open access

Vol 77, No 1 (2009)
ORIGINAL PAPERS
Published online: 2008-12-19
Submitted: 2013-02-22
Get Citation

Analysis of solitary pulmonary nodules found in chest radiograms

Marta Dąbrowska, Anna Kolasa, Małgorzata Żukowska, Jan Lesiński, Joanna Domagała-Kulawik, Marta Maskey-Warzęchowska, Rafał Krenke, Olgierd Rowiński, Ryszarda Chazan
Pneumonol Alergol Pol 2009;77(1):37-42.

open access

Vol 77, No 1 (2009)
ORIGINAL PAPERS
Published online: 2008-12-19
Submitted: 2013-02-22

Abstract


Introduction: The detection of solitary pulmonary nodules (SPNs) has increased due to widespread use of computed tomography; nevertheless, chest radiographs still remain the basic routine examination. The aim of the study was to estimate the detection of SPNs in routine chest X-rays in hospitalized patients and to assess the incidence of malignancy in newly diagnosed SPNs.
Material and methods: We analyzed 5726 routine chest radiographs of patients admitted to the Department of Internal Diseases, Pneumology and Allergology in 2004 and 2005. Most of the patients were admitted to hospital due to emergency reasons. The malignant nature of the nodules was confirmed by pathological examination. The nature of benign nodules was confirmed either by pathological examination or based on radiological criteria: no growth within 2 years of radiological follow up, regression in control radiograms or CT scans, benign pattern of calcification.
Results: Among the 5726 radiograms we found 116 newly diagnosed SPNs (2.2%). Twenty-four nodules (21%) were malignant: NSCLC in 21 cases and metastases in 3 cases. Fifty-one nodules (44%) were benign. In 19 patients (16%) SPNs proved to be artefacts or erroneously interpreted extrathoracic lesions. In 22 cases (19%) there was no final diagnosis (lack of data, diagnostic procedure renunciation).
Conclusion: The incidence of newly detected SPNs in chest X-rays was 2.2%. Most SPNs were benign. About 21% of SPNs were diagnosed as malignant.

Abstract


Introduction: The detection of solitary pulmonary nodules (SPNs) has increased due to widespread use of computed tomography; nevertheless, chest radiographs still remain the basic routine examination. The aim of the study was to estimate the detection of SPNs in routine chest X-rays in hospitalized patients and to assess the incidence of malignancy in newly diagnosed SPNs.
Material and methods: We analyzed 5726 routine chest radiographs of patients admitted to the Department of Internal Diseases, Pneumology and Allergology in 2004 and 2005. Most of the patients were admitted to hospital due to emergency reasons. The malignant nature of the nodules was confirmed by pathological examination. The nature of benign nodules was confirmed either by pathological examination or based on radiological criteria: no growth within 2 years of radiological follow up, regression in control radiograms or CT scans, benign pattern of calcification.
Results: Among the 5726 radiograms we found 116 newly diagnosed SPNs (2.2%). Twenty-four nodules (21%) were malignant: NSCLC in 21 cases and metastases in 3 cases. Fifty-one nodules (44%) were benign. In 19 patients (16%) SPNs proved to be artefacts or erroneously interpreted extrathoracic lesions. In 22 cases (19%) there was no final diagnosis (lack of data, diagnostic procedure renunciation).
Conclusion: The incidence of newly detected SPNs in chest X-rays was 2.2%. Most SPNs were benign. About 21% of SPNs were diagnosed as malignant.
Get Citation

Keywords

solitary pulmonary nodule; chest X-ray; computed tomography of the chest; lung cancer

About this article
Title

Analysis of solitary pulmonary nodules found in chest radiograms

Journal

Advances in Respiratory Medicine

Issue

Vol 77, No 1 (2009)

Pages

37-42

Published online

2008-12-19

Bibliographic record

Pneumonol Alergol Pol 2009;77(1):37-42.

Keywords

solitary pulmonary nodule
chest X-ray
computed tomography of the chest
lung cancer

Authors

Marta Dąbrowska
Anna Kolasa
Małgorzata Żukowska
Jan Lesiński
Joanna Domagała-Kulawik
Marta Maskey-Warzęchowska
Rafał Krenke
Olgierd Rowiński
Ryszarda Chazan

