Long‐term follow‐up of persistent pulmonary subsolid nodules: Natural course of pure, heterogeneous, and real part‐solid ground‐glass nodules

BACKGROUND: Previous studies have suggested the applicability of three classifications of subsolid nodules (SSNs). However, few studies have unraveled the natural history of the three types of SSNs. METHODS: A retrospective study from two medical centers between November 2007 and November 2017 was conducted to explore the long‐term follow‐up results of three different types of SSNs, which were divided into pure ground‐glass nodules (pGGNs), heterogeneous ground‐glass nodules (hGGNs), and real part‐solid nodules (rPSNs). RESULTS: A total of 306 consecutive patients, including 361 SSNs with long‐term follow‐up, were reviewed. The median growth times of pGGNs, hGGNs, and rPSNs were 7.7, 6.0, and 2.0 years, respectively. For pGGNs, the median period of development into rPSNs was 4.6 years, while that of hGGNs was 1.8 years, and the time from pGGNs to hGGNs was 3.1 years (p < 0.05). In SSNs with an initial lung window consolidation tumor ratio (LW‐CTR) >0.5 and mediastinum window (MW)‐CTR >0.2, all cases with growth were identified within 5 years. Meanwhile, in SSNs whose LW‐CTR and MW‐CTR were 0, it took over 5 years to detect nodular growth. Pathologically, 90.6% of initial SSNs with LW‐CTR >0 were invasive carcinomas (invasive adenocarcinoma and micro‐invasive adenocarcinoma). Among patients with rPSNs in the initial state, 100.0% of the final pathological results were invasive carcinoma. Cox regression showed that age (p = 0.038), initial maximal diameter (p < 0.001), and LW‐CTR (p = 0.002) were independent risk factors for SSN growth. CONCLUSIONS: pGGNs, hGGNs, and rPSNs have significantly different natural histories. Age, initial nodule diameter, and LW‐CTR are important risk factors for SSN growth.