The long-term course of subsolid nodules and predictors of interval growth on chest CT: a systematic review and meta-analysis

Objectives To calculate the pooled incidence of interval growth after long-term follow-up and identify predictors of interval growth in subsolid nodules (SSNs) on chest CT. Methods A search of MEDLINE (PubMed), Cochrane Library, Web of Science Core Collection, and Embase was performed on November 08, 2021, for relevant studies. Patient information, CT scanner, and SSN follow-up information were extracted from each included study. A random-effects model was applied along with subgroup and meta-regression analyses. Study quality was assessed by the Newcastle-Ottawa scale, and publication bias was assessed by Egger's test. Results Of the 6802 retrieved articles, 16 articles were included and analyzed, providing a total of 2898 available SSNs. The pooled incidence of growth in the 2898 SSNs was 22% (95% confidence interval [CI], 15-29%). The pooled incidence of growth in the subgroup analysis of pure ground-glass nodules was 26% (95% CI: 12-39%). The incidence of SSN growth after 2 or more years of stability was only 5% (95% CI: 3-7%). An initially large SSN size was found to be the most frequent risk factor affecting the incidence of SSN growth and the time of growth. Conclusions The pooled incidence of SSN growth was as high as 22%, with a 26% incidence reported for pure ground-glass nodules. Although the incidence of growth was only 5% after 2 or more years of stability, long-term follow-up is needed in certain cases. Moreover, the initial size of the SSN was the most frequent risk factor for growth.

Automated summary

The pooled incidence of interval growth in subsolid nodules (SSNs) after long-term follow-up was 22%, with a 26% incidence reported for pure ground-glass nodules. Although the growth incidence was only 5% after 2 or more years of stability, long-term follow-up is still necessary in certain cases. Moreover, the initial size of the SSN was identified as the most frequent risk factor for growth.