title: CT Screening for Lung Cancer: Nonsolid Nodules in Baseline and Annual Repeat Rounds.
abstract: OBJECTIVE
  To address the frequency of identifying nonsolid nodules, diagnosing lung cancer manifesting as such nodules, and the long-term outcome after treatment in a prospective cohort, the International Early Lung Cancer Action Program.
  
  
  METHODS
  A total of 57,496 participants underwent baseline and subsequent annual repeat computed tomographic (CT) screenings according to an institutional review board, HIPAA-compliant protocol. Informed consent was obtained. The frequency of participants with nonsolid nodules, the course of the nodule at follow-up, and the resulting diagnoses of lung cancer, treatment, and outcome are given separately for baseline and annual repeat rounds of screening. The χ(2) statistic was used to compare percentages.
  
  
  RESULTS
  A nonsolid nodule was identified in 2392 (4.2%) of 57,496 baseline screenings, and pathologic pursuit led to the diagnosis of 73 cases of adenocarcinoma. A new nonsolid nodule was identified in 485 (0.7%) of 64,677 annual repeat screenings, and 11 had a diagnosis of stage I adenocarcinoma; none were in nodules 15 mm or larger in diameter. Nonsolid nodules resolved or decreased more frequently in annual repeat than in baseline rounds (322 [66%] of 485 vs 628 [26%] of 2392, P < .0001). Treatment of the cases of lung cancer was with lobectomy in 55, bilobectomy in two, sublobar resection in 26, and radiation therapy in one. Median time to treatment was 19 months (interquartile range [IQR], 6-41 months). A solid component had developed in 22 cases prior to treatment (median transition time from nonsolid to part-solid, 25 months). The lung cancer-survival rate was 100% with median follow-up since diagnosis of 78 months (IQR, 45-122 months).
  
  
  CONCLUSIONS
  Nonsolid nodules of any size can be safely followed with CT at 12-month intervals to assess transition to part-solid. Surgery was 100% curative in all cases, regardless of the time to treatment.
authors.affiliation: From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).
authors.forename: David F
authors.initials: DF
authors.lastname: Yankelevitz
authors.affiliation: From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).
authors.forename: Rowena
authors.initials: R
authors.lastname: Yip
authors.affiliation: From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).
authors.forename: James P
authors.initials: JP
authors.lastname: Smith
authors.affiliation: From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).
authors.forename: Mingzhu
authors.initials: M
authors.lastname: Liang
authors.affiliation: From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).
authors.forename: Dong Ming
authors.initials: DM
authors.lastname: Xu
authors.affiliation: From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).
authors.forename: Mary M
authors.initials: MM
authors.lastname: Salvatore
authors.affiliation: From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Wolf
authors.affiliation: From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).
authors.forename: Raja M
authors.initials: RM
authors.lastname: Flores
authors.affiliation: From the Departments of Radiology (D.F.Y., R.Y., M.L., Y.L., D.M.X., M.M.S., C.I.H.) and Thoracic Surgery (A.S.W., R.M.F.), Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Pl, New York, NY 10029; Department of Medicine, Weill Cornell Medical College, New York, NY (J.P.S.); Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China (M.L.); Department of Diagnostic Radiology, Cancer Hospital Chinese Academy of Medical Sciences & National Cancer Center of China, Beijing, China (Y.L.).
authors.forename: Claudia I
authors.initials: CI
authors.lastname: Henschke
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods*