Clinical significance of perifissural nodules in the oncologic population


      • Perifissural nodules (PFNs) are common in the general population.
      • In our dedicated cancer population, PFNs were found to be stable or decreased in size over a follow up, similar to the general population and; therefore, can be presumed benign.
      • While a pulmonary or pleural nodule will still necessitate follow up in cancer patients, our results indicate we as radiologists can provide reassurance to our oncologic colleagues and oncologic patients.



      To evaluate for stability of perifissural nodules (PFNs) in a dedicated oncologic population.


      A retrospective review of 500 computed tomography (CT) chests from oncologic patients at our tertiary care cancer center with at least a three year follow up yielded 76 patients with PFNs. Patients with metastases on baseline CT chest were excluded (n = 14) as the presence of a PFN would not be clinically relevant, thus our final patient cohort was 62 patients with a total of 112 PFNs. PFN features, clinical features, and ancillary information was recorded from the CT and the electronic medical record for all patients. The two patient cohorts—stable or decreased PFN vs. increased PFN—were then compared.


      112 PFNs were examined in 62 patients with a median follow up interval of 5.7 years. Of 62 patients, 59 (95.2%, 95% CI: 86.5, 99.0) had decreased/stable PFNs on follow up scan (median follow up 5.6 years) and 3 (4.8%, 95% CI: 1.0, 13.5%) had enlarged PFNs (median follow up 6.3 years). None of the PFN features, clinical features, nor ancillary information from the CT proved to be statistically significant.


      Despite the lack of statistically significant distinguishing features to predict growth, our results are reassuring, since the majority of PFNs in our oncology patients were decreased or unchanged in size which is comparable to previously published data on PFNs in non-oncologic patients. Thus, we can similarly presume these nodules are most likely benign and can provide reassurance to our oncologic colleagues and our patients. Larger studies are warranted to further evaluate PFNs in the oncologic population which also examines the nodules by cancer type.


