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ORIGINAL ARTICLE
Year : 2022  |  Volume : 18  |  Issue : 7  |  Page : 2041-2048

Computed tomography findings, associated factors, and management of pulmonary nodules in 54,326 healthy individuals


1 Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, No. 16766, Jingshi Road; Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province, China
2 Shandong Second Provincial General Hospital, Jinan, Shandong Province, China
3 Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong Province; Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Jinan, Shandong, China
4 Department of Health Management, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, Shandong Province, China
5 Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, No. 16766, Jingshi Road; Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
6 Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, No. 16766 Jingshi Road, Jinan, Shandong, China
7 Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, No. 16766, Jingshi Road, Jinan, Shandong Province, China

Date of Submission01-Aug-2022
Date of Decision01-Aug-2022
Date of Acceptance28-Oct-2022
Date of Web Publication11-Jan-2023

Correspondence Address:
Guang Zhang
Department of Health Management, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, Shandong Province, 250014
China
Qingshi Zeng
Department of Radiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, No. 16766, Jingshi Road, Jinan, Shandong Province, 250014
China
Xin Ye
Department of Oncology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Lung Cancer Institute, No. 16766, Jingshi Road, Jinan, Shandong Province, 250014
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcrt.jcrt_1586_22

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 > Abstract 


Introduction: To investigate the pulmonary nodules detected by low-dose computed tomography (LDCT), identified factors affecting the size and number of pulmonary nodules (single or multiple), and the pulmonary nodules diagnosed and management as lung cancer in healthy individuals.
Methods: A retrospective analysis was conducted on 54,326 healthy individuals who received chest LDCT screening. According to the results of screening, the detection rates of pulmonary nodules, grouped according to the size and number of pulmonary nodules (single or multiple), and the patients' gender, age, history of smoking, hypertension, and diabetes were statistically analyzed to determine the correlation between each factor and the characteristics of the nodules. The pulmonary nodules in healthy individuals diagnosed with lung cancer were managed with differently protocols.
Results: The detection rate of pulmonary nodules was 38.8% (21,055/54,326). The baseline demographic characteristics of patients with pulmonary nodules were: 58% male and 42% female patients, 25.7% smoking and 74.3% nonsmoking individuals, 40–60 years old accounted for 49%, 54.8% multiple nodules, and 45.2% single nodules, and ≤5-mm size accounted for 80.4%, 6–10 mm for 18.2%, and 11–30 mm for 1.4%. Multiple pulmonary nodules were more common in hypertensive patients. Diabetes is not an independent risk factor for several pulmonary nodules. Of all patients with lung nodules, 26 were diagnosed with lung cancer, accounting for 0.1% of all patients with pulmonary nodules, 0.6% with nodules ≥5 mm, and 2.2% with nodules ≥8 mm, respectively. Twenty-six patients with lung cancer were treated with surgical resection (57.7%), microwave ablation (MWA, 38.5%), and follow-up (3.8%).
Conclusions: LDCT was suitable for large-scale pulmonary nodules screening in healthy individuals, which was helpful for the early detection of suspicious lesions in the lung. In addition to surgical resection, MWA is an option for early lung cancer treatment.

Keywords: Low-dose computed tomography, lung cancer, microwave ablation, pulmonary nodules


How to cite this article:
Liang X, Kong Y, Shang H, Yang M, Lu W, Zeng Q, Zhang G, Ye X. Computed tomography findings, associated factors, and management of pulmonary nodules in 54,326 healthy individuals. J Can Res Ther 2022;18:2041-8

How to cite this URL:
Liang X, Kong Y, Shang H, Yang M, Lu W, Zeng Q, Zhang G, Ye X. Computed tomography findings, associated factors, and management of pulmonary nodules in 54,326 healthy individuals. J Can Res Ther [serial online] 2022 [cited 2023 Jan 27];18:2041-8. Available from: https://www.cancerjournal.net/text.asp?2022/18/7/2041/367465

Authors Xinyu Liang, Yongmei Kong and Hui Shang contributed to the paper equally.





