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Background <p>Pulmonary subsolid nodules (SSNs) represent a heterogeneous spectrum, ranging from common benign conditions to malignancies with variable growth patterns. Standardized management criteria for SSNs remain unclear, and therapeutic decisions often need to be individualized. This study aims to identify indicators for invasiveness that may guide optimal treatment decisions.</p> Methods <p>This retrospective study analyzed 92 SSNs from 86 patients who underwent surgery between 2012 and 2022. Clinical data were obtained from the hospital database, and computed tomography (CT) scans, positron emission tomography (PET)/CT images, and histopathological sections were independently re-evaluated regardless of the original reports.</p> Results <p>The mean age was 61 ± 10 years; 53.5% were female, 73.5% had a history of smoking, and 47% had a prior malignancy. Preoperative CT revealed 27 pure ground-glass nodules (pGGNs), 61 part-solid nodules (PSNs), and 4 solid nodules that had initially appeared subsolid on CT. Invasive adenocarcinoma (IA) was more frequent in PSNs than in pGGNs (64% vs. 37%; p = 0.019). In pGGNs, a coronal long-axis diameter &gt; 12 mm, and in PSNs, a solid component diameter ≥ 7 mm (measured in the lung window), predicted IA with sensitivities of 70% and 71.8%, respectively. Metabolic parameters, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were also effective predictors of IA in SSNs. Additionally, specific radiological features, such as irregular shape, air bubbles or cystic components, vascular signs, and pleural retraction were associated with invasiveness.</p> Conclusion <p>A coronal long-axis diameter &gt; 12 mm in pGGNs, a solid component diameter ≥ 7 mm in PSNs, and metabolic parameters including MTV and TLG in SSNs were strong indicators of invasiveness, which represents the most critical factor guiding treatment decisions.</p>

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Morphologic and metabolic indicators of invasiveness in subsolid pulmonary nodules

  • 期刊论文

  • 发表日期：

    2026年2月21日

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  • Ulkar Ismayilova,
  • Rashad Ismayilov,
  • Olcay Kurtulan,
  • Gamze Durhan,
  • Oguz Kodaz,
  • Gursan Kaya,
  • Serkan Uysal,
  • Ulas Kumbasar,
  • Erkan Dikmen,
  • Riza Dogan,
  • Omer Ugur,
  • Meltem Gulsun Akpinar,
  • Figen Demirkazik,
  • Sevgen Celik Onder,
  • Sevinc Sarinc,
  • Deniz Koksal

摘要

Background

Pulmonary subsolid nodules (SSNs) represent a heterogeneous spectrum, ranging from common benign conditions to malignancies with variable growth patterns. Standardized management criteria for SSNs remain unclear, and therapeutic decisions often need to be individualized. This study aims to identify indicators for invasiveness that may guide optimal treatment decisions.

Methods

This retrospective study analyzed 92 SSNs from 86 patients who underwent surgery between 2012 and 2022. Clinical data were obtained from the hospital database, and computed tomography (CT) scans, positron emission tomography (PET)/CT images, and histopathological sections were independently re-evaluated regardless of the original reports.

Results

The mean age was 61 ± 10 years; 53.5% were female, 73.5% had a history of smoking, and 47% had a prior malignancy. Preoperative CT revealed 27 pure ground-glass nodules (pGGNs), 61 part-solid nodules (PSNs), and 4 solid nodules that had initially appeared subsolid on CT. Invasive adenocarcinoma (IA) was more frequent in PSNs than in pGGNs (64% vs. 37%; p = 0.019). In pGGNs, a coronal long-axis diameter > 12 mm, and in PSNs, a solid component diameter ≥ 7 mm (measured in the lung window), predicted IA with sensitivities of 70% and 71.8%, respectively. Metabolic parameters, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were also effective predictors of IA in SSNs. Additionally, specific radiological features, such as irregular shape, air bubbles or cystic components, vascular signs, and pleural retraction were associated with invasiveness.

Conclusion

A coronal long-axis diameter > 12 mm in pGGNs, a solid component diameter ≥ 7 mm in PSNs, and metabolic parameters including MTV and TLG in SSNs were strong indicators of invasiveness, which represents the most critical factor guiding treatment decisions.