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. 2024 Jan;310(1):e231219.
doi: 10.1148/radiol.231219.

Radiologic Features of Nodules Attached to the Mediastinal or Diaphragmatic Pleura at Low-Dose CT for Lung Cancer Screening

Yeqing Zhu  1 , Rowena Yip  1 , Jiafang Zhang  1 , Qiang Cai  1 , Qi Sun  1 , Pengfei Li  1 , Natela Paksashvili  1 , Natthaya Triphuridet  1 , Claudia I Henschke  1 , David F Yankelevitz  1 ; Investigators of the International Early Lung Cancer Action Program and Initiative for Early Lung Cancer Research on Treatment–Mount Sinai Health System  1 ; Investigators of the International Early Lung Cancer Action Program; Investigators of the Initiative for Early Lung Cancer Research on Treatment–Mount Sinai Health System
Collaborators, Affiliations

Radiologic Features of Nodules Attached to the Mediastinal or Diaphragmatic Pleura at Low-Dose CT for Lung Cancer Screening

Yeqing Zhu et al. Radiology. 2024 Jan.

Abstract

Background Pulmonary noncalcified nodules (NCNs) attached to the fissural or costal pleura with smooth margins and triangular or lentiform, oval, or semicircular (LOS) shapes at low-dose CT are recommended for annual follow-up instead of immediate workup. Purpose To determine whether management of mediastinal or diaphragmatic pleura-attached NCNs (M/DP-NCNs) with the same features as fissural or costal pleura-attached NCNs at low-dose CT can follow the same recommendations. Materials and Methods This retrospective study reviewed chest CT examinations in participants from two databases. Group A included 1451 participants who had lung cancer that was first present as a solid nodule with an average diameter of 3.0-30.0 mm. Group B included 345 consecutive participants from a lung cancer screening program who had at least one solid nodule with a diameter of 3.0-30.0 mm at baseline CT and underwent at least three follow-up CT examinations. Radiologists reviewed CT images to identify solid M/DP-NCNs, defined as nodules 0 mm in distance from the mediastinal or diaphragmatic pleura, and recorded average diameter, margin, and shape. General descriptive statistics were used. Results Among the 1451 participants with lung cancer in group A, 163 participants (median age, 68 years [IQR, 61.5-75.0 years]; 92 male participants) had 164 malignant M/DP-NCNs 3.0-30.0 mm in average diameter. None of the 164 malignant M/DP-NCNs had smooth margins and triangular or LOS shapes (upper limit of 95% CI of proportion, 0.02). Among the 345 consecutive screening participants in group B, 146 participants (median age, 65 years [IQR, 59-71 years]; 81 female participants) had 240 M/DP-NCNs with average diameter 3.0-30.0 mm. None of the M/DP-NCNs with smooth margins and triangular or LOS shapes were malignant after a median follow-up of 57.8 months (IQR, 46.3-68.1 months). Conclusion For solid M/DP-NCNs with smooth margins and triangular or LOS shapes at low-dose CT, the risk of lung cancer is extremely low, which supports the recommendation of Lung Imaging Reporting and Data System version 2022 for annual follow-up instead of immediate workup. © RSNA, 2024 See also the editorial by Goodman and Baruah in this issue.

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Conflict of interest statement

Disclosures of conflicts of interest: Y.Z. No relevant relationships. R.Y. No relevant relationships. J.Z. No relevant relationships. Q.C. No relevant relationships. Q.S. No relevant relationships. P.L. No relevant relationships. N.P. No relevant relationships. N.T. No relevant relationships. C.I.H. Participation on an advisory board without compensation for Lunglife AI; named inventor on a number of patents and patent applications relating to the evaluation of pulmonary nodules on CT scans of the chest that are owned by Cornell Research Foundation (CRF) (since 2009, has not accepted any financial benefit from these patents including royalties and any other proceeds related to the patents or patent applications owned by CRF); and president and on the board of the Early Diagnosis and Treatment Research Foundation (receives no compensation from the foundation; the foundation is established to provide grants for projects, conferences, and public databases for research on early diagnosis and treatment of diseases; recipients include I-ELCAP among others; funding comes from a variety of sources including philanthropic donations, grants, and contracts with agencies [federal and nonfederal], and imaging and pharmaceutical companies relating to image processing assessments; various sources of funding exclude any funding from tobacco companies or tobacco-related sources). D.F.Y. Royalties or licenses from HeartLung and General Electric; on an advisory board and owns equity in HeartLung; named inventor on a number of patents and patent applications with HeartLung and General Electric related to the evaluation of chest diseases including measurements of chest nodules and has received financial compensation for the licensing of these patents; on medical advisory boards for Median Technologies and Carestream; and consultant and co-owner of Accumetra.

Figures

None
Graphical abstract
Flowchart of participants. Group A included participants with malignant mediastinal or diaphragmatic pleura–attached noncalcified nodules (M/DP-NCNs) from the Initiative for Early Lung Cancer Research on Treatment–Mount Sinai Health System (IELCART-MSHS) and the International Early Lung Cancer Action Program (I-ELCAP). Group B included participants from a lung cancer (LC) screening program (Mount Sinai I-ELCAP [MS-ELCAP]) with benign M/DP-NCNs screened at three hospitals within the Mount Sinai Health System.
Figure 1:
Flowchart of participants. Group A included participants with malignant mediastinal or diaphragmatic pleura–attached noncalcified nodules (M/DP-NCNs) from the Initiative for Early Lung Cancer Research on Treatment–Mount Sinai Health System (IELCART-MSHS) and the International Early Lung Cancer Action Program (I-ELCAP). Group B included participants from a lung cancer (LC) screening program (Mount Sinai I-ELCAP [MS-ELCAP]) with benign M/DP-NCNs screened at three hospitals within the Mount Sinai Health System.
Example low-dose chest CT images of malignant mediastinal or diaphragmatic pleura–attached noncalcified nodules (NCNs) in participants of the Initiative for Early Lung Cancer Research on Treatment–Mount Sinai Health System cohort. (A) Axial standard-dose contrast-enhanced CT image in a 77-year-old female participant with adenocarcinoma shows a mediastinal pleura–attached NCN lung cancer (arrow) with a nonsmooth margin and round shape. (B) Axial low-dose CT image in a 76-year-old female participant with typical carcinoid shows a mediastinal pleura–attached NCN lung cancer (arrow) with a smooth margin and round shape. (C) Axial and (D) sagittal low-dose CT images in a 59-year-old female participant with adenocarcinoma show a diaphragmatic pleura–attached NCN lung cancer (arrow) with a smooth margin and round shape.
Figure 2:
Example low-dose chest CT images of malignant mediastinal or diaphragmatic pleura–attached noncalcified nodules (NCNs) in participants of the Initiative for Early Lung Cancer Research on Treatment–Mount Sinai Health System cohort. (A) Axial standard-dose contrast-enhanced CT image in a 77-year-old female participant with adenocarcinoma shows a mediastinal pleura–attached NCN lung cancer (arrow) with a nonsmooth margin and round shape. (B) Axial low-dose CT image in a 76-year-old female participant with typical carcinoid shows a mediastinal pleura–attached NCN lung cancer (arrow) with a smooth margin and round shape. (C) Axial and (D) sagittal low-dose CT images in a 59-year-old female participant with adenocarcinoma show a diaphragmatic pleura–attached NCN lung cancer (arrow) with a smooth margin and round shape.
Example low-dose chest CT images of benign mediastinal or diaphragmatic pleura–attached noncalcified nodules (NCNs) in participants of the Initiative for Early Lung Cancer Research on Treatment–Mount Sinai Health System cohort. (A) Axial low-dose CT image in a 73-year-old male participant shows a mediastinal pleura–attached NCN (arrow) with a smooth margin and triangular shape. (B) Axial low-dose CT image in a 56-year-old female participant shows a mediastinal pleura–attached NCN (arrow) with a smooth margin and oval shape. (C) Axial low-dose CT image in a 64-year-old female participant shows a diaphragmatic pleura–attached NCN (arrow) with a smooth margin and triangular shape. (D) Axial (top) and sagittal (bottom) low-dose CT images in a 65-year-old female participant show a diaphragmatic pleura–attached NCN (arrow) with a smooth margin and semicircular shape.
Figure 3:
Example low-dose chest CT images of benign mediastinal or diaphragmatic pleura–attached noncalcified nodules (NCNs) in participants of the Initiative for Early Lung Cancer Research on Treatment–Mount Sinai Health System cohort. (A) Axial low-dose CT image in a 73-year-old male participant shows a mediastinal pleura–attached NCN (arrow) with a smooth margin and triangular shape. (B) Axial low-dose CT image in a 56-year-old female participant shows a mediastinal pleura–attached NCN (arrow) with a smooth margin and oval shape. (C) Axial low-dose CT image in a 64-year-old female participant shows a diaphragmatic pleura–attached NCN (arrow) with a smooth margin and triangular shape. (D) Axial (top) and sagittal (bottom) low-dose CT images in a 65-year-old female participant show a diaphragmatic pleura–attached NCN (arrow) with a smooth margin and semicircular shape.
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