目的

分析既往恶性肿瘤病史、既往恶性肿瘤来源对肺部影像报告和数据系统（lung imaging-reporting and data system，Lung-RADS）2022 版及肺结节影像分级评估系统（pulmonary node imaging-grading and reporting system，PNI-GARS）对肺结节诊断的影响。

方法

选择2018 年1 月至2021 年11 月我院收治的既往有癌症病史行肺结节切除术者451 例，收集患者胸部CT 影像和临床资料，依据Lung-RADS 和PNI-GARS 进行分类或分级判断。 根据罹患癌症种类不同分为既往肺癌（prior lung cancer，PLC）组144 例和既往肺外癌（prior extrapulmonary cancer，PEPC）组307 例。 术后组织病理判断Lung-RADS 和PNI-GARS 诊断一致率（agreement rate，AR），比较两种系统的诊断AR 及不同肺结节类型占比。

结果

451 例565 枚肺结节，PLC 组既往癌症病史＜5 年135 例，175 枚肺结节；既往癌症病史≥5 年9 例，12 枚肺结节。 PEPC 组既往癌症病史＜5 年219 例，278 枚肺结节；既往癌症病史≥5 年88 例，100 枚肺结节。 Lung-RADS 对部分实性结节诊断AR 93.0% 和实性结节88.1% 接近（P=0.131），高于磨玻璃密度结节24.0%（P＜0.001）。 PNI-GARS 对部分实性结节诊断AR 高达100%（P＜0.001），对实性结节与磨玻璃密度结节的诊断AR 相似（88.5% vs. 84.8%）（P=0.273）。 Lung-RADS 评价既往癌症病史＜5 年不同类型肺结节PLC 组诊断AR 58.9%，PEPC 组76.6%（P＜0.001）； PLC 组（≥5 年）vs. PEPC（≥5 年）；PLC（＜5 年）vs. PLC（≥5 年）；PEPC（＜5 年）vs. PEPC（≥5 年）肺结节诊断AR 相似（P＞0.05）。 不同组PNI-GARS 的诊断AR 差异无统计学意义，与既往癌症病史、既往恶性肿瘤类型无关。

结论

既往癌症病史和既往恶性肿瘤类型不影响PNI-GARS 诊断，既往癌症病史可能影响Lung-RADS 诊断。

Objective

To investigate the effect of the length and source of malignancy history on the diagnostic efficacy of Lung-RADS （lung imaging-reporting and data system） 2022 and PNI-GARS （pulmonary node imaging-grading and reporting system） in pulmonary nodules （PNs）.

Methods

Chest computed tomography and clinical data of PNs in 451 patients with a history of cancer who underwent surgical resection in The First Affiliated Hospital of Chongqing Medical University from January，2018，to November，2021，were retrospectively collected and evaluated based on Lung-RADS and PNI-GARS，respectively.All PNs were divided into 2 groups：the prior lung cancer （PLC）144 cases and the prior extrapulmonary cancer （PEPC）groups 307cases.The diagnostic agreement rate（AR）of Lung-RADS and PNI-GARS was evaluated based on the pathological diagnosis of nodules after operation.The AR of the two systems and the composition ratios of PNs with different types between different groups were calculated and compared.

Results

A total of 451 patients with 565 PNs were included in this study.These patients were divided into the PLC group （＜5 years：135 cases，175 PNs； ≥5 years：9 cases，12 PNs） and the PEPC group （＜5 years：219 cases，278 PNs； ≥5 years：88 cases，100 PNs）.The diagnostic AR of Lung-RADS of partial solid nodules （93.0%） and solid nodules （88.1%） was close （P = 0.131），while both were higher than that of the ground-glass nodules（24.0%，all P values ＜0.001）.However，the diagnostic AR of PNI-GARS of partial solid nodules was the highest （100%，all P＜0.001），and the AR of solid nodules and ground glass nodules were similar with each other （88.5% vs. 84.8%， P=0.273）.Within 5 years，the composition ratio of PNs and the diagnostic AR of Lung-RADS （PLC：58.9%，PEPC：76.6%） between the PLC and PEPC groups were all different （all P values＜0.001），and the others （composition ratio of PNs & the diagnostic AR：PLC （≥5 years） vs. PEPC（≥5 years）； PLC （＜5 years） vs. PLC （≥5 years）； PEPC （＜5 years） vs. PEPC （≥5 years） were similar（all P values ＞0.05）.On the contrary，the diagnostic AR for PNI-GARS did not vary regardless of the length of previous cancer history or the type of previous malignancy.

Conclusion

The diagnostic efficiency of PNI-GARS would not be affected by the length of previous cancer history and the origin of previous malignancy，and the length of prior cancer history may impact the diagnostic performance of Lung-RADS.