events, showing a PSN with solid components of 5.6 mm and a solid nodule with a diameter of 19.9 mm.

Conclusions

pGGNs of 5–10 mm showed an indolent clinical course. Follow-up CT imaging of pGGNs in the latter half of the first two years should be a rational management strategy. Small pGGNs with a larger overall m-CTA and roundness index on baseline CT are more likely to grow.

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan, Xigang District, Dalian, 116011, China

    Yifan He, Ziqi Xiong, Di Tian, Jingyu Zhang & Zhiyong Li

  2. Shanghai United Imaging Intelligence, Co., Ltd., Shanghai, China

    Jianzhou Chen

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  1. Yifan He
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  2. Ziqi Xiong
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Correspondence to Zhiyong Li.

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Ethical statement

The Institutional Review Board of our hospital approved the retrospective study, and the requirement for informed consent was waived. The ethical approval number is PJ-KS-KY-2022-13.

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He, Y., Xiong, Z., Tian, D. et al. Natural progression of persistent pure ground-glass nodules 10 mm or smaller: long-term observation and risk factor assessment. Jpn J Radiol 41, 605–616 (2023). https://doi.org/10.1007/s11604-022-01382-y

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  • DOI: https://doi.org/10.1007/s11604-022-01382-y

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