 > Introduction Top


In 2020, about 2.2 million new lung cancer cases were detected worldwide. It was the leading cause of cancer-related deaths, with an estimated 1.8 million deaths.[1] In China, lung cancer has the highest morbidity and mortality.[2] The pathological and clinical stages of lung cancer are closely related to the patient's survival rate.[3] However, early diagnosis and treatment are essential approaches to reducing mortality. In 2011, the National Lung Screening Trial reported that lung cancer mortality in high-risk populations could be reduced by 20% using low-dose computed tomography (LDCT) screening instead of standard chest X-ray.[4] As LDCT screening programs have been widely carried out in recent years, asymptomatic pulmonary nodules have been detected more frequently. The detection rate of pulmonary nodules in China is 20%–80%.[5],[6],[7],[8] In an article on chest computed tomography (CT) screening for lung cancer, the authors used a comprehensive and systematic analysis of 88,497 patients to show a significant reduction in lung cancer-related mortality and an increase in early-stage tumor diagnosis.[9] Pulmonary nodules are generally regarded as an early manifestation of lung cancer, so they have received much attention. However, more than >97% of the pulmonary nodules found by LDCT screening are benign. Lung cancer has a detection rate of only 0.7%–2.3%.[10],[11] A high detection rate may lead to overdiagnosis, overtreatment, waste of medical resources, and higher levels of anxiety in patients.[9],[12],[13],[14],[15] This study retrospectively analyzed 54,326 healthy individuals who underwent chest LDCT screening. According to the screening results, the detection rates of pulmonary nodules, associated factors, and the pulmonary nodules diagnosed and management as lung cancer in healthy individuals.


 > Materials and Methods Top


Study participants

The relevant information on physical examinations of the healthy individuals, who received LDCT screening in the First Affiliated Hospital of Shandong First Medical University, from January 1, 2020, to December 31, 2020, was analyzed. A total of 54,326 subjects were enrolled and included in the study cohort. The subjects of this investigation were mainly school teachers, government staff, enterprise employees, and some urban residents of Jinan city, Shandong province [Table 1]. Criteria for determination of pulmonary nodules in lung-imaging features are manifested as focal and increased hazy opacities in the lung parenchyma, with preservation of the bronchial structures and vascular margins, clear or unclear boundary, a diameter ≤3 cm (round or quasi-circular shadow), single or multiple pulmonary nodules, and without atelectasis, hilus lymph node enlargement, or pleural effusion. Pulmonary nodules were diagnosed by two radiologists with more than five years of experience in radiology.
Table 1: Baseline demographic characteristics of 21,055 patients with pulmonary nodules

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Thoracic computed tomography scans

All participants underwent CT scans (uCT 760, United Imaging Healthcare Co., Ltd.). Sixty-four CT scans were performed with the following parameters; 120 kVp, tube current of 100~120 mA, and scan layer thickness of 5 mm.[16] The scans were performed from the tip of the lung to the costal diaphragmatic angle (including both lungs). Deep breathing exercises preceded them to ensure the clarity of CT images. The mediastinal and pulmonary windows were imaged on this basis to obtain 1.25~1.55 mm thin layer reconstruction. At the same time, thin layers of pulmonary nodules were imaged by maximal density projection to understand their surrounding morphology and boundaries, such as the structure of adjacent blood vessels and trachea. In this study, the positive result of the CT examination was at least one noncalcified nodule with a diameter of less than 30 mm on the lung image. At least two experienced radiologists performed image analyses before their clinical data. Through the correlation analysis of CT images and the evaluation of the images by computer-aided detection software, the diagnosis rate of pulmonary nodules can be improved, and missed diagnoses can be avoided.

