Risk of Malignancy in Incidentally Detected Lung Nodules in Patients Aged Younger Than 35 Years.

The risk of malignancy in pulmonary nodules incidentally detected on computed tomography (CT) in patients who are aged younger than 35 years is unclear. The aim of this study was to evaluate the incidence of lung cancer in incidental pulmonary nodules in patients who are 15-34 years old. This retrospective study included patients aged 15-34 years who had an incidental pulmonary nodule on chest CT from 2010 to 2018 at our hospital. Patients with prior, current, or suspected malignancy were excluded. A chart review identified patients with diagnosis of malignancy. Incidental pulmonary nodule was deemed benign if stable or resolved on a follow-up CT at least 2 years after initial or if there was a medical visit in our health care network at least 2 years after initial CT without diagnosis of malignancy.Receiver operating characteristic curve analysis was performed with nodule size. Association of categorical variables with lung cancer diagnosis was performed with Fisher exact test, and association of continuous variables was performed with logistic regression. Five thousand three hundred fifty-five chest CTs performed on patients aged 15-34 years between January 2010 and December 2018. After excluding patients without a reported pulmonary nodule and prior or current malignancy, there were a total of 779 patients. Of these, 690 (89%) had clinical or imaging follow-up after initial imaging. Of these, 545 (70% of total patients) patients had imaging or clinical follow-up greater than 2 years after their initial imaging.A malignant diagnosis was established in 2/779 patients (0.3%; 95% confidence interval, 0.1%-0.9%). Nodule size was strongly associated with malignancy ( P = 0.007), with area under the receiver operating characteristic curve of 0.97. There were no malignant nodules that were less than 10 mm in size. Smoking history, number of nodules, and nodule density were not associated with malignancy. Risk of malignancy for incidentally detected pulmonary nodules in patients aged 15-34 years is extremely small (0.3%). There were no malignant nodules that were less than 10 mm in size. Routine follow-up of subcentimeter pulmonary nodules should be carefully weighed against the risks.

Byrne SC ，Peers C ，Gargan ML ，Lacson R ，Khorasani R ，Hammer MM ... -  《-》

Incidental Pulmonary Nodules: Differential Diagnosis and Clinical Management.

Baum P ，Schlamp K ，Klotz LV ，Eichhorn ME ，Herth F ，Winter H ... -  《Deutsches Arzteblatt International》

Mortality impact, risks, and benefits of general population screening for ovarian cancer: the UKCTOCS randomised controlled trial.

Menon U ，Gentry-Maharaj A ，Burnell M ，Ryan A ，Kalsi JK ，Singh N ，Dawnay A ，Fallowfield L ，McGuire AJ ，Campbell S ，Skates SJ ，Parmar M ，Jacobs IJ ... -  《-》

Defining the optimum strategy for identifying adults and children with coeliac disease: systematic review and economic modelling.

Elwenspoek MM ，Thom H ，Sheppard AL ，Keeney E ，O'Donnell R ，Jackson J ，Roadevin C ，Dawson S ，Lane D ，Stubbs J ，Everitt H ，Watson JC ，Hay AD ，Gillett P ，Robins G ，Jones HE ，Mallett S ，Whiting PF ... -  《-》

ACPA is a main risk factor for CT-proven pulmonary nodule progression in patients with rheumatoid arthritis.

To determine the features of rheumatoid pulmonary nodules and the factors associated with nodule progression in patients with rheumatoid arthritis. Between January 2010 and September 2018, RA patients with at least one chest computed tomography (CT) were included. Two experienced radiologists examined chest CTs. Nodules with changing dimensions on follow-up or at least two nodules with different sizes or cavitary nodules were considered rheumatoid pulmonary nodules. To identify follow-up changes in the nodules, progression was defined as the appearance of any new nodules or increase in the size of the nodules, regression was no new nodules and no increase in the size of any nodules and decrease in the size of at least one nodule, and stability was no appearance of new nodules and no change in the size of nodules and no disappearance of the nodule. We compared the demographics, comorbidities, RA-specific treatments, and nodule characteristics according to seropositivity. Factors that may be associated with RPN progression were studied. A total of 204 (136 (66.7%) female) patients were included in the study. The median disease duration at baseline CT was 7.29 years (0.05-57.5). Pulmonary nodules were detected in the first CT of 21 (10.2%) patients before RA diagnosis, with a median time of 10.38 (0.46-254) months. The median number of nodules and median diameter of the dominant nodule were higher, and cavitation was more prevalent in seropositive patients. ACPA positivity was independently associated with progression (OR 3.69 (1.33-12.4), p = 0.03). Cs-DMARDs and b/ts-DMARDs, especially anti-TNF agents, did not affect nodule progression. Rheumatoid pulmonary nodules may precede RA, and seropositivity, especially ACPA, is an important independent risk factor for RPN occurrence and progression. Key Points • Rheumatoid pulmonary nodules were mainly located peripherally, in the right lobe, and had a high cavitation rate. • ACPA positivity was found as a main effective factor in RPN progression. • Cs/b-DMARD treatments were not associated with RPN progression.

Uzun GS ，Sarıkaya Y ，Arslan S ，Ekici M ，Ata EB ，Karcıoğlu O ，Bilgin E ，Kılıç L ，Kiraz S ，Ertenli Aİ ，Arıyürek M ，Kalyoncu U ... -  《-》