Unravelling complexities of the subsolid pulmonary nodule—detection, characterization, natural history, monitoring and (future) patient management

Lung cancer is a major cause of death worldwide with an estimated 1.8 million new diagnoses and 1.6 million deaths annually (1). The five-year survival rate is poor as symptoms usually occur in an advanced stage of cancer where treatment options are limited and no curative therapies are available. Detecting suspicious lesions at an early stage is therefore thought to improve overall lung cancer survival and for this reason several lung cancer screening trials with chest computed tomography have been employed. In addition, the use of chest computed tomography (CT) in clinical care has sharply risen in the past decade. This has taught us important lessons on pulmonary lesions that look like cancer and even have malignant cells in histology, but do not behave malignant. This observation is quite similar to indolent lesions in other organs (2).