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Background  The growth rate of thymic epithelial tumors (TETs) and thymic cysts was investigated to determine whether they can be differentiated and clinico‐radiological predictors of interval growth was identified.    Methods  This retrospective study included 122 patients with pathologically proven thymic cysts ( n  = 56) or TETs ( n  = 66) who underwent two serial chest computed tomography scans at least eight weeks apart. Average diameters and attenuation were measured, volume‐doubling times (VDTs) were calculated, and clinical characteristics were recorded. VDTs were compared using the log‐rank test. Predictors of growth were analyzed using the log‐rank test and Cox regression analysis.    Results  The frequency of growth did not differ significantly between TETs and thymic cysts ( P  = 0.279). The VDT of thymic cysts (median 324 days) was not significantly different from that of the TETs (median 475 days;  P  = 0.808). Water attenuation (≤ 20 Hounsfield units) predicted growth in thymic cysts ( P  = 0.016; hazard ratio 13.2, 95% confidence interval 1.6–107.3), while lesion size (> 17.2 mm) predicted growth in TETs ( P  = 0.008 for size,  P  = 0.029 for size*time). For the growing lesions, the positive and negative predictive values of water attenuation for thymic cysts were 93% and 80%, respectively.    Conclusion  The frequencies of interval growth and VDTs were indistinguishable between TETs and thymic cysts. Water attenuation and lesion size predicted growth in thymic cysts and TETs, respectively. Among the growing lesions, water attenuation was a differential feature of thymic cysts.

Growth of thymic epithelial tumors and thymic cysts: Differential radiological points