title: Clinical significance of pulmonary nodules detected on abdominal CT in pediatric patients.
abstract: BACKGROUND
  The clinical significance of a pulmonary nodule that is detected incidentally on CT studies in children is unknown. In addition, there is limited information regarding the management of incidentally detected pulmonary nodules discovered on abdominal CT studies in children.
  
  
  OBJECTIVE
  The purpose of this study was to investigate the clinical significance of incidental pulmonary nodules detected on abdominal CT studies in children.
  
  
  METHODS
  This was a retrospective study performed following institutional review board approval. Abdominal CT reports in patients younger than 18 years of age from July 2004 to June 2011 were reviewed for the terms "nodule," "nodular" or "mass" in reference to the lung bases. The study population included those pediatric patients in whom pulmonary nodules were initially detected on abdominal CT studies. The largest pulmonary nodules detected on CT studies were evaluated for their features (size, shape, margin, attenuation, location, and presence of calcification and cavitation). Follow-up CT studies and clinical records were reviewed for demographic information, history of underlying malignancies and the clinical outcome of the incidental pulmonary nodules. Comparison of malignant versus benign pulmonary nodules was performed with respect to the size of the nodule, imaging features on CT, and patient history of malignancy using the Student's t-test and Fisher exact test. Youden J-index in receiver operating characteristic (ROC) analysis was used to determine the optimal cut-off size for suggesting a high risk of malignancy of incidentally detected pulmonary nodules.
  
  
  RESULTS
  Pulmonary nodules meeting inclusion criteria were detected in 62 (1.2%) of 5,234 patients. The mean age of patients with nodules was 11.2 years (range: 5 months-18 years). Thirty-one patients (50%) had follow-up CT studies and two of these patients (6%) were subsequently found to have malignant pulmonary nodules. Both of these patients had a history of malignancy. Of the remaining 31 patients without follow-up CT studies, none had a history of malignancy. Clinical follow-up data was available in 26 of these 31 patients (84%) and none had any evidence of malignant pulmonary nodule development. There was a significant association between history of malignancy and incidentally detected pulmonary nodules on abdominal CT studies subsequently found to be malignant (P = 0.036). The size was significantly larger for the malignant pulmonary nodules compared to the benign pulmonary nodules with a size ≥7 mm in diameter being the optimal cut-off for suggesting a high risk of malignancy (11.5 ± 6.4 mm vs. 4.7 ± 3.0 mm, P = 0.003).
  
  
  CONCLUSIONS
  The incidence of pulmonary nodules found on pediatric abdominal CT studies is 1.2%. The incidence of malignancy in such pulmonary nodules is low (3%) and only seen in the setting of pulmonary nodules ≥7 mm in diameter in children with a history of malignancy. Therefore, further investigation is warranted for pulmonary nodules that are ≥7 mm in children with a history of malignancy while further imaging work-up may not be necessary in the remaining patients in this pediatric patient population.
authors.affiliation: Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA. micheal.breen@childrens.harvard.edu.
authors.forename: Micheál
authors.initials: M
authors.lastname: Breen
authors.affiliation: Departments of Anesthesiology and Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Zurakowski
authors.affiliation: Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA. edward.lee@childrens.harvard.edu.
authors.forename: Edward Y
authors.initials: EY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008168:Lung / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D011860:Radiography, Abdominal; D015203:Reproducibility of Results; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
keywords: Abdomen; Children; Computed tomography; Incidental findings; Lung; Pulmonary nodules