Volume doubling time under 200 days marks all malignant nodules in 27 studies of lung cancer screening programs

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Frontiers in Medicine Published June 4, 2026 Medically reviewed June 4, 2026 DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Note that volume doubling time under 200 days indicates malignancy risk in lung nodules.

This narrative review examines nodule features such as volume doubling time, size, and attenuation within the context of lung cancer screening programs. The analysis draws on 27 studies, comprising 23 original investigations and 4 reviews, to assess nodule malignancy risk. The authors report that all malignant nodules had a volume doubling time under 200 days. Shortest volume doubling times were observed in aggressive histological subtypes and advanced disease stages. Additionally, PET-CT positivity correlated with shorter volume doubling times, and never-smokers exhibited faster nodule growth than ever-smokers. A trend of decreasing volume doubling time with disease progression was also noted. The review identifies variability in study designs and classification criteria as significant limitations. Standardizing volume doubling time reporting and incorporating it into personalized lung cancer screening algorithms could enhance early detection and reduce overtreatment. Digital tools can support this integration by enabling accurate, automated volume doubling time calculations, improving measurement consistency, and facilitating the incorporation of volumetric and attenuation data into advanced risk prediction models, provided that healthcare professionals receive proper training to use these tools effectively.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedJun 2026

View Original Abstract ↓

Background/objectivesLow-dose computed tomography screening plays a pivotal role in early lung cancer detection. This narrative review aims to evaluate nodule characteristics, especially volume doubling time (VDT), and their relevance to lung cancer suspicion, staging, and clinical outcomes, to support more accurate risk stratification in screening programs for lung cancer.Materials and methodsA literature search was conducted in PubMed, Scopus, and Web of Science, covering studies published from January 2012 to August 2024. A total of 27 studies (23 original and 4 reviews) were included. Key nodule features (VDT, size, attenuation, margins, histology, and stage) were extracted, reclassified, and analyzed to ensure standardized graphical comparison. Diagnostic performance metrics such as sensitivity, specificity, and predictive values of VDT were also assessed.ResultsFindings revealed that all malignant nodules had a VDT under 200 days, with the shortest VDTs observed in aggressive histological subtypes and advanced disease stages. PET-CT positivity correlated with shorter VDTs, and never-smokers exhibited faster nodule growth than ever-smokers. Stage-specific growth patterns showed a trend of decreasing VDT with disease progression. However, variability in study designs and classification criteria made it necessary to implement standardization. Digital tools in the field of lung imaging may be valuable assets in early detection and risk prediction and could minimize inter-reader variability and thus overdiagnosis.ConclusionsVDT is a valuable indicator for assessing nodule malignancy risk but should be integrated into multifactorial risk models. Standardizing VDT reporting and incorporating it into personalized lung cancer screening algorithms could enhance early detection and reduce overtreatment. Digital tools can support this integration by enabling accurate, automated VDT calculations, improving measurement consistency, and facilitating the incorporation of volumetric and attenuation data into advanced risk prediction models, provided that healthcare professionals receive proper training to use these tools effectively.