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Small Pulmonary Nodules on CT Accompanying Surgically Resectable Lung Cancer: Likelihood of Malignancy

Kim, Young Han M.D.; Lee, Kyung Soo M.D.; Primack, Steven L. M.D.; Kim, Hojoong M.D.; Kwon, O. Jung M.D.; Kim, Tae Sung M.D.; Kim, Eun A. M.D.; Kim, Jhingook M.D.; Shim, Young Mog M.D.

Original Articles

The aim of this study was to determine the likelihood of malignancy in small nodules in the nonprimary lobe in patients with resectable bronchogenic carcinoma. In 141 patients who underwent curative resection of bronchogenic carcinoma and had adequate follow-up CT examinations, the presence of small nodules in the nonprimary lobe preoperatively and change of preexisting nodules, if any, was assessed. The criteria used to determine benignity of a nodule was stability or decrease in size for 24 months on CT. Histopathology of the nodules was reviewed for an additional 10 patients who underwent surgical biopsy for an accompanying nodule before curative surgery. Sixty-two (44%) of 141 patients had a total of 138 small (≤ 10 mm) nodules in the nonprimary lobes (< 5 mm in 113, 5–10 mm in 25). Of these 138 nodules, 132 were benign with only six nodules malignant (with histopathologic confirmation for the enlarging nodules). The 132 benign nodules showed no change (n = 120), decrease in size (n = 11), or increase in size (n = 1) on follow-up studies, with the single enlarging nodule proved benign on biopsy. In 10 patients who had a preoperative biopsy of a single preexisting nodule in the nonprimary lobe (< 5 mm = 1; 5–10 mm = 5; > 10 mm = 4) two proved to be malignant (both > 10 mm) and eight were benign. Most small (< 10 mm) nodules associated with resectable bronchogenic carcinoma are benign, consistent with published results of other studies. However, a small number of nodules are malignant and CT does not reliably distinguish between benign and malignant nodules.

From the Department of Radiology (Y.H.K., K.S.L., T.S.K., E.A.K.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; the Department of Radiology (S.L.P.), Oregon Health Sciences University, Portland, OR; the Division of Pulmonary and Critical Care Medicine (H.K., O.J.K.), the Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; and the Department of Thoracic Surgery (J.K., Y.M.S), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

The study was presented in the scientific assemblies of RSNA 2000 and STR 2001.

Address correspondence and reprint requests to Kyung Soo Lee, M.D., Department of Radiology, Samsung Medical Center Sungkyunkwan University School of Medicine 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea; e-mail:

© 2002 Lippincott Williams & Wilkins, Inc.