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        • Trapnell D.H.
        Recognition and incidence of intrapulmonary lymph nodes.
        Thorax. 1964; 19: 44-50
        • Miyake H.
        • Yamada Y.
        • Kawagoe T.
        • Hori Y.
        • Mori H.
        • Yokoyama S.
        Intrapulmonary lymph nodes: CT and pathological features.
        Clin Radiol. 1999; 54: 640-643
        • Yokomise H.
        • Mizuno H.
        • Ike O.
        • Wada H.
        • Hitomi S.
        • Itoh H.
        Importance of intrapulmonary lymph nodes in the differential diagnosis of small pulmonary nodular shadows.
        Chest. 1998; 113: 703-706
        • Matsuki M.
        • Noma S.
        • Kuroda Y.
        • Oida K.
        • Shindo T.
        • Kobashi Y.
        Thin-section CT features of intrapulmonary lymph nodes.
        J Comput Assist Tomogr. 2001; 25: 753-756
        • Diederich S.
        Screening for early lung cancer with low-dose spiral computed tomography.
        Lancet. 2003; 362: 588-589
        • van Klaveren R.J.
        • Oudkerk M.
        • Prokop M.
        • Scholten E.T.
        • Nackaerts K.
        • Vernhout R.
        • et al.
        Management of lung nodules detected by volume CT scanning.
        N Engl J Med. 2009; 361: 2221-2229
        • Manos D.
        • Seely J.M.
        • Taylor J.
        • Borgaonkar J.
        • Roberts H.C.
        • Mayo J.R.
        The Lung Reporting and Data System (LU-RADS): a proposal for computed tomography screening.
        Can Assoc Radiol J. 2014; 65: 121-134
        • Wang L.C.
        • DeMartini W.B.
        • Partridge S.C.
        • Peacock S.
        • Lehman C.D.
        MRI-detected suspicious breast lesions: predictive values of kinetic features measured by computer-aided evaluation.
        AJR Am J Roentgenol. 2009; 193: 826-831
        • Xu D.M.
        • van der Zaag-Loonen H.J.
        • Oudkerk M.
        • Wang Y.
        • Vliegenthart R.
        • Scholten E.T.
        • et al.
        Smooth or attached solid indeterminate nodules detected at baseline CT screening in the NELSON study: cancer risk during 1 year of follow-up.
        Radiology. 2009; 250: 264-272
        • Bankoff M.S.
        • McEniff N.J.
        • Bhadelia R.A.
        • Garcia-Moliner M.
        • Daly B.D.
        Prevalence of pathologically proven intrapulmonary lymph nodes and their appearance on CT.
        AJR Am J Roentgenol. 1996; 167: 629-630
        • Ahn M.I.
        • Gleeson T.G.
        • Chan I.H.
        • McWilliams A.M.
        • Macdonald S.L.
        • Lam S.
        • et al.
        Perifissural nodules seen at CT screening for lung cancer.
        Radiology. 2010; 254: 949-956
        • Sykes A.M.
        • Swensen S.J.
        • Tazelaar H.D.
        • Jung S.H.
        Computed tomography of benign intrapulmonary lymph nodes: retrospective comparison with sarcoma metastases.
        Mayo Clin Proc. 2002; 77: 329-333
        • Mets O.M.
        • Chung K.
        • Scholten E.T.
        • Veldhuis W.B.
        • Prokop M.
        • van Ginneken B.
        • et al.
        Incidental perifissural nodules on routine chest computed tomography: lung cancer or not?.
        Eur Radiol. 2018; 28: 1095-1101
        • de Hoop B.
        • van Ginneken B.
        • Gietema H.
        • Prokop M.
        Pulmonary perifissural nodules on CT scans: rapid growth is not a predictor of malignancy.
        Radiology. 2012; 265: 611-616
        • Kradin R.L.
        • Spirn P.W.
        • Mark E.J.
        Intrapulmonary lymph nodes. Clinical, radiologic, and pathologic features.
        Chest. 1985; 87: 662-667
        • Goo J.M.
        Juxtapleural (Perifissural) Nodules: Does Location Mean a Benign Lesion?.
        Radiology. 2018; 288: 876-877
      1. Callister ME, Baldwin DR, Akram AR, Barnard S, Cane P, Draffan J, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax 2015; 70 Suppl 2: ii 1-ii 54.

        • Schreuder A.
        • van Ginneken B.
        • Scholten E.T.
        • Jacobs C.
        • Prokop M.
        • Sverzellati N.
        • et al.
        Classification of CT pulmonary opacities as perifissural nodules: reader variability.
        Radiology. 2018; 288: 867-875
        • Takashima S.
        • Sone S.
        • Li F.
        • Maruyama Y.
        • Hasegawa M.
        • Kadoya M.
        Indeterminate solitary pulmonary nodules revealed at population-based CT screening of the lung: using first follow-up diagnostic CT to differentiate benign and malignant lesions.
        AJR Am J Roentgenol. 2003; 180: 1255-1263
        • Shin K.E.
        • Lee K.S.
        • Yi C.A.
        • Chung M.J.
        • Shin M.H.
        • Choi Y.H.
        Subcentimeter lung nodules stable for 2 years at LDCT: long-term follow-up using volumetry.
        Respirology (Carlton, Vic). 2014; 19: 921-928
        • MacMahon H.
        • Naidich D.P.
        • Goo J.M.
        • Lee K.S.
        • Leung A.N.C.
        • Mayo J.R.
        • et al.
        Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017.
        Radiology. 2017; 284: 228-243
        • Masuya D.
        • Gotoh M.
        • Nakashima T.
        • Liu D.
        • Ishikawa S.
        • Yamamoto Y.
        • et al.
        A surgical case of primary lung cancer with peripheral intrapulmonary lymph node metastasis.
        Ann Thorac Cardiovasc Surg. 2007; 13: 53-55