Abstract
OBJECTIVE: To investigate the incidence and timing of late growth of subsolid nodules (SSNs) ≥6 mm after initial 5-year stability, its clinical implications, and the appropriate follow-up strategy. MATERIALS AND METHODS: This retrospective study included SSNs ≥6 mm that remained stable for the initial five years after detection. The incidence and timing of subsequent growth after five years of stability were analyzed using the Kaplan-Meier method. Descriptive analyses were conducted to evaluate the clinical stage shift in the SSNs, showing growth and the presence of metastasis during the follow-up period. Finally, an effective follow-up CT scan strategy for managing SSNs after a 5-year period of stability was investigated. RESULTS: Two hundred thirty-five eligible SSNs (211 pure ground-glass and 24 part-solid nodules) in 235 patients (median age, 63 years; 132 female) were followed for additional <1 to 181 months (median, 87.0 months; interquartile range [IQR], 47.0-119.0 months) after 5-year stability. Fourteen SSNs (6.0%) showed growth at two to 145 months (median, 96 months; IQR: 43.0-122.25 months) from the CT scan confirming 5-year stability, with the estimated cumulative incidence of growth of 0.4%, 2.1%, and 6.5% at 1, 5, and 10 years, respectively. Nine SSNs (3.8%) exhibited clinical stage shifts. No lung cancer metastases were observed. Hypothetical follow-up CT scans performed at 5, 10, and 15 years after 5-years of stability, would have detected 5 (36%), 11 (79%), and 14 (100%) of the 14 growing SSNs, along with 4 (44%), 8 (89%), and 9 (100%) of the nine stage shifts, respectively. CONCLUSION: During a long-term follow-up of pulmonary SSNs ≥6 mm after 5-years of stability, a low incidence of growth without occurrence of metastasis was noted. CT scans every five years after the initial 5-year stability period may be reasonable.