• Marjolein A Heuvelmans, Joan E Walter, Robin B Peters, BockGeertruida H deGHDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands., Uraujh Yousaf-Khan, AalstCarlijn M van derCMVDepartment of Public Health, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands., GroenHarry J MHJMUniversity of Groningen, University Medical Center Groningen, Department of Pulmonary Diseases, Groningen, The Netherlands., Kristiaan Nackaerts, Peter Ma van Ooijen, KoningHarry J deHJDepartment of Public Health, Erasmus Medical Centre Rotterdam, Rotterdam, The Netherlands., Matthijs Oudkerk, and Rozemarijn Vliegenthart.
• University of Groningen, University Medical Center Groningen, Center for Medical Imaging - North East Netherlands, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands; Department of Pulmonology, Medisch Spectrum Twente, Enschede, The Netherlands. Electronic address: m.a.heuvelmans@umcg.nl.
• Lung Cancer. 2017 Nov 1; 113: 45-50.

ObjectivesTo explore the relationship between nodule count and lung cancer probability in baseline low-dose CT lung cancer screening.Materials And MethodsIncluded were participants from the NELSON trial with at least one baseline nodule (3392 participants [45% of screen-group], 7258 nodules). We determined nodule count per participant. Malignancy was confirmed by histology. Nodules not diagnosed as screen-detected or interval cancer until the end of the fourth screening round were regarded as benign. We compared lung cancer probability per nodule count category.Results1746 (51.5%) participants had one nodule, 800 (23.6%) had two nodules, 354 (10.4%) had three nodules, 191 (5.6%) had four nodules, and 301 (8.9%) had>4 nodules. Lung cancer in a baseline nodule was diagnosed in 134 participants (139 cancers; 4.0%). Median nodule count in participants with only benign nodules was 1 (Inter-quartile range [IQR]: 1-2), and 2 (IQR 1-3) in participants with lung cancer (p=NS). At baseline, malignancy was detected mostly in the largest nodule (64/66 cancers). Lung cancer probability was 62/1746 (3.6%) in case a participant had one nodule, 33/800 (4.1%) for two nodules, 17/354 (4.8%) for three nodules, 12/191 (6.3%) for four nodules and 10/301 (3.3%) for>4 nodules (p=NS).ConclusionIn baseline lung cancer CT screening, half of participants with lung nodules have more than one nodule. Lung cancer probability does not significantly change with the number of nodules. Baseline nodule count will not help to differentiate between benign and malignant nodules. Each nodule found in lung cancer screening should be assessed separately independent of the presence of other nodules.Copyright © 2017 Elsevier B.V. All rights reserved.

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