New and growing nodules are strongly associated with malignancy in follow-up screens for lung cancer: a cohort study.
[BACKGROUND] Pulmonary nodules are frequently detected on low dose computed tomography (LDCT) screening for lung cancer, though the majority are benign.
- p-value p<0.0001
- OR 3.9
APA
Long KJ, Ward R, et al. (2026). New and growing nodules are strongly associated with malignancy in follow-up screens for lung cancer: a cohort study.. Chest. https://doi.org/10.1016/j.chest.2026.01.030
MLA
Long KJ, et al.. "New and growing nodules are strongly associated with malignancy in follow-up screens for lung cancer: a cohort study.." Chest, 2026.
PMID
41850482
Abstract
[BACKGROUND] Pulmonary nodules are frequently detected on low dose computed tomography (LDCT) screening for lung cancer, though the majority are benign. Nodules detected on follow-up scans may be new or show interval growth since baseline.
[RESEARCH QUESTION] What is the risk of malignancy among new or growing nodules detected on follow up screening CT scans?
[STUDY DESIGN AND METHODS] Subjects in the LDCT screening arm of the National Lung Cancer Screening Trial (NLST) with a baseline screen and at least one follow-up screen were included. The primary exposure of interest was nodules that were new or growing on the first (T1) follow-up LDCT. Other covariates included age, sex, family history of lung cancer, presence of emphysema, nodule size, attenuation, lobe location and spiculation. The primary outcome was lung cancer diagnosis within 2 years of T1.
[RESULTS] Among 24,604 participants with baseline and T1 follow-up LDCT, 6,952 had nodules present during the first round of follow-up screening from which lung cancer was diagnosed within 2 years in 208 participants. Compared to pre-existing nodules with no growth, new nodules were associated with nearly 4-fold greater odds of lung cancer within 2 years (OR: 3.9, 95% CI: 2.51, 6.05, p<0.0001); pre-existing nodules with growth were associated with nearly 20-fold increased odds (OR: 19.7, 95% CI: 13.6, 28.4, p<0.0001).
[INTERPRETATION] New and growing nodules detected on follow-up LDCT are strongly associated with the risk of malignancy. The magnitude of these risks is substantially greater than for most other well-established risk factors.
[RESEARCH QUESTION] What is the risk of malignancy among new or growing nodules detected on follow up screening CT scans?
[STUDY DESIGN AND METHODS] Subjects in the LDCT screening arm of the National Lung Cancer Screening Trial (NLST) with a baseline screen and at least one follow-up screen were included. The primary exposure of interest was nodules that were new or growing on the first (T1) follow-up LDCT. Other covariates included age, sex, family history of lung cancer, presence of emphysema, nodule size, attenuation, lobe location and spiculation. The primary outcome was lung cancer diagnosis within 2 years of T1.
[RESULTS] Among 24,604 participants with baseline and T1 follow-up LDCT, 6,952 had nodules present during the first round of follow-up screening from which lung cancer was diagnosed within 2 years in 208 participants. Compared to pre-existing nodules with no growth, new nodules were associated with nearly 4-fold greater odds of lung cancer within 2 years (OR: 3.9, 95% CI: 2.51, 6.05, p<0.0001); pre-existing nodules with growth were associated with nearly 20-fold increased odds (OR: 19.7, 95% CI: 13.6, 28.4, p<0.0001).
[INTERPRETATION] New and growing nodules detected on follow-up LDCT are strongly associated with the risk of malignancy. The magnitude of these risks is substantially greater than for most other well-established risk factors.