Trajectories of pulmonary subsolid nodules in children and adolescents: a retrospective multicenter cohort study.
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OBJECTIVES: To investigate the clinical course of subsolid nodules (SSNs) in children and adolescents and explore risk factors associated with their progression. MATERIALS AND METHODS: This retrospective multicenter cohort investigation enrolled children and adolescents with incidental persistent SSNs between January 2010 and December 2024. The incidence of SSN progression, clinical characteristics, radiologic features, and survival status were assessed. Univariable and multivariable Cox regression analyses were used to identify potential risk factors for nodule growth and subsequent lung cancer diagnosis. RESULTS: Overall, 333 incidental persistent SSNs in 241 patients (100 females; median age, 17 years; median follow-up period, 34 months) were included in the final analysis. 35 of the 333 (10.5%) SSNs showed interval growth, including 32 pure ground-glass nodules (PGGNs) and three part-solid nodules (PSNs). 22 PGGNs and two PSNs exhibited an increase in nodule size. One PSN demonstrated an increase in solid components, and ten PGGNs showed a new small solid component. Among 21 surgically resected nodules, approximately 95% (20/21) were early-stage lung adenocarcinoma. There were no deaths or metastases during the follow-up period. PSN was a significant predictor of growth. PSN and ≥ 10 mm were significant predictive risk factors for subsequent lung cancer diagnosis. CONCLUSION: 10.5% of incidental persistent SSNs exhibit subsequent growth. The identified risk factors were predominantly related to varying SSN characteristics. Our findings underscore that the individualized risk-stratified management strategies-long-interval follow-up (2 years or longer) for PGGNs and short-interval follow-up (annual or shorter) for PSNs-should be recommended to guide appropriate clinical decision-making. KEY POINTS: QuestionDue to the lack of recommendations for SSNs in the pediatric population, clinicians and radiologists might inappropriately apply Fleischner guideline data to these patients. Findings10.5% of persistent SSNs in children and adolescents showed subsequent growth. PSNs are identified as an independent risk factor for predicting nodule growth. Clinical relevanceThe individualized risk-stratified management strategies should be recommended for the pediatric population with SSNs to guide appropriate clinical decision-making.