Group

According to CT examination results, 21,055 patients with pulmonary nodules were divided into groups, including the number of pulmonary nodules (single and multiple) and the size of pulmonary nodules (micronodules, <5 mm diameter; minor nodule, 5–10 mm diameter; nodule, 11–30 mm diameter).[17] The age, sex, body mass index (BMI), smoking history, alcohol consumption, hypertension history, and diabetes history of patients with pulmonary nodules were statistically analyzed using different grouping methods.

Statistical analysis

SPSS 20.0 statistical software was used to analyze the data, and the classification data were expressed in composition ratio and frequency. Chi square test was used to compare the two groups, and binary logistic regression was used to analyze the factors affecting the size and number of pulmonary nodules. P < 0.05 was considered statistically significant.


 > Results Top


Study participants

This study detected pulmonary nodules in 21,055 of 54,326 healthy individuals, with a total detection rate of 38.8%. Pulmonary nodules were detected in 12,194 men (57.9%) and 8,861 women (42.1%) patients. According to the number of nodules, 21,055 patients with pulmonary nodules were classified, among which 9,519 patients with single pulmonary nodule (SPN) accounted for 45.2%, and 11,536 patients with multiple pulmonary nodules (MPN) accounted for 54.8%. The baseline demographic characteristics of 21,055 patients with pulmonary nodules are shown in [Table 1].

During the screening process, 21,055 patients were detected with pulmonary nodules, of which 26 patients were diagnosed with malignant pulmonary tumors, accounting for 0.1% of all patients with pulmonary nodules, 0.6% of 4127 patients with nodules larger than 5 mm, 2.2% of 1208 patients with nodules ≥8 mm. Among them. Among them, 69.2% were female, and 30.8% male patients. Subsolid nodules accounted for 84.6%, and solid nodules accounted for 15.4%. Among the pathological types of lung cancer, 25 patients with adenocarcinoma accounted for 95.8% [42.3% adenocarcinoma in situ (AIS), 53.8% microinvasive adenocarcinoma (MIA)], and one with nonadenocarcinoma accounted for 3.8%. Smoking patients accounted for about 19.2%, and nonsmokers accounted for about 80.8%. In this screening, about 30.8% of lung cancer patients were younger than 50 years old, about 19.2% were 51–60 years old, about 26.9% were 61–70 years old, and about 23.1% were older than 70 years old. In the selection of treatment methods, 15 (57.7%) patients underwent surgical resection, 10 (38.5%) patients underwent microwave ablation (MWA) [Figure 1], and 1 (3.8%) was followed up. It can be concluded that MWA, as a new treatment method, is entirely feasible in treating lung cancer. The detailed information of 26 patients with lung cancer is shown in [Table 2].
Figure 1: A 70-year-old man with pure ground-glass opacity (GGO) (the upper lift lobe, with the size of 25 × 16 mm) was diagnosed pathologically as microinvasive lung adenocarcinoma (MIA). (a) A pure GGO of the left upper lobe pre-microwave ablation (MWA). (b) Two microwave ablation antennas punctured into the lesion. (c) Immediate postablation. (d) Forty-eight hours postablation showed a fried egg sign or a reverse halo sign. (e) One-month postablation. (f) Six months postablation. (g) Twelve months postablation. (h) Twenty-four months postablation, the lesion involuted into a fibrous scar

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Table 2: Detection rate of lung cancer in patients with pulmonary nodules

