Low-Dose CT Screening in East Asian Women Who Have Never Smoked: Association between Family History of Lung Cancer and Ground-Glass Nodule Prevalence and Growth

Background Characteristics of ground-glass nodules (GGNs) in Asian women who have never smoked with family history of lung cancer (FHLC) remain unexamined. Purpose To investigate the differences in GGN progression to lung cancer at low-dose CT (LDCT) screening between Asian women who have never smoked with and without FHLC, and to examine associations between FHLC and GGN prevalence and growth. Materials and Methods This single-center retrospective study included East Asian women who had never smoked and had no personal history of lung cancer who underwent baseline LDCT for a health checkup between January 2011 and December 2015. Radiologists reviewed GGNs at baseline and follow-up, using Fleischner Society guidelines. Prevalence of persistent, multiple, and growing GGNs and incidence of pathology-confirmed lung cancer were compared in patients with and without FHLC. Multivariable logistic and Cox regression analyses were used to explore associations between FHLC and GGN prevalence and growth, adjusting for total size and solid proportion of baseline GGNs. Results Of 10 151 patients (mean age, 54 years ± 10 [SD]), 694 (6.8%) reported FHLC and 9457 (93.2%) did not. Among all patients, 515 (5.1%) had persistent GGNs (median follow-up period, 2551 days [IQR, 1104-3458 days]), 199 (2.0%) had multiple GGNs, 49 (0.5%) experienced GGN growth, and 31 (0.3%) were diagnosed with lung cancer. Patients with FHLC had a higher prevalence of persistent GGNs (8.2% [57 of 694] vs 4.8% [458 of 9457]; <i>P</i> < .001), multiple GGNs (3.7% [26 of 694] vs 1.8% [173 of 9457]; <i>P</i> < .001), and growing GGNs (1.3% [nine of 694] vs 0.4% [40 of 9457]; <i>P</i> = .001) and higher lung cancer incidence (0.9% [six of 694] vs 0.3% [25 of 9457]; <i>P</i> = .006). In multivariable analysis, FHLC was associated with increased prevalence of persistent GGNs (odds ratio [OR], 1.69 [95% CI: 1.26, 2.26]; <i>P</i> < .001) and multiple GGNs (OR, 2.02 [95% CI: 1.32, 3.08]; <i>P</i> = .001). FHLC was an independent risk factor for GGN growth over a 10-year period (hazard ratio, 2.14 [95% CI: 1.03, 4.44]; <i>P</i> = .04) after adjustments. Conclusion In East Asian women who had never smoked and who underwent LDCT screening, FHLC was associated with an increased prevalence of persistent and multiple GGNs, including proven adenocarcinomas, and was an independent risk factor for GGN growth over a 10-year period. © RSNA, 2024 <i>Supplemental material is available for this article.</i> See also the editorial by Chang in this issue.