Risk factors for growth of small solid pulmonary nodules: a single-center retrospective case-control study.
- 1Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Abstract
Current clinical guidelines recommend conservative surveillance for 3-6 mm small solid pulmonary nodules (PNs), which may overlook a high-growth-risk subgroup. This study aimed to investigate independent risk factors for volume growth of small solid PNs and identify high-growth-risk subgroups. This single-center retrospective case-control study enrolled patients with solid PNs (3 to <6 mm) who underwent chest computed tomography (CT) between January 2010 and December 2025. The growth group included nodules with volume increase >25% during follow-up; the stable group included nodules with volume change ≤25% over ≥5 years. Clinical characteristics and CT features were compared. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for growth. Receiver operating characteristic (ROC) curves were plotted to evaluate the discriminatory ability of the multivariate regression model. A total of 175 patients were included, with 83 in the growth group and 92 in the stable group. Multivariate logistic regression identified coexistent emphysema [odds ratio (OR) =5.45, 95% confidence interval (CI): 1.37-21.68, P=0.02], irregular shape (OR =3.05, 95% CI: 1.26-7.40, P=0.01), and pleural retraction (OR =4.99, 95% CI: 1.20-20.82, P=0.03) as independent risk factors for nodule growth. ROC curve analysis showed that the multivariate model achieved acceptable discriminatory performance with an area under the curve (AUC) of 0.80 (95% CI: 0.73-0.87). Among growth group cases, the median volume doubling time (VDT) was 364 days [interquartile range (IQR): 172-1,002 days]. Among the 28 nodules that underwent resection or biopsy, 75.0% (21/28) were malignant, whereas the remaining 25.0% (7/28) were benign. Emphysema, irregular shape, and pleural retraction are independent risk factors for growth in small solid PNs. Shortened CT surveillance intervals may be considered for patients with these high-risk signs. Given the single-center retrospective design without external validation, prospective multicenter verification is required for validation of this strategy.
Related
- Preoperative fractional exhaled nitric oxide in differentiating pulmonary nodules and pathological examination of non-small cell lung cancer: a retrospective cohort study
- Intraoperative model-guided anchor placement with CT verification for non-percutaneous localization of small pulmonary nodules: a retrospective feasibility study
- Factors associated with treatment response to microwave ablation of benign thyroid nodules: a retrospective single-center study of nodule composition and vascularity
- Pulmonary sclerosing pneumocytoma demonstrated heterogeneous tumor growth rate on serial CT: a retrospective cohort study
- Factors Influencing the Treatment Response of Tetracyclines for Papulopustular Rash Induced by Epidermal Growth Factor Receptor-Tyrosine Kinase Inhibitors: A Retrospective Study.
BibTeX
@article{duan2026risk,
title = {{Risk factors for growth of small solid pulmonary nodules: a single-center retrospective case-control study.}},
author = {Ya-Ni Duan and Xue Lin and Jun-Zhe Wen and Yan-Qiu Zhu and Xiu-Zhen Chen and Zhi-Ying Yan and Yue-Fei Guo and Jie Qin},
journal = {Quantitative imaging in medicine and surgery},
year = {2026},
month = sep,
doi = {10.21037/qims-2026-1165},
url = {https://europepmc.org/article/MED/42997774},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Risk factors for growth of small solid pulmonary nodules: a single-center retrospective case-control study.
AU - Ya-Ni Duan
AU - Xue Lin
AU - Jun-Zhe Wen
AU - Yan-Qiu Zhu
AU - Xiu-Zhen Chen
AU - Zhi-Ying Yan
AU - Yue-Fei Guo
AU - Jie Qin
PY - 2026
DA - 2026/09/30
JO - Quantitative imaging in medicine and surgery
DO - 10.21037/qims-2026-1165
UR - https://europepmc.org/article/MED/42997774
AB - Current clinical guidelines recommend conservative surveillance for 3-6 mm small solid pulmonary nodules (PNs), which may overlook a high-growth-risk subgroup. This study aimed to investigate independent risk factors for volume growth of small solid PNs and identify high-growth-risk subgroups. This single-center retrospective case-control study enrolled patients with solid PNs (3 to <6 mm) who underwent chest computed tomography (CT) between January 2010 and December 2025. The growth group included nodules with volume increase >25% during follow-up; the stable group included nodules with volume change ≤25% over ≥5 years. Clinical characteristics and CT features were compared. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for growth. Receiver operating characteristic (ROC) curves were plotted to evaluate the discriminatory ability of the multivariate regression model. A total of 175 patients were included, with 83 in the growth group and 92 in the stable group. Multivariate logistic regression identified coexistent emphysema [odds ratio (OR) =5.45, 95% confidence interval (CI): 1.37-21.68, P=0.02], irregular shape (OR =3.05, 95% CI: 1.26-7.40, P=0.01), and pleural retraction (OR =4.99, 95% CI: 1.20-20.82, P=0.03) as independent risk factors for nodule growth. ROC curve analysis showed that the multivariate model achieved acceptable discriminatory performance with an area under the curve (AUC) of 0.80 (95% CI: 0.73-0.87). Among growth group cases, the median volume doubling time (VDT) was 364 days [interquartile range (IQR): 172-1,002 days]. Among the 28 nodules that underwent resection or biopsy, 75.0% (21/28) were malignant, whereas the remaining 25.0% (7/28) were benign. Emphysema, irregular shape, and pleural retraction are independent risk factors for growth in small solid PNs. Shortened CT surveillance intervals may be considered for patients with these high-risk signs. Given the single-center retrospective design without external validation, prospective multicenter verification is required for validation of this strategy.
SN - 2223-4292
SN - 2223-4306
ER -