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Pulmonary nodules

Statistical analysis of pulmonary nodules showed that among the positive patients screened, more male patients were found than female patients (57.9% vs. 42.1%) and were mainly distributed in the 40–60 age group. Pulmonary nodules were more common in nonsmokers (smokers: 19.7% vs. nonsmokers: 80.3%). Patients with only one pulmonary nodule were defined as SPN patients, and patients with ≥2 pulmonary nodules were defined as MPN patients. Age was an independent risk factor for the number of pulmonary nodules. [Table 3] Patients older than 60 years were more likely to have MPN than patients younger than 60 years (risk factor: 1.556, confidence interval: 1.460–1.659, P < 0.001); hypertension was also an independent risk factor for the number of pulmonary nodules, and MPN was more common in hypertensive patients than in nonhypertensive patients (hazard coefficient: 1.486, confidence interval: 1.336–1.654, P < 0.001); diabetes was not an independent risk factor for the number of pulmonary nodules (hazard factor: 1.172; confidence interval: 0.994–1.382; P = 0.058).
Table 3: Statistical table of patient's baseline characteristics and single/multiple disease information

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Of the 21,055 patients with pulmonary nodules, 16,923 (80.4%) had micronodules; 3,827 (18.2%) minor nodules, and 305 (1.4%) nodules. Additional subgroup analysis according to the lung nodule size showed that gender, age, smoking, hypertension, and diabetes had statistically significant effects on lung nodule size [p < 0.05, [Table 4]], while BMI and alcohol consumption had no statistically significant effects on lung nodule size [P > 0.05, [Table 4]].
Table 4: Statistical table of factors affecting the size of pulmonary nodules in lung cancer patients

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According to the sample size and combined with previous studies,[18],[19] we divided the nodule size into two groups, with 8 mm as the boundary value, and then converted it into a dichotomous variable for logistic regression analysis. The number of patients with nodule sizes larger than 8 mm was 1,208 (2.2%). Age and sex were independent risk factors for nodule size. In our study, among the patients with nodule diameter greater than 8 mm, 3.6% were less than 30 years old, 9% were 30–40 years old, 16% were 41–50 years old, 27.5% were 50–60 years old, 22.8% were 60–70 years old, and 14.9% were 70–80 years old. According to the statistical analysis, there were more male than female patients with nodules larger than 8 mm, and the detection rate was highest in patients aged 50–60. Patients over 80 years old accounted for 6.2% of cases. This suggests that nodules larger than 8 mm are more common in older patients over 60 (risk factor: 2.147, confidence interval: 1.900–2.427, P < 0.001). The study also found that men were more likely to have greater nodules than women (risk factor: 1.196, confidence interval: 1.046–1.368, P = 0.009).


 > Discussion Top


There are multiple similar lung cancer screening programs. However, the detection rate of pulmonary nodules varies significantly with lung cancer screening programs in Europe, the United States, Asia, and China. In the International Early Lung Cancer Action Plan (I-ELCAP), 4,186 patients had pulmonary nodules among the 31,567 participants (13.3%).[20] In another UK Lung Cancer Screening (UK), 1,015 of 1,991 patients developed pulmonary nodules, accounting for about 50% of cases.[21] In one study, of 65,374 baseline screenings, noncalcified nodules were identified in 28,279 patients (43.3%).[22] In 2017, Liu Yuping et al.[23] screened 53,202 asymptomatic patients for pulmonary nodules, and the results showed that 35,808 patients were diagnosed with at least one pulmonary nodule, with a detection rate of 67.31%. In our study, the incidence of pulmonary nodules investigated was 38.8%. Swensen and Diederich[24],[25] reported that the detection rate of pulmonary nodules was 41%–50% when the minimum threshold of pulmonary nodules was set at 3 mm, which was not much different from the detection rate of pulmonary nodules detected by this study. CT scan layer thickness can also be used to explain the difference in incidence. It has been reported that when CT scan layer thickness is set at 5 mm, the detection rate of pulmonary nodules is 13.3%.[21] In the screening of pulmonary nodules, the initial CT scan thickness was set as 5 mm, the mediastinal window and pulmonary window were used for imaging, and thin layer reconstruction images of 1.25–1.55 mm were obtained. Therefore, the detection rate of pulmonary nodules was higher than 5 mm slice thickness scanning. The setting of relevant parameters during CT scanning and the update of CAD may also lead to different detection rates of pulmonary nodules.[26],[27],[28],[29],[30] On the other hand, in the 2021 study by Lianzhen Huang et al.,[31] there were 1,629 patients aged 40–60 years with pulmonary nodules, accounting for 83.1% of cases. This significantly differed from our study's 5,178 patients (24.6%) with pulmonary nodules aged 40–60 years. The large difference between the two may be due to different inclusion criteria.

