Pulmonary subsolid nodules: what radiologists need to know about the imaging features and management strategy

Authors: Hyungjin Kim, Chang Min Park, Jae Moon Koh, Sang Min Lee, Jin Mo Goo

Pulmonary subsolid nodules (SSNs) refer to pulmonary nodules with pure ground-glass nodules and part-solid ground-glass nodules. SSNs are frequently encountered in the clinical setting, such as screening chest computed tomography (CT). The main concern regarding pulmonary SSNs, particularly when they are persistent, has been lung adenocarcinoma and its precursors. The CT manifestations of SSNs help radiologists and clinicians manage these lesions. However, the management plan for SSNs has not previously been standardized. Recently, the Fleischner Society published recommendations for the management of incidentally detected SSNs. The guidelines reflect the new lung adenocarcinoma classification system proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society (IASLC/ATS/ERS) and include six specific recommendations according to the nodule size, solid portion and multiplicity. This review aims to increase the understanding of SSNs and the imaging features of SSNs according to their histology, natural course, possible radiologic interventions, such as biopsy, localization prior to surgery, and current management.