Clinical and non-contrast computed tomography characteristics and disease development in patients with benign pulmonary subsolid nodules with a solid component ≤ 5 mm

Objectives To evaluate the clinical and non-contrast computed tomography (CT) features of patients with benign pulmonary subsolid nodules (SSNs) with a solid component ≤ 5 mm and their development trends via follow-up CT. Methods We retrospectively collected 436 data from patients who had SSNs with a solid component ≤ 5 mm, including 69 with absorbable benign SSNs (AB-SSNs), 70 with nonabsorbable benign SSNs (NB-SSNs), and 297 with malignant SSNs (M-SSNs). Models 1, 2, and 3 for distinguishing the different types of SSNs were then developed and validated. Results Patients with AB-SSNs were younger and exhibited respiratory symptoms more frequently than those with M-SSNs. The frequency of nodules detected during follow-up CT was in the following order: AB-SSNs > NB-SSNs > M-SSNs. NB-SSNs were smaller than M-SSNs, and ill-defined margins were more frequent in AB-SSNs than in NB-SSNs and M-SSNs. Benign SSNs exhibited irregular shape, target sign, and lower CT values more frequently compared to M-SSNs, whereas the latter demonstrated bubble lucency more commonly compared to the former. Furthermore, AB-SSNs showed more thickened interlobular septa and satellite lesions than M-SSNs and M-SSNs had more pleural retraction than AB-SSNs (all p < 0.017). The three models had AUCs ranging 0.748–0.920 and 0.790–0.912 in the training and external validation cohorts, respectively. A follow-up CT showed nodule progression in four benign SSNs. Conclusions The three SSN types have different clinical and imaging characteristics, with some benign SSNs progressing to resemble malignancy. Critical relevance statement A good understanding of the imaging features and development trends of benign SSNs may help reduce unnecessary follow-up or interventions. This retrospective study explores the CT characteristics of benign SSNs with a solid component ≤ 5 mm by comparing AB-SSNs, NB-SSNs, and M-SSNs and delineates their development trends via follow-up CT. Key points 1. Different subsolid nodule types exhibit distinct clinical and imaging features. 2. A miniscule number of benign subsolid nodules can progress to resemble malignancy. 3. Knowing the clinical and imaging features and development trends of benign subsolid nodules can improve management. Graphical Abstract