Surveillance of subsolid nodules avoids unnecessary resections in lung cancer screening: Long-term results of the prospective BioMILD trial

BackgroundThe management of sub-solid nodules (SSNs) in lung cancer screening (LCS) is still a topic of debate, with no current uniform strategy to deal with these lesions at risk of overdiagnosis and overtreatment.ObjectiveThe BioMILD LCS trial has implemented a prospective conservative approach for SSNs, managing with annual low-dose CT nonsolid nodules (NSNs) and part-solid nodules (PSNs) with a solid component <5 mm, regardless of the size of the nonsolid component. The present study aims to determine the lung cancer (LC) detection and survival in BioMILD volunteers with SSNs.Materials and methodsEligible participants were 758 out of 4071 (18.6%) BioMILD volunteers without baseline LC and at least one SSN detected at the baseline or further LDCT rounds. The outcomes of the study were LC detection and long-term survival.ResultsA total of 844 NSNs and 241 PSNs were included. LC detection was 3.7% (31/844) in NSNs and 7.1% (17/241) in PSNs, being significantly greater in prevalent than incident nodules (8.4%versus1.3% in NSNs; 14.1%versus2.1% in PSNs; p-value for both nodule types<0.01). Most LCs from SSNs were stage I (42/48, 87.5%), resectable (47/48, 97.9%), and caused no deaths. The 8-year cumulative survival of volunteers with LC derived from SSNs and not derived from SSNs was 93.8% and 74.9%, respectively.ConclusionConservative management of SSNs in LCS enables timely diagnosis and treatment of LCs arising from SSNs while ensuring the resection of more aggressive LCs detected away from SSNs.