Lung Nodule Management in Low-Dose CT Screening for Lung Cancer: Lessons from the NELSON Trial

Danrong Zhong; Grigory Sidorenkov; Colin Jacobs; Pim A de Jong; Hester A Gietema; Ralph Stadhouders; Kristiaan Nackaerts; Joachim G Aerts; Mathias Prokop; Harry J M Groen; Geertruida H de Bock; Rozemarijn Vliegenthart; Marjolein A Heuvelmans

doi:10.1148/radiol.240535

Lung Nodule Management in Low-Dose CT Screening for Lung Cancer: Lessons from the NELSON Trial

Radiology. 2024 Oct;313(1):e240535. doi: 10.1148/radiol.240535.

Affiliation

¹ From the Departments of Epidemiology (D.Z., G.S., G.H.d.B., M.A.H.), Radiology (G.S., M.P., R.V.), and Pulmonary Disease (H.J.M.G.), University of Groningen, University Medical Center Groningen, Hanzeplein 1, Postbus 30.001, 9700RB Groningen, the Netherlands; Department of Medical Imaging, Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, the Netherlands (C.J., M.P.); Department of Radiology, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands (P.A.d.J.); Department of Radiology and Nuclear Medicine, Maastricht University, Maastricht University Medical Center, Maastricht, the Netherlands (H.A.G.); GROW School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands (H.A.G.); Department of Pulmonary Medicine, University of Rotterdam, University Medical Center Rotterdam, Rotterdam, the Netherlands (R.S., J.G.A.); Department of Respiratory Oncology, University Hospitals Leuven, Leuven, Belgium (K.N.); Institute for Diagnostic Accuracy, Groningen, the Netherlands (M.A.H.); and Department of Respiratory Medicine, Amsterdam University Medical Center, Amsterdam, the Netherlands (M.A.H.).

^# Contributed equally.

PMID: 39436294
DOI: 10.1148/radiol.240535

Abstract

Screening with low-dose CT (LDCT) in a high-risk population, as defined by age and smoking behavior, reduces lung cancer-related mortality. However, LDCT screening presents a major challenge. Numerous, mostly benign, nodules are seen in the lungs during screening. The question is how to distinguish the malignant from the benign nodules. Various studies use different protocols for nodule management. The Dutch-Belgian NELSON (Nederlands-Leuvens Longkanker Screenings Onderzoek) trial, the largest European lung cancer screening trial, used distinctions based on nodule volumetric assessment and growth rate. This review discusses key findings from the NELSON study regarding the characteristics of screening-detected nodules, including nodule size and its volumetric assessment, growth rate, subtype, and their associated malignancy risk. These results are compared with findings from other screening studies and current recommendations for lung nodule management. By examining differences in nodule management strategies and providing a comprehensive overview of outcomes specific to lung cancer screening, this review aims to contribute to the broader discussion on optimizing lung nodule management in screening programs.

Publication types

Review

MeSH terms

Early Detection of Cancer* / methods
Humans
Lung / diagnostic imaging
Lung Neoplasms* / diagnostic imaging
Mass Screening / methods
Radiation Dosage*
Solitary Pulmonary Nodule* / diagnostic imaging
Tomography, X-Ray Computed* / methods