The objective of this study was to determine the optimal method of defining growth for indeterminate pulmonary nodules detected in lung cancer screening. The study evaluated 115 nodules (93 solid and 22 part-solid) by measuring average diameters and volumes on baseline and follow-up LDCT scans using semi-automated segmentation. The results showed that percentage volume growth of ≥25% had higher sensitivity but lower specificity than diametrical measurement compared to absolute diameter growth of >1.5 mm. The radiologist's subjective decision had equivalent sensitivity but higher specificity compared to volume growth, but did not differ from diameter growth. Sensitivity and specificity of diagnostic referral based on volume doubling time (VDT) thresholds of ≤200 and ≤300 days were significantly lower and higher, respectively, than the VDT threshold of 600 days. A-view LungScreen, a commercial software from Coreline Soft, was used for measuring nodule size. The study suggests that growth evaluation of screening-detected indeterminate nodules with volumetric measurement exhibited higher sensitivity but lower specificity compared to diametric measurements.
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