Non-Nodular CT Patterns of Solid Lung Cancer in the Early Growth Phase: A Two-Center Retrospective Study

Our plain-English summary of Non-Nodular CT Patterns of Solid Lung Cancer in the Early Growth Phase: A Two-Center Retrospective Study, by X.F. Wu, X.D. Ge, T. Li, et al (Diagnostics, 2026).

The study

• Authors: X.F. Wu, X.D. Ge, T. Li, Q.Y. Zhong, F.J. Lv, Z.G. Chu
• Journal: Diagnostics
• Published: 2026;16(20)
• Read it: PubMed · Publisher · Free full text

Abstract

Background/Objectives: Early diagnosis of solid lung cancer (SLC) is essential for better prognosis. However, non-nodular patterns, atypical CT manifestations of SLC in the early growth phase, are easily overlooked, potentially leading to delayed diagnosis. This study aimed to characterize the clinical features and CT findings of non-nodular patterns of SLC in the early growth phase. Methods: Between January 2015 and October 2025, 365 patients with 365 pathologically confirmed SLCs were retrospectively enrolled from two centers. Based on initial morphological appearances, lesions were classified into nodular and non-nodular groups (patch-like, strip-like, bead-like, pleural plaque-like, and cystic-cavity subtypes). Clinical data and CT findings were summarized and compared between the two groups. Results: Of the 365 SLCs, 107 (29.32%) initially presented as non-nodular lesions, among which patch-like lesions (56, 52.34%) were the most prevalent, followed by bead-like (20, 18.69%), strip-like (16, 14.95%), pleural plaque-like (9, 8.41%), and cystic-cavity lesions (6, 5.61%). Both nodular and non-nodular lesions were predominantly located in the upper lobes (55.04% vs. 58.88%, p = 0.611). Multivariable analysis revealed that smoking history (adjusted odds ratio [aOR], 2.93; 95% confidence interval [CI], 1.05-8.28; p = 0.040), subpleural distribution (aOR, 3.37; 95% CI, 1.61-7.72; p < 0.001), interstitial lung disease (ILD) (aOR, 66.45; 95% CI, 23.57-220.04; p < 0.001), and post-tuberculosis lung changes (aOR, 8.60; 95% CI, 2.37-32.64; p = 0.001) were independently associated with a non-nodular pattern (AUC: 0.869; p < 0.001). Conclusions: In smokers or patients with ILD/post-tuberculosis lung changes, subpleural non-nodular lesions in the upper lobes require close monitoring for growth.

In plain English

This two-center retrospective study from Chongqing, China, examined how solid lung cancers first looked on chest CT. The article does not mention asbestos. Its 'pleural plaque-like' category describes a cancer's shape on CT, not asbestos-related pleural plaques. The authors reviewed serial scans of 365 patients, each with one pathologically confirmed solid lung cancer. On the first scan, 258 (70.68%) cancers appeared as nodules and 107 (29.32%) as non-nodular lesions, most often patch-like (56 of 107). Non-nodular lesions were more often first read as benign (71.00% vs. 32.20% of nodules). In multivariable analysis, a non-nodular appearance was independently associated with smoking history (adjusted odds ratio 2.93; 95% CI 1.05 to 8.28), subpleural location (3.37; 1.61 to 7.72), interstitial lung disease (66.45; 23.57 to 220.04) and post-tuberculosis lung changes (8.60; 2.37 to 32.64). The authors concluded that in smokers or patients with these lung conditions, non-nodular lesions near the pleura in the upper lobes need close monitoring. They noted possible selection bias, small subtype numbers and no benign comparison group.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Two-center retrospective study of serial preoperative chest CT scans
• Who was studied: 365 patients, each with one pathologically confirmed solid lung cancer. 317 came from the First Affiliated Hospital of Chongqing Medical University (January 2015 to October 2025) and 48 from the Second Affiliated Hospital of Army Medical University (May 2021 to June 2025), Chongqing, China.
• Exposure: No asbestos or occupational exposure was studied. The factors examined in relation to CT appearance were patient characteristics (age, sex, smoking history), lesion location, and background lung conditions: interstitial lung disease, emphysema and post-tuberculosis lung changes.
• Main results:
  • Of 365 solid lung cancers, 258 (70.68%) first appeared as nodules and 107 (29.32%) as non-nodular lesions.
  • Among the 107 non-nodular lesions, the breakdown was 56 (52.34%) patch-like, 20 (18.69%) bead-like, 16 (14.95%) strip-like, 9 (8.41%) pleural plaque-like and 6 (5.61%) cystic-cavity.
  • On the initial CT, non-nodular lesions were more often misinterpreted as benign abnormalities than nodules were (71.00% vs. 32.20%).
  • Smoking history was independently associated with a non-nodular pattern (adjusted odds ratio 2.93; 95% CI 1.05 to 8.28; p = 0.040).
  • Subpleural location (adjusted odds ratio 3.37; 95% CI 1.61 to 7.72; p < 0.001) and interstitial lung disease (adjusted odds ratio 66.45; 95% CI 23.57 to 220.04; p < 0.001) were independently associated with a non-nodular pattern.
  • Post-tuberculosis lung changes were independently associated with a non-nodular pattern (adjusted odds ratio 8.60; 95% CI 2.37 to 32.64; p = 0.001).
  • Non-nodular lesions had a longer follow-up interval than nodules (median 734.00 vs. 377.50 days; p < 0.001) and were larger on the last CT, while volume doubling times were similar.
• The authors' conclusion: The authors concluded that, besides nodules, early solid lung cancers may appear as diverse non-nodular abnormalities. In smokers or patients with interstitial lung disease or post-tuberculosis lung changes, subpleural non-nodular lesions in the upper lobes warrant close follow-up for growth.
• Limitations the authors state:
  • The retrospective design and inclusion of only pathologically confirmed cancers with sufficient longitudinal CT data may introduce selection bias.
  • Small sample sizes for some non-nodular subtypes limit the precision of comparisons among subtypes.
  • The proposed classification of non-nodular lesions has rarely been reported and needs external validation.
  • No benign comparison group was included, so how specific these patterns are for cancer is not established.
  • Contrast-enhanced CT findings and other quantitative imaging biomarkers were not assessed.

Topics

Medical terms in this study, explained in our Lexicon: Lung Cancer, Prognosis, Pleural Plaques, Odds Ratio, confidence interval, Interstitial Lung Disease.

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