Early-Stage Lung Cancer Linked to Nodular Wall Thickening in Cystic Lung Lesions: Study

A recent study published in the journal of Radiology revealed that certain imaging features of cystic lung lesions, specifically those with nodular wall thickening, are significantly associated with a higher risk of developing lung cancer. However, this study also found that these malignant lesions tend to grow slowly, allowing for early detection and treatment.

The study analyzed data from 15,762 patients who underwent CT lung cancer screening between January 2015 and July 2023. Among them, 235 individuals were identified with cystic lung lesions. Of these, 33 patients (14%) were ultimately diagnosed with lung cancer originating from these cystic abnormalities.

The key findings pointed to nodular wall thickening as a critical indicator of malignancy. The patients with this feature had an 11-fold increased risk of cancer. Additionally, the presence of a solid nodule within the cyst significantly raised cancer risk (odds ratio [OR] of 5.3), especially when it was accompanied by a ground-glass component which was linked to an even higher OR of 24.

The study found that multilocularity, or the presence of multiple compartments within a cyst, did not strongly correlate with malignancy risk (OR 1.7; P > .2). More reassuringly, unilocular cystic lesions (those with a single compartment) without any wall thickening showed no cases of malignancy across the dataset. This supports the notion that such lesions may require less aggressive follow-up.

The study also tracked lesion evolution over time using follow-up imaging. Lesion growth or an increase in structural complexity strongly correlated with higher cancer risk (P < .001). The median time for a lesion to show measurable growth was 636 days, and the average time to cancer diagnosis was 482 days. Also, 85% of these cancers were diagnosed at stage 0 or I, the stages where treatment outcomes are generally favorable.

This research noted that while cystic lesions with suspicious features should not be ignored, they often develop slowly. This indolent behavior provides a crucial window for monitoring and intervention. The study emphasized the value of serial imaging in identifying progressive changes and guiding management decisions.

Overall, this study reinforces the importance of CT imaging characteristics in evaluating lung cancer risk. Radiologists and clinicians should pay close attention to nodular wall thickening and solid components within cystic lesions, but also recognize the generally slow progression of such malignancies.

Source:

Byrne, S. C., Hunsaker, A. R., & Hammer, M. M. (2025). Risk of malignancy in cystic lung lesions in a lung cancer CT screening program. Radiology, 315(2), e243166. https://doi.org/10.1148/radiol.243166