3 years ago

Incidental perifissural nodules on routine chest computed tomography: lung cancer or not?

Pim A. de Jong, Wouter B. Veldhuis, Kaman Chung, Onno M. Mets, Bram van Ginneken, Ernst Th. Scholten, Cornelia M. Schaefer-Prokop, M. Prokop



Perifissural nodules (PFNs) are a common finding on chest CT, and are thought to represent non-malignant lesions. However, data outside a lung cancer-screening setting are currently lacking.


In a nested case-control design, out of a total cohort of 16,850 patients ≥ 40 years of age who underwent routine chest CT (2004-2012), 186 eligible subjects with incident lung cancer and 511 controls without were investigated. All non-calcified nodules ≥ 4 mm were semi-automatically annotated. Lung cancer location and subject characteristics were recorded.


Cases (56 % male) had a median age of 64 years (IQR 59–70). Controls (60 % male) were slightly younger (p<0.01), median age of 61 years (IQR 51–70). A total of 262/1,278 (21 %) unique non-calcified nodules represented a PFN. None of these were traced to a lung malignancy over a median follow-up of around 4.5 years. PFNs were most often located in the lower lung zones (72 %, p<0.001). Median diameter was 4.6 mm (range: 4.0–8.1), volume 51 mm3 (range: 32–278). Some showed growth rates < 400 days.


Our data show that incidental PFNs do not represent lung cancer in a routine care, heterogeneous population. This confirms prior screening-based results.

Key Points

One-fifth of non-calcified nodules represented a perifissural nodule in our non-screening population.

PFNs fairly often show larger size, and can show interval growth.

When morphologically resembling a PFN, nodules are nearly certainly not a malignancy.

The assumed benign aetiology of PFNs seems valid outside the screening setting.

Publisher URL: https://link.springer.com/article/10.1007/s00330-017-5055-x

DOI: 10.1007/s00330-017-5055-x

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