分析术前高度怀疑恶性，经术后组织病理学确诊为良性难定性肺结节的临床、影像学及组织病理学特征，为提升术前诊断准确率、减少不必要外科手术干预提供依据。

选择2020年1月至2024年12月我院收治的术前疑似恶性、接受外科手术且术后组织病理学证实为良性肺结节患者271例为研究对象，分析临床基线、影像学、实验室及病理资料。

五年间我院行肺结节手术共13 201例，其中术前难定性肺结节961例(7.28%)，本研究纳入术后组织病理学证实为良性者271例占同期肺结节手术总例数2.05%，占术前难定性肺结节总例数28.20%。271例中健康体检发现肺结节166例(61.25%)，症状性发现58例(21.40%)，其他疾病检查机会性发现47例(17.34%)。影像学特征：多发结节213例(78.60%)，单发结节58例(21.40%)；实性结节240例(88.56%)，混合磨玻璃及纯磨玻璃结节31例(11.44%)；右肺结节165例(60.39%)，左肺结节106例(39.11%)；结节最大直径>1.0 cm 162例(59.78%)，≤1.0 cm 109例(40.22%)；提示恶性影像学征象中分叶征101例(37.27%)，毛刺征86例(31.73%)、胸膜粘连征78例(28.78%)、血管穿行征68例(25.09%)；伴有颈部淋巴结肿大87例(41.83%)。PET-CT SUVmax升高者195例(71.96%)，其中SUVmax≥2.5者81例(41.54%)，SUVmax<2.5者114例(58.46%)。术后组织病理学示炎性病变者184例(67.89%)，其中肉芽肿炎116例，确诊结核39例，真菌15例。良性肿瘤中错构瘤36例(55.38%)和硬化性血管细胞瘤18例(27.69%)。空腹血糖升高者88例(32.47%)，其中炎性病变者血糖升高率38.59%高于非炎性病变的19.54%(P＝0.002)。肺结节经胸腔镜肺楔形切除术151例(55.72%)、肺段切除术70例(25.83%)和肺叶切除术50例(18.45%)。

术前疑似恶性行手术切除的肺部良性结节影像学特征多表现为实性、多发，并伴有恶性结节的影像学征象，术后组织病理学以炎性病变，尤其肉芽肿性炎症常见。肺结节患者糖代谢异常并非少见，术前鉴别诊断中除常规影像评估与随访，应关注糖代谢状态，综合评估后优化诊疗决策，减少不必要外科手术。

To analyze the clinical, radiological, laboratory, and histopathological characteristics of indeterminate pulmonary nodules that were highly suspected of malignancy preoperatively but were confirmed as benign by postoperative pathology, and to provide evidence for improving the accuracy of preoperative diagnosis and reducing unnecessary surgical intervention.

A total of 271 patients with pulmonary nodules who were preoperatively suspected of having malignant lesions, underwent surgical resection, and were pathologically confirmed to have benign pulmonary nodules after surgery at our hospital, between January 2020 and December 2024 were retrospectively included. Their clinical baseline characteristics, radiological findings, laboratory results, and pathological data were systematically analyzed.

During the 5-year study period, a total of 13, 201 surgical resections for pulmonary nodules were performed at our hospital, including 961 preoperatively indeterminate pulmonary nodules (7.28%). The 271 patients included in this study were pathologically confirmed to have benign lesions after surgery, accounting for 2.05% of all pulmonary nodule resections during the same period and 28.20% of all preoperatively indeterminate pulmonary nodules. Among the 271 patients, pulmonary nodules were mainly detected during routine health examinations in 166 patients (61.25%), followed by symptom-related detection in 58 patients (21.40%) and incidental detection during evaluation for other diseases in 47 patients (17.34%). Radiologically, multiple nodules were observed in 213 patients (78.60%) and solitary nodules in 58(21.40%); solid nodules were found in 240 patients (88.56%), whereas mixed ground-glass and pure ground-glass nodules were found in 31 patients (11.44%). Nodules were located in the right lung in 165 patients (60.89%) and in the left lung in 106(39.11%). The maximum nodule diameter was >1.0 cm in 162 patients (59.78%) and ≤1.0 cm in 109 patients (40.22%). Among radiological signs suggestive of malignancy, lobulation was the most common, occurring in 101 patients (37.27%), followed by spiculation in 86 patients (31.73%), pleural adhesion in 78 patients (28.78%), and the vascular penetration sign in 68 patients (25.09%). Lymphadenopathy was present in 87 patients (41.83%). PET/CT showed an increased SUVmax in 195 patients (71.96%); among them, 81 patients had an SUVmax ≥2.5 (41.54%), and 114 patients had an SUVmax <2.5 (58.46%). Postoperative pathology showed inflammatory lesions in 184 patients (67.89%), among which granulomatous inflammation accounted for 116 cases; confirmed tuberculosis and fungal infection accounted for 39 cases (33.62%)and 15 cases (12.93%), respectively. Among benign tumors, hamartoma was the most common type, with 36 cases (55.38%), followed by pulmonary sclerosing pneumocytoma in 18 cases (27.69%). Elevated fasting blood glucose was identified in 88 of the 271 patients, with an overall incidence of 32.47%. The incidence of elevated blood glucose was significantly higher in the inflammatory lesion group than in the non-inflammatory lesion group(38.59%比19.54%, P=0.002).Surgical procedures included thoracoscopic wedge resection in 151 patients (55.72%), segmentectomy in 70 patients (25.83%), and lobectomy in 50 patients (18.45%).

Benign pulmonary nodules surgically resected due to preoperative suspicion of malignancy were predominantly solid and multiple, and frequently exhibited imaging features suggestive of malignant nodules. Postoperative pathology most commonly revealed inflammatory lesions, particularly granulomatous inflammation. Abnormal glycemic status was not uncommon in this patient population, suggesting that, in addition to routine imaging assessment and follow-up, glycemic status should also be considered during the preoperative differential diagnosis. Comprehensive evaluation may help optimize clinical decision-making and reduce unnecessary surgical intervention.