References (36)
  1. Grzanka P, Bestry I. Badania obrazowe. Choroby układu oddechowego. In: Szczeklik A. ed. Choroby wewnętrzne. Medycyna Praktyczna, Kraków 2005: 481.
  2. Tan BB, Flaherty KR, Kazerooni EA, et al. American College of Chest Physicians. The solitary pulmonary nodule. Chest. 2003; 123(1 Suppl): 89S–96S.
  3. Jeong YJ, Yi CA, Lee KS. Solitary pulmonary nodules: detection, characterization, and guidance for further diagnostic workup and treatment. AJR Am J Roentgenol. 2007; 188(1): 57–68.
  4. Winer-Muram HT. The solitary pulmonary nodule. Radiology. 2006; 239(1): 34–49.
  5. Gould MK, Fletcher J, Iannettoni MD, et al. American College of Chest Physicians. Evaluation of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007; 132(3 Suppl): 108S–130S.
  6. Wahidi MM, Govert JA, Goudar RK, et al. American College of Chest Physicians. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007; 132(3 Suppl): 94S–107S.
  7. HOLIN SM, DWORK RE, GLASER S, et al. Solitary pulmonary nodules found in a community-wide chest roentgenographic survey; a five-year follow-up study. Am Rev Tuberc. 1959; 79(4): 427–439.
  8. COMSTOCK GW, VAUGHAN RH, MONTGOMERY G. Outcome of solitary pulmonary nodules discovered in an x-ray screening program. N Engl J Med. 1956; 254(22): 1018–1022.
  9. GOOD CA, WILSON TW. The solitary circumscribed pulmonary nodule; study of seven hundred five cases encountered roentgenologically in a period of three and one-half years. J Am Med Assoc. 1958; 166(3): 210–215.
  10. Swensen SJ, Silverstein MD, Edell ES, et al. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med. 1997; 157(8): 849–855.
  11. Kubík A, Polák J. Lung cancer detection. Results of a randomized prospective study in Czechoslovakia. Cancer. 1986; 57(12): 2427–2437.
  12. Fontana R, Sanderson D, Woolner L, et al. Lung Cancer Screening: The Mayo Program. Journal of Occupational and Environmental Medicine. 1986; 28(8): 746–750.
  13. Maskey-Warzęchowska M, Domagała-Kulawik J, Rubinsztajn R, et al. Występowanie raka płuca u chorych z POChP — analiza obrazu klinicznego. Pol Arch Med Wewn. 2002; 108: 769–775.
  14. Friedmann G, Bohndorf K, Krüger J. Radiology of pulmonary metastases: comparison of imaging techniques with operative findings. Thorac Cardiovasc Surg. 1986; 34 Spec No 2: 120–124.
  15. Goldmeier E. Limits of visibility of bronchogenic carcinoma. Am Rev Respir Dis. 1965; 91: 232–239.
  16. Austin JH, Romney BM, Goldsmith LS. Missed bronchogenic carcinoma: radiographic findings in 27 patients with a potentially resectable lesion evident in retrospect. Radiology. 1992; 182(1): 115–122.
  17. Tsubamoto M, Kuriyama K, Kido S, et al. Detection of lung cancer on chest radiographs: analysis on the basis of size and extent of ground-glass opacity at thin-section CT. Radiology. 2002; 224(1): 139–144.
  18. Bepler G, Goodridge Carney D, Djulbegovic B, et al. A systematic review and lessons learned from early lung cancer detection trials using low-dose computed tomography of the chest. Cancer Control. 2003; 10(4): 306–314.
  19. Wu N, Gamsu G, Czum J, et al. Detection of small pulmonary nodules using direct digital radiography and picture archiving and communication systems. J Thorac Imaging. 2006; 21(1): 27–31.
  20. Schilham AMR, van Ginneken B, Loog M. A computer-aided diagnosis system for detection of lung nodules in chest radiographs with an evaluation on a public database. Med Image Anal. 2006; 10(2): 247–258.
  21. Ogata Y, Naito H, Tomiyama N, et al. Evaluation of usefulness of color digital summation radiography for solitary pulmonary nodules on chest radiographs. Radiat Med. 2006; 24(5): 351–357.
  22. Kakeda S, Moriya J, Sato H, et al. Improved detection of lung nodules on chest radiographs using a commercial computer-aided diagnosis system. AJR Am J Roentgenol. 2004; 182(2): 505–510.
  23. Ketai L, Malby M, Jordan K, et al. Small nodules detected on chest radiography: does size predict calcification? Chest. 2000; 118(3): 610–614.
  24. Sone S, Li F, Yang ZG, et al. Results of three-year mass screening programme for lung cancer using mobile low-dose spiral computed tomography scanner. Br J Cancer. 2001; 84(1): 25–32.
  25. Henschke CI, McCauley DI, Yankelevitz DF, et al. Early Lung Cancer Action Project: overall design and findings from baseline screening. Lancet. 1999; 354(9173): 99–105.
  26. Diederich S, Thomas M, Semik M, et al. Screening for early lung cancer with low-dose spiral CT: prevalence in 817 asymptomatic smokers. Radiology. 2002; 222(3): 773–781.
  27. Swensen SJ, Jett JR, Sloan JA, et al. Screening for lung cancer with low-dose spiral computed tomography. Am J Respir Crit Care Med. 2002; 165(4): 508–513.
  28. Berger WG, Erly WK, Krupinski EA, et al. The solitary pulmonary nodule on chest radiography: can we really tell if the nodule is calcified? AJR Am J Roentgenol. 2001; 176(1): 201–204.
  29. Yankelevitz DF, Henschke CI. Does 2-year stability imply that pulmonary nodules are benign? AJR Am J Roentgenol. 1997; 168(2): 325–328.
  30. Prosch H, Strasser G, Oschatz E, et al. Management of patients with small pulmonary nodules: a survey of radiologists, pulmonologists, and thoracic surgeons. AJR Am J Roentgenol. 2006; 187(1): 143–148.
  31. Kowalewski J, Dancewicz M. Pojedynczy cień okrągły w płucu — ciągle aktualny problem diagnostyczny. Pneumonol Alergol Pol. 2005; 73: 198–201.
  32. Gould MK, Ananth L, Barnett PG, et al. Veterans Affairs SNAP Cooperative Study Group. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest. 2007; 131(2): 383–388.
  33. Gurney JW, Lyddon DM, McKay JA, et al. Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part I. Theory. Radiology. 1993; 186(2): 405–413.
  34. Swensen SJ, Viggiano RW, Midthun DE, et al. Lung nodule enhancement at CT: multicenter study. Radiology. 2000; 214(1): 73–80.
  35. Blum J, Handmaker H, Lister-James J, et al. A multicenter trial with a somatostatin analog (99m)Tc depreotide in the evaluation of solitary pulmonary nodules. Chest. 2000; 117(5): 1232–1238.
  36. Gould MK, Maclean CC, Kuschner WG, et al. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA. 2001; 285(7): 914–924.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl