Clinical analysis of preoperative misdiagnosed benign pulmonary nodules and typical malignant pulmonary nodules

doi:10.3877/cma.j.issn.1674-6902.2024.01.009

Abstract

Abstract:

Objective

To analyze the clinical and imaging characteristics of benign solitary pulmonary nodule (SPN), misdiagnosed as malignant, and typical malignant SPN before surgery, and establish a model to predict malignant SPN.

Methods

A total of 621 patients with suspected malignant SPN admitted to our hospital from January 2019 to March 2022 who underwent surgical treatment before surgery were selected, 243 patients with benign SPN confirmed by postoperative pathology were divided into observation group, and 378 cases with typical malignant SPN were divided into control group. The clinical image data of patients were collected, the risk factors of malignant SPN were screened by multi-factor logistic regression analysis, and the prediction model of malignant SPN was established to verify the prediction efficiency of the model.

Results

There were 129 females (53.09%) in the observation group, with an average age of (54.66±10.52)years, and 242 females (64.02%) in the control group, with an average age of (59.68±8.48) years (P<0.05). In the observation group, there were 173 solid nodules (71.19%), 155 peripheral pulmonary cleft nodules (63.79%), and 143 circular/quasi-circular nodules(58.85%), while in the control group, 184 solid nodules (48.68%), 77 peripheral pulmonary cleft nodules (20.37%), and 161 circular/quasi-circular nodules(42.59%)(P<0.05). Multivariate regression analysis showed that age, tumor markers, diameter, average CT value of volume, clear boundary, relationship with pulmonary fissure location, lobed, pleural depression sign were risk factors for malignant SPN (P<0.05). The model verified that the area under the receiver operating characteristic curve was 0.815, which was larger than the PKUPH model (0.785, P=0.776) and Mayo model (0.502, P=0.012).

Conclusions

The majority of benign SPN women are easily misdiagnosed as malignant before surgery. The age of onset is younger. The imaging features are round/quasi-round, and the solid components around the pulmonary fissure are dominant. The model is effective in predicting malignant SPN and has clinical significance.

Key words: Solitary pulmonary nodule, Imaging features, Benign/malignant, Misdiagnosis, Predictive model

Lijun Duan, Xin Dong, Ruonan Pan, Mengran Ren, Xiaoqian Lu, Dianbo Cao. Clinical analysis of preoperative misdiagnosed benign pulmonary nodules and typical malignant pulmonary nodules[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(01): 46-50.

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References 33

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影像学特征	观察组(n＝243)	对照组(n＝378)	χ²/t值	P值
病灶肺叶位置			23.142	0.000^a
右肺上叶	53(21.81)	122(32.28)
右肺中叶	29(11.93)	29(7.67)
右肺下叶	50(20.58)	53(14.02)
左肺上叶	53(21.81)	117(30.95)
左肺下叶	58(23.87)	57(15.08)
与肺裂位置关系			119.136	0.000^a
肺裂周围	155(63.79)	77(20.37)
肺内	88(36.21)	301(79.63)
结节成分			30.727	0.000^a
实性	173(71.19)	184(48.68)
部分实性	39(16.05)	105(27.78)
纯磨玻璃	31(12.76)	89(23.54)
直径(cm)	1.31±0.53	1.89±0.0.58	－12.862	0.000^a
体积(cm³)	1.57±2.00	3.08±2.73	－7.953	0.000^a
体积平均CT(HU)	－134.90±227.13	－249.50±244.26	5.955	0.000^a
形状			15.640	0.000^a
圆形/类圆形	143(58.85)	161(42.59)
不规则	100(41.15)	217(57.41)
边界			52.177	0.000^a
清楚	108(44.44)	67(17.72)
模糊	135(55.56)	311(82.28)
分叶征	87(35.80)	224(59.26)	32.554	0.000^a
毛刺征	59(24.28)	174(46.03)	29.854	0.000^a
空泡征	9(3.70)	57(15.08)	20.151	0.000^a
空洞征	6(2.47)	22(5.82)	3.858	0.050
支气管充气征	22(9.05)	46(12.17)	1.473	0.225
血管集束征	108(44.44)	168(44.44)	0.000	1.000
胸膜凹陷征	49(20.16)	208(55.03)	74.106	0.000^a
晕征	6(2.47)	9(2.38)	0.005	0.944

影像学特征	观察组(n＝243)	对照组(n＝378)	χ²/t值	P值
病灶肺叶位置			23.142	0.000^a
右肺上叶	53(21.81)	122(32.28)
右肺中叶	29(11.93)	29(7.67)
右肺下叶	50(20.58)	53(14.02)
左肺上叶	53(21.81)	117(30.95)
左肺下叶	58(23.87)	57(15.08)
与肺裂位置关系			119.136	0.000^a
肺裂周围	155(63.79)	77(20.37)
肺内	88(36.21)	301(79.63)
结节成分			30.727	0.000^a
实性	173(71.19)	184(48.68)
部分实性	39(16.05)	105(27.78)
纯磨玻璃	31(12.76)	89(23.54)
直径(cm)	1.31±0.53	1.89±0.0.58	－12.862	0.000^a
体积(cm³)	1.57±2.00	3.08±2.73	－7.953	0.000^a
体积平均CT(HU)	－134.90±227.13	－249.50±244.26	5.955	0.000^a
形状			15.640	0.000^a
圆形/类圆形	143(58.85)	161(42.59)
不规则	100(41.15)	217(57.41)
边界			52.177	0.000^a
清楚	108(44.44)	67(17.72)
模糊	135(55.56)	311(82.28)
分叶征	87(35.80)	224(59.26)	32.554	0.000^a
毛刺征	59(24.28)	174(46.03)	29.854	0.000^a
空泡征	9(3.70)	57(15.08)	20.151	0.000^a
空洞征	6(2.47)	22(5.82)	3.858	0.050
支气管充气征	22(9.05)	46(12.17)	1.473	0.225
血管集束征	108(44.44)	168(44.44)	0.000	1.000
胸膜凹陷征	49(20.16)	208(55.03)	74.106	0.000^a
晕征	6(2.47)	