Our study divided lung nodules into three types according to their size. Among them, micronodules accounted for about 80.4%, about the same percentage of micronodules screened by Huang and others.[31] At the same time, gender was also an important characteristic. In our study, there were more male than female patients with lung nodules (p < 0.05), which was statistically significant and was consistent with the results of some other domestic studies that lung nodules are more common in males.[32],[33] In our study, hypertension was an independent risk factor affecting the number of pulmonary nodules, and hypertensive patients were more common in MPN, similar to Bao AIhua et al.[34] Among all patients with pulmonary nodules, 174 MPN patients showed a history of hypertension, 319 SPN patients, 103 MPN patients without hypertension, and 314 SPN patients. These results showed that patients with a history of hypertension were more prone to MPN. However, the effect of hypertension on pulmonary nodules still needs further exploration. Smoking history, an important feature of lung nodules, has also attracted attention from researchers. In our study, 4,149 patients with pulmonary nodules had a smoking history, accounting for 19.7% of cases. There were 16,906 patients with pulmonary nodules without a smoking history, accounting for 80.3% of cases. This is consistent with recent reports of a gradually increasing incidence of pulmonary nodules in nonsmoking patients. In 2013, Cho et al.[35] analyzed 218 patients with pulmonary nodules, in which 453 ground-glass nodules or ground-glass opacity (GGN or GGO) were found. Among them, 125 (57%) were nonsmokers. Among the 84 smokers (39%), 9 had missing information at follow-up. Overall, 60% of patients with pulmonary nodules in this study were nonsmokers, somewhat different from our study results. However, both studies confirm that most patients with pulmonary nodules were nonsmokers. However, Gould et al.[36] noted that the incidence of pulmonary nodules was higher in smokers than in nonsmokers and that a smoking history was an independent risk factor for pulmonary nodules. Another study suggests that smoking could affect the process of protein transcription and translation and may cause direct damage to the DNA chain, resulting in the malignant transformation of delicate cells and ultimately leading to the generation of pulmonary nodules.[37] Therefore, further studies must confirm the association between pulmonary nodules and smoking.

In our study, 26 patients with lung cancer were screened out of 21,055 patients with pulmonary nodules. Of the 26 patients diagnosed with lung cancer, 15 underwent video-assisted thoracoscopic surgery (VATS), and 10 underwent MWA. VATS treatment is still the primary therapy for GGO-like lung cancer. As a minimally invasive local therapy, MWA has achieved good results and shown certain advantages in treating GGO-like lung cancer.[38],[39],[40],[41] In one study, the authors argued that MWA was performed with good results for patients at high surgical risk or who refused surgery. We also reviewed a retrospective, multicenter study by Yang et al.[39] in which postoperative follow-up confirmed the value of MWA in treating early lung cancer.[38] However, there are still many challenges to overcome for applying thermal ablation for GGO- like lung cancer. To become the first-line therapy for GGOs, a prospective, multicenter, randomized, and controlled study focusing on the effectiveness of MWA for single and multiple pulmonary subsolid nodules is needed.[42]

In conclusion, LDCT was suitable for large-scale lung cancer screening, which was helpful for the early detection of suspicious lung lesions. More attention should be paid to lung cancer screening for patients with pulmonary nodules in men aged ≥40 and nodules ≥8 mm. In addition to surgical resection, MWA is an option for treating early lung cancer.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Shandong Provincial Key Research and Development Program (No. 2019GGX101044), the Natural Science Foundation of Shandong Province (No. ZR2020MF026) and The Provincial Natural Science Foundation of China (No. ZR2020MH294) supported this study.

