Abstract
Pulmonary nodules are a frequently encountered incidental phenomenon on thoracic CT. This chapter will review a number of strategies that are available to help clinicians distinguish between benign and malignant nodules, including assessment of nodule size, nodule morphology, nodule density and nodule growth rate.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM et al (2011) Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 365(5):395–409
Ahn MI, Gleeson TG, Chan IH, McWilliams AM, Macdonald SL, Lam S et al (2010) Perifissural nodules seen at CT screening for lung cancer. Radiology 254(3):949–956
Baldwin DR, Duffy SW, Wald NJ, Page R, Hansell DM, Field JK (2011) UK Lung Screen (UKLS) nodule management protocol: modelling of a single screen randomised controlled trial of low-dose CT screening for lung cancer. Thorax 66(4):308–313
Barrett TW, Schierling M, Zhou C, Colfax JD, Russ S, Conatser P et al (2009) Prevalence of incidental findings in trauma patients detected by computed tomography imaging. Am J Emerg Med 27(4):428–435
Bartholmai BJ, Koo CW, Johnson GB, White DB, Raghunath SM, Rajagopalan S et al (2015) Pulmonary nodule characterization, including computer analysis and quantitative features. J Thorac Imaging 30(2):139–156
Callister ME, Baldwin DR, Akram A, Bardard S, Cane P, Draffan J, Franks K (2015) British thoracic society guidelines for the investigation and management of pulmonary nodules. Thorax 70 Suppl 2:ii1–ii54
Chae HD, Park CM, Park SJ, Lee SM, Kim KG, Goo JM (2014) Computerized texture analysis of persistent part-solid ground-glass nodules: differentiation of preinvasive lesions from invasive pulmonary adenocarcinomas. Radiology 273(1):285–293
de Hoop B, Gietema H, Van de Vorst S, Murphy K, van Klaveren RJ, Prokop M (2010) Pulmonary ground-glass nodules: increase in mass as an early indicator of growth. Radiology 255(1):199–206
de Hoop B, van Ginneken B, Gietema H, Prokop M (2012) Pulmonary perifissural nodules on CT scans: rapid growth is not a predictor of malignancy. Radiology 265(2):611–616
Detterbeck FC, Gibson CJ (2008) Turning gray: the natural history of lung cancer over time. J Thorac Oncol 3(7):781–792
Diederich S, Hansen J, Wormanns D (2005) Resolving small pulmonary nodules: CT features. Eur Radiol 15(10):2064–2069
Gierada DS, Pinsky P, Nath H, Chiles C, Duan F, Aberle DR (2014). Projected outcomes using different nodule sizes to define a positive CT lung cancer screening examination. J Natl Cancer Inst. 106(11):284.
Gomez-Saez N, Gonzalez-Alvarez I, Vilar J, Hernandez-Aguado I, Domingo ML, Lorente MF et al (2014) Prevalence and variables associated with solitary pulmonary nodules in a routine clinic-based population: a cross-sectional study. Eur Radiol 24(9):2174–2182
Gould MK, Ananth L, Barnett PG, Veterans Affairs SCSG (2007a) A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest 131(2):383–388
Gould MK, Fletcher J, Iannettoni MD, Lynch WR, Midthun DE, Naidich DP et al (2007b) Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 132(3 Suppl):108S–130S
Gould MK, Donington J, Lynch WR, Mazzone PJ, Midthun DE, Naidich DP et al (2013) Evaluation of individuals with pulmonary nodules: when is it lung cancer? diagnosis and management of lung cancer, 3rd ed: american college of chest physicians evidence-based clinical practice guidelines. Chest 143(5 Suppl):e93S–e120S
Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner society: glossary of terms for thoracic imaging. Radiology 246(3):697–722
Harders SW, Madsen HH, Rasmussen TR, Hager H, Rasmussen F (2011) High resolution spiral CT for determining the malignant potential of solitary pulmonary nodules: refining and testing the test. Acta Radiol 52(4):401–409
Henschke CI, Yankelevitz DF, Yip R, Reeves AP, Farooqi A, Xu D et al (2012) Lung cancers diagnosed at annual CT screening: volume doubling times. Radiology 263(2):578–583
Horeweg N, van Rosmalen J, Heuvelmans MA, van der Aalst CM, Vliegenthart R, Scholten ET et al (2014) Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol 15(12):1332–1341
Hyodo T, Kanazawa S, Dendo S, Kobayashi K, Hayashi H, Kouno Y et al (2004) Intrapulmonary lymph nodes: thin-section CT findings, pathological findings, and CT differential diagnosis from pulmonary metastatic nodules. Acta Med Okayama 58(5):235–240
Ikeda K, Awai K, Mori T, Kawanaka K, Yamashita Y, Nomori H (2007) Differential diagnosis of ground-glass opacity nodules: CT number analysis by three-dimensional computerized quantification. Chest 132(3):984–990
Ishikawa H, Koizumi N, Morita T, Tani Y, Tsuchida M, Umezu H et al (2005) Ultrasmall pulmonary opacities on multidetector-row high-resolution computed tomography: a prospective radiologic-pathologic examination. J Comput Assist Tomogr 29(5):621–625
Jeong YJ, Lee KS, Jeong SY, Chung MJ, Shim SS, Kim H et al (2005) Solitary pulmonary nodule: characterization with combined wash-in and washout features at dynamic multi-detector row CT. Radiology 237(2):675–683
Kazerooni EA, Armstrong MR, Amorosa JK, Hernandez D, Liebscher LA, Nath H et al (2015) ACR CT accreditation program and the lung cancer screening program designation. J Am Coll Radiol 12(1):38–42
Kim HY, Shim YM, Lee KS, Han J, Yi CA, Kim YK (2007) Persistent pulmonary nodular ground-glass opacity at thin-section CT: histopathologic comparisons. Radiology 245(1):267–275
Lee HY, Lee KS (2011) Ground-glass opacity nodules histopathology, imaging evaluation, implications. J Thorac Imaging 26(2):106–118
Lee SM, Park CM, Goo JM, Lee HJ, Wi JY, Kang CH (2013) Invasive pulmonary adenocarcinomas versus preinvasive lesions appearing as ground-glass nodules: differentiation by using CT features. Radiology 268(1):265–273
Lee HY, Choi YL, Lee KS, Han J, Zo JI, Shim YM et al (2014) Pure ground-glass opacity neoplastic lung nodules: histopathology, imaging, and management. AJR Am J Roentgenol 202(3):W224–W233
Li F, Aoyama M, Shiraishi J, Abe H, Li Q, Suzuki K et al (2004) Radiologists’ performance for differentiating benign from malignant lung nodules on high-resolution CT using computer-estimated likelihood of malignancy. AJR Am J Roentgenol 183(5):1209–1215
Li Y, Yang ZG, Chen TW, Yu JQ, Sun JY, Chen HJ (2010) First-pass perfusion imaging of solitary pulmonary nodules with 64-detector row CT: comparison of perfusion parameters of malignant and benign lesions. Br J Radiol 83(993):785–790
Lim HJ, Ahn S, Lee KS, Han J, Shim YM, Woo S et al (2013) Persistent pure ground-glass opacity lung nodules >/= 10 mm in diameter at CT scan: histopathologic comparisons and prognostic implications. Chest 144(4):1291–1299
MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP et al (2005) Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the fleischner society. Radiology 237(2):395–400
McWilliams A, Tammemagi MC, Mayo JR, Roberts H, Liu G, Soghrati K et al (2013) Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 369(10):910–919
