title: Screen-detected subsolid pulmonary nodules: long-term follow-up and application of the PanCan lung cancer risk prediction model.
abstract: OBJECTIVE
  To report the long-term follow-up of subsolid nodules (SSNs) detected in participants of a prospective low-dose CT lung cancer screening cohort, and to investigate the utility of the PanCan model in stratifying risk in baseline SSNs.
  
  
  METHODS
  Participants underwent a baseline scan, two annual incidence scans and further follow-up scans for the detected nodules. All SSNs underwent a minimum of 2 years of follow-up (unless resolved or resected). Risk of malignancy was estimated using the PanCan model; discrimination [area under the receiver-operating characteristic curve (AUC)] and calibration (Hosmer-Lemeshow goodness-of-fit test) were assessed. The Mann-Whitney U-Wilcoxon test was used to compare estimated risk between groups.
  
  
  RESULTS
  70 SSNs were detected in 41 (16.0%) out of 256 total participants. Median follow-up period was 25.5 months (range 2.0-74.0 months). 29 (41.4%) SSNs were transient. Five (7.1%) SSNs were resected, all found to be Stage I lung adenocarcinoma, including one SSN stable in size for 3.0 years before growth was detected. The PanCan model had good discrimination for the 52 baseline SSNs (AUC = 0.89; 95% confidence interval 0.76-1); the Hosmer-Lemeshow goodness-of-fit test was non-significant (p = 0.27). Estimated risk was significantly higher in the baseline SSNs found to be cancer vs those not found to be cancer after 2-6 years of follow-up (p < 0.01).
  
  
  CONCLUSIONS
  Our findings support a long-term follow-up approach for screen-detected SSNs for 3 years or longer. The PanCan model appeared discriminatory and well calibrated in this cohort.
  
  
  CONCLUSIONS
  The PanCan model may have utility in identifying low-risk SSNs which could be followed with less frequent CT scans.
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Henry
authors.identifier: http://orcid.org/0000-0002-9804-2043
authors.initials: H
authors.lastname: Zhao
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.|2 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Henry M
authors.identifier: http://orcid.org/0000-0002-9626-8014
authors.initials: HM
authors.lastname: Marshall
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.|2 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Ian A
authors.initials: IA
authors.lastname: Yang
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.|2 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Rayleen V
authors.initials: RV
authors.lastname: Bowman
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Ayres
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Crossin
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Melanie
authors.initials: M
authors.lastname: Lau
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.|4 School of Physical and Chemical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Richard E
authors.initials: RE
authors.lastname: Slaughter
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Stanley
authors.initials: S
authors.lastname: Redmond
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Linda
authors.initials: L
authors.lastname: Passmore
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: McCaul
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Deborah
authors.initials: D
authors.lastname: Courtney
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.|2 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Leong
authors.affiliation: 2 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.|3 Department of Thoracic Surgery, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Morgan
authors.initials: M
authors.lastname: Windsor
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.|2 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Paul V
authors.initials: PV
authors.lastname: Zimmerman
authors.affiliation: 1 The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, Brisbane, QLD, Australia.|2 Department of Thoracic Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia.
authors.forename: Kwun M
authors.initials: KM
authors.lastname: Fong
mesh_terms: D000368:Aged; D055088:Early Detection of Cancer / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D055613:Multiple Pulmonary Nodules / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed / Q000379:methods