National Natural Science Foundation of China (NSFC 81901851, 82072028) supported this study.

Conflicts of interest

There are no conflicts of interest.



 
 > References Top

1.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2021;71:209-49.  Back to cited text no. 1
    
2.
Zheng R, Zhang S, Zeng H, Wang S, Sun K, Chen R, et al. Cancer incidence and mortality in China. 2016. JNCC 2022;2:1-9.  Back to cited text no. 2
    
3.
Ruffini E, Rami-Porta R, Huang J, Ahmad U, Appel S, Bille A, et al. The international association for the study of lung cancer thymic epithelial tumor staging project: Unresolved Issues to be Addressed for the Next Ninth Edition of the TNM Classification of Malignant Tumors. J Thorac Oncol 2022;17:838-51.  Back to cited text no. 3
    
4.
National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011;365:395-409.  Back to cited text no. 4
    
5.
He YT, Zhang YC, Shi GF, Wang Q, Xu Q, Liang D, et al. Risk factors for pulmonary nodules in north China: A prospective cohort study. Lung Cancer 2018;120:122-9.  Back to cited text no. 5
    
6.
Yang W, Qian F, Teng J, Wang H, Manegold C, Pilz LR, et al. Community-based lung cancer screening with low-dose CT in China: Results of the baseline screening. Lung Cancer 2018;117:20-6.  Back to cited text no. 6
    
7.
Liu B, Ye X. Management of pulmonary multifocal ground-glass nodules: How many options do we have? J Cancer Res Ther 2020;16:199-202.  Back to cited text no. 7
    
8.
Xu G, Huang H, Chen B, Wang D, Wu J, Luo Y, et al. [A study on the first chest low-dose CT screening and susceptible factors of pulmonary nodules in 23,695 physical examinees in a medical examination center.] Fudan Xue Bao (in Chinese) 2020;47:654-659+668. Chinese.  Back to cited text no. 8
    
9.
Passiglia F, Cinquini M, Bertolaccini L, Del Re M, Facchinetti F, Ferrara R, et al. Benefits and harms of lung cancer screening by chest computed tomography: A systematic review and meta-analysis. J Clin Oncol 2021;39:2574-85.  Back to cited text no. 9
    
10.
Ye X, Fan W, Wang Z, Wang J, Wang H, Wang J, et al. Expert consensus on thermal ablation therapy of pulmonary subsolid nodules (2021 Edition). J Cancer Res Ther 2021;17:1141-56.  Back to cited text no. 10
    
11.
Liu Y, Luo H, Qing H, Wang X, Ren J, Xu G, et al. Screening baseline characteristics of early lung cancer on low-dose computed tomography with computer-aided detection in a Chinese population. Cancer Epidemiol 2019;62:101567.  Back to cited text no. 11
    
12.
Bach PB, Mirkin JN, Oliver TK, Azzoli CG, Berry DA, Brawley OW, et al. Benefits and harms of CT screening for lung cancer: A systematic review. JAMA 2012;307:2418-29.  Back to cited text no. 12
    
13.
Kaaks R, Delorme S. Lung cancer screening by low-dose computed tomography-Part 1: Expected benefits, possible harms, and criteria for eligibility and population targeting. Rofo 2021;193:527-36.  Back to cited text no. 13
    
14.
Poonia DR, Sehrawat A, Gupta MK. Lung cancer screening: An unending tale. J Cancer Res Ther 2021;17:1289-93.  Back to cited text no. 14
    
15.
Callister MEJ, Sasieni P, Robbins HA. Overdiagnosis in lung cancer screening. Lancet Respir Med 2021;9:7-9.  Back to cited text no. 15
    
16.
Zhang P, Liu JM, Zhang YY, Hua R, Xia FF, Shi YB. Computed tomography-guided lung biopsy: A meta-analysis of low-dose and standard-dose protocols. J Cancer Res Ther 2021;17:695-701.  Back to cited text no. 16
    