Naidich DP, Bankier AA, MacMahon H, Schaefer-Prokop CM, Pistolesi M, Goo JM et al (2013) Recommendations for the management of subsolid pulmonary nodules detected at CT: a statement from the fleischner society. Radiology 266(1):304–317
Noguchi M, Morikawa A, Kawasaki M, Matsuno Y, Yamada T, Hirohashi S et al (1995) Small adenocarcinoma of the lung. Histologic characteristics and prognosis. Cancer 75(12):2844–2852
Oda S, Awai K, Liu D, Nakaura T, Yanaga Y, Nomori H et al (2008) Ground-glass opacities on thin-section helical CT: differentiation between bronchioloalveolar carcinoma and atypical adenomatous hyperplasia. AJR Am J Roentgenol 190(5):1363–1368
Oh JY, Kwon SY, Yoon HI, Lee SM, Yim JJ, Lee JH et al (2007) Clinical significance of a solitary ground-glass opacity (GGO) lesion of the lung detected by chest CT. Lung Cancer 55(1):67–73
Ohno Y, Koyama H, Takenaka D, Nogami M, Maniwa Y, Nishimura Y et al (2008) Dynamic MRI, dynamic multidetector-row computed tomography (MDCT), and coregistered 2-[fluorine-18]-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/CT: comparative study of capability for management of pulmonary nodules. J Magn Reson Imaging 27(6):1284–1295
Ohno Y, Koyama H, Matsumoto K, Onishi Y, Takenaka D, Fujisawa Y et al (2011) Differentiation of malignant and benign pulmonary nodules with quantitative first-pass 320-detector row perfusion CT versus FDG PET/CT. Radiology 258(2):599–609
Ohno Y, Nishio M, Koyama H, Fujisawa Y, Yoshikawa T, Matsumoto S et al (2013) Comparison of quantitatively analyzed dynamic area-detector CT using various mathematic methods with FDG PET/CT in management of solitary pulmonary nodules. AJR Am J Roentgenol 200(6):W593–W602
Ohno Y, Nishio M, Koyama H, Seki S, Tsubakimoto M, Fujisawa Y et al (2014) Solitary pulmonary nodules: comparison of dynamic first-pass contrast-enhanced perfusion area-detector CT, dynamic first-pass contrast-enhanced MR imaging, and FDG PET/CT. Radiology 132289
Oshiro Y, Kusumoto M, Moriyama N, Kaneko M, Suzuki K, Asamura H et al (2002) Intrapulmonary lymph nodes: thin-section CT features of 19 nodules. J Comput Assist Tomogr 26(4):553–557
Park CM, Goo JM, Lee HJ, Lee CH, Kim HC, Chung DH et al (2006) CT findings of atypical adenomatous hyperplasia in the lung. Korean J Radiol 7(2):80–86
Revel MP, Bissery A, Bienvenu M, Aycard L, Lefort C, Frija G (2004) Are two-dimensional CT measurements of small noncalcified pulmonary nodules reliable? Radiology 231(2):453–458
Scholten ET, de Jong PA, de Hoop B, van Klaveren R, van Amelsvoort-van de Vorst S, Oudkerk M et al (2015) Towards a close computed tomography monitoring approach for screen detected subsolid pulmonary nodules? Eur Respir J 45(3):765–773
Shaham D, Vazquez M, Bogot NR, Henschke CI, Yankelevitz DF (2010) CT features of intrapulmonary lymph nodes confirmed by cytology. Clin Imaging 34(3):185–190
Silva M, Sverzellati N, Manna C, Negrini G, Marchiano A, Zompatori M et al (2012) Long-term surveillance of ground-glass nodules: evidence from the MILD trial. J Thorac Oncol 7(10):1541–1546
Son JY, Lee HY, Lee KS, Kim JH, Han J, Jeong JY et al (2014) Quantitative CT analysis of pulmonary ground-glass opacity nodules for the distinction of invasive adenocarcinoma from pre-invasive or minimally invasive adenocarcinoma. PLoS One 9(8), e104066
Swensen SJ, Morin RL, Schueler BA, Brown LR, Cortese DA, Pairolero PC et al (1992) Solitary pulmonary nodule: CT evaluation of enhancement with iodinated contrast material--a preliminary report. Radiology 182(2):343–347
Swensen SJ, Brown LR, Colby TV, Weaver AL (1995) Pulmonary nodules: CT evaluation of enhancement with iodinated contrast material. Radiology 194(2):393–398
Swensen SJ, Brown LR, Colby TV, Weaver AL, Midthun DE (1996) Lung nodule enhancement at CT: prospective findings. Radiology 201(2):447–455
Swensen SJ, Viggiano RW, Midthun DE, Muller NL, Sherrick A, Yamashita K et al (2000) Lung nodule enhancement at CT: multicenter study. Radiology 214(1):73–80
Swensen SJ, Jett JR, Hartman TE, Midthun DE, Sloan JA, Sykes AM et al (2003) Lung cancer screening with CT: mayo clinic experience. Radiology 226(3):756–761
Takenaka M, Uramoto H, Shimokawa H, So T, Hanagiri T, Aoki T et al (2013) Discriminative features of thin-slice computed tomography for peripheral intrapulmonary lymph nodes. Asian J Surg 36(2):69–73
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y et al (2011) International association for the study of lung cancer/american thoracic society/european respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 6(2):244–285
van Klaveren RJ, Oudkerk M, Prokop M, Scholten ET, Nackaerts K, Vernhout R et al (2009) Management of lung nodules detected by volume CT scanning. N Engl J Med 361(23):2221–2229
Wang CW, Teng YH, Huang CC, Wu YC, Chao YK, Wu CT (2013) Intrapulmonary lymph nodes: computed tomography findings with histopathologic correlations. Clin Imaging 37(3):487–492
Wood DE, Kazerooni E, Baum SL, Dransfield MT, Eapen GA, Ettinger DS et al (2015) Lung cancer screening, version 1.2015: featured updates to the NCCN guidelines. J Natl Compr Canc Netw 13(1):23–34, quiz
Xu DM, van Klaveren RJ, de Bock GH, Leusveld A, Zhao Y, Wang Y et al (2008) Limited value of shape, margin and CT density in the discrimination between benign and malignant screen detected solid pulmonary nodules of the NELSON trial. Eur J Radiol 68(2):347–352
Xu DM, van der Zaag-Loonen HJ, Oudkerk M, Wang Y, Vliegenthart R, Scholten ET et al (2009) Smooth or attached solid indeterminate nodules detected at baseline CT screening in the NELSON study: cancer risk during 1 year of follow-up. Radiology 250(1):264–272
Yamashita Y, Torashima M, Takahashi M, Mizutani H, Miyazaki K, Matsuura K et al (1995) Contrast-enhanced dynamic MR imaging of postmolar gestational trophoblastic disease. Acta Radiol 36(2):188–192
Yi CA, Lee KS, Kim EA, Han J, Kim H, Kwon OJ et al (2004) Solitary pulmonary nodules: dynamic enhanced multi-detector row CT study and comparison with vascular endothelial growth factor and microvessel density. Radiology 233(1):191–199
Zhang M, Kono M (1997) Solitary pulmonary nodules: evaluation of blood flow patterns with dynamic CT. Radiology 205(2):471–478
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing
About this chapter
Cite this chapter
Devaraj, A., Sayer, C., Field, J. (2016). Computed Tomography Characterisation of Lung Nodules and Management of Incidentally Detected Nodules. In: Schoepf, U., Meinel, F. (eds) Multidetector-Row CT of the Thorax. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/978-3-319-30355-0_10
Download citation
DOI: https://doi.org/10.1007/978-3-319-30355-0_10
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-30353-6
Online ISBN: 978-3-319-30355-0
eBook Packages: MedicineMedicine (R0)