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Evolution of lung nodules 5 mm detected with low-dose CT in asymptomatic smokers

¹ School of Medicine, University of Milano, 7 Via Festa del Perdono, 20122 Milan, Italy, Departments of ² Radiology, ³ Thoracic Surgery and ⁴ Epidemiology and Biostatistics, European Institute of Oncology, 435 Via Ripamonti, 20141 Milan, Italy

Correspondence: Prof. Massimo Bellomi, MD, Professor of Radiology, School of Medicine University of Milan, Dept. of Radiology European Institute of Oncology, 435 Via Ripamonti, Milan 20141, Italy. E-mail: massimo.bellomi{at}ieo.it

Low-dose CT is widely employed for the early diagnosis of lung cancer in high-risk populations even if screening programmes have not been clinically validated yet; however, the optimum follow-up schedule for small lung nodules of uncertain status has not been defined. The aim of this study was to assess outcomes for small pulmonary nodules (diameter 5 mm) detected by CT in asymptomatic smokers

In 2000–2001, 1035 high-risk people were enrolled in an observational study for the early detection of lung cancer by yearly CT. The prevalence, incidence and evolution of small lung solid nodules are described

238 solid lung nodules 5 mm were identified at initial low-dose CT in 165 people (prevalence 15.9%). 26% of them were not detected in the following 4 years, 43.3% did not change and 10.1% grew to >5 mm; three were removed and found to be malignant (all T1N0); the remaining 21 were followed yearly

In the following year, 79 new small nodules were detected (incidence 7.9%). 11.4% were not detected in the subsequent 3 years, 79.7% did not change, 2.5% grew to > 5 mm and were followed yearly

In conclusion, prevalent and incident nodules 5 mm detected by low-dose CT screening for lung cancer can be safely checked at 1 year intervals.