17.
Society of Respiratory Diseases Lung Cancer Group of Chinese Medical Association, Chinese Lung Cancer Association. [Chinese expert consensus on diagnosis and treatment of lung nodules (2018 edition)]. Zhonghua Jie He Hu Xi Za Zhi (in Chinese) 2018;41:763-71. Chinese.  Back to cited text no. 17
    
18.
González Maldonado S, Delorme S, Hüsing A, Motsch E, Kauczor HU, Heussel CP, et al. Evaluation of prediction models for identifying malignancy in pulmonary nodules detected via low-dose computed tomography. JAMA Netw Open 2020;3:e1921221.  Back to cited text no. 18
    
19.
Ye X, Fan W, Wang Z, Wang J, Wang H, Wang J, et al. [Expert Consensus for Thermal Ablation of Pulmonary Subsolid Nodules (2021 Edition)]. Zhongguo Fei Ai Za Zhi 2021;24:305-22. Chinese.  Back to cited text no. 19
    
20.
International Early Lung Cancer Action Program Investigators, Henschke CI, Yankelevitz DF, Libby DM, Pasmantier MW, Smith JP, et al. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med 2006;355:1763-71.  Back to cited text no. 20
    
21.
Field JK, Duffy SW, Baldwin DR, Whynes DK, Devaraj A, Brain KE, et al. UK Lung Cancer RCT Pilot Screening Trial: Baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening. Thorax 2016;71:161-70.  Back to cited text no. 21
    
22.
Henschke CI, Salvatore M, Cham M, Powell CA, DiFabrizio L, Flores R, et al. Baseline and annual repeat rounds of screening: Implications for optimal regimens of screening. Eur Radiol 2018;28:1085-94.  Back to cited text no. 22
    
23.
Yuping Liu, Gang Feng. [Analysis of early lung cancer screening results and risk factors with low-dose CT in physical examination population]. Zhonghua Lao Nian Yi Xue Za Zhi 2017;36:1242-6. Chinese.  Back to cited text no. 23
    
24.
Swensen SJ, Jett JR, Hartman TE, Midthun DE, Sloan JA, Sykes AM, et al. Lung cancer screening with CT: Mayo Clinic experience. Radiology 2003;226:756-61.  Back to cited text no. 24
    
25.
Diederich S, Wormanns D, Semik M, Thomas M, Lenzen H, Roos N, et al. Screening for early lung cancer with low-dose spiral CT: Prevalence in 817 asymptomatic smokers. Radiology 2002;222:773-81.  Back to cited text no. 25
    
26.
van Ginneken B, Armato SG 3rd, de Hoop B, van Amelsvoort-van de Vorst S, Duindam T, Niemeijer M, et al. Comparing and combining algorithms for computer-aided detection of pulmonary nodules in computed tomography scans: The ANODE09 study. Med Image Anal 2010;14:707-22.  Back to cited text no. 26
    
27.
Jacobs C, van Rikxoort EM, Twellmann T, Scholten ET, de Jong PA, Kuhnigk JM, et al. Automatic detection of subsolid pulmonary nodules in thoracic computed tomography images. Med Image Anal 2014;18:374-84.  Back to cited text no. 27
    
28.
Han H, Li L, Han F, Song B, Moore W, Liang Z. Fast and adaptive detection of pulmonary nodules in thoracic CT images using a hierarchical vector quantization scheme. IEEE J Biomed Health Inform 2015;19:648-59.  Back to cited text no. 28
    
29.
Madero Orozco H, Vergara Villegas OO, Cruz Sánchez VG, Ochoa Domínguez Hde J, Nandayapa Alfaro Mde J. Automated system for pulmonary nodules classification based on wavelet feature descriptor and support vector machine. Biomed Eng Online 2015;14:9.  Back to cited text no. 29
    
30.
Firmino M, Angelo G, Morais H, Dantas MR, Valentim R. Computer-aided detection (CADe) and diagnosis (CADx) system for lung cancer with the likelihood of malignancy. Biomed Eng Online 2016;15:2.  Back to cited text no. 30
    
31.
Huang L, Cheng Q, Liao H, Huang P. [Comparison of incidence and risk factors of pulmonary nodules between sanitation workers and ordinary residents in Xiangzhou District of Zhuhai city]. Jilin Yi Xue (in Chinese) 2010;42:1445-8. Chinese.  Back to cited text no. 31
    
32.
Pan Yue; Jiang Qicheng. [Analysis of pulmonary nodules detection and influencing factors in healthy people]. Yu Fang Yi Xue Qing Bao Za Zhi (in Chinese) 2020;36:356 359+364. Chinese.  Back to cited text no. 32
    
33.
Hui She, Fang Z, Chen F, Fang Dong, Lai G. [Clinical characteristics of solitary pulmonary nodules]. Zhongguo Hu Xi Yu Wei Zhong Jian Hu Za Zhi (in Chinese) 2015;14:376-9. Chinese.  Back to cited text no. 33
    
34.
Bao A, Guo H, He Z, Zhang X, Chen D, Rao Y, et al. [Pulmonary nodules in the elderly population of Songjiang city, Shanghai]. Lin Chuang Fei Ke Za Zhi (in Chinese). 2019;24:1061-5. Chinese.  Back to cited text no. 34
    
35.
Cho J, Kim ES, Kim SJ, Lee YJ, Park JS, Cho YJ, et al. Long-Term Follow-up of Small Pulmonary Ground-Glass Nodules Stable for 3 Years: Implications of the Proper Follow-up Period and Risk Factors for Subsequent Growth. J Thorac Oncol 2016;11:1453-9.  Back to cited text no. 35
    
36.
Gould NS, Min E, Huang J, Chu HW, Good J, Martin RJ, et al. Glutathione depletion accelerates cigarette smoke- induced inflammation and airspace enlargement. Toxicol Sci 2015;147:466-74.  Back to cited text no. 36
    
37.
Xin Wang, Xu Y, Du Z, Qin Y, Xu Z, Shi M, et al. [CT imaging features of isolated pulmonary nodules and the establishment of the benign and malignant prediction model]. Zhonghua Zhong Liu Za Zhi (in Chinese) 2018;40:115-20. Chinese.  Back to cited text no. 37
    
38.
Hertzanu Y, Ye X. Computed tomography-guided percutaneous microwave ablation: A new weapon to treat ground-glass opacity-lung adenocarcinoma. J Cancer Res Ther 2019;15:265-6.  Back to cited text no. 38
    
39.
Yang X, Ye X, Lin Z, Jin Y, Zhang K, Dong Y, et al. Computed tomography-guided percutaneous microwave ablation for treatment of peripheral ground-glass opacity-lung adenocarcinoma: A pilot study. J Cancer Res Ther 2018;14:764-71.  Back to cited text no. 39
    
40.
Xue G, Li Z, Wang G, Wei Z, Ye X. Computed tomography-guided percutaneous microwave ablation for pulmonary multiple ground-glass opacities. J Cancer Res Ther 2021;17:811-3.  Back to cited text no. 40
    
41.
Huang G, Yang X, Li W, Wang J, Han X, Wei Z, et al. A feasibility and safety study of computed tomography-guided percutaneous microwave ablation: A novel therapy for multiple synchronous ground-glass opacities of the lung. Int J Hyperthermia 2020;37:414-22.  Back to cited text no. 41
    
42.
Iezzi R. Thermal ablation for pulmonary subsolid nodules: Which consensus guidelines? which future perspectives? J Cancer Res Ther 2021;17:1593-5.  Back to cited text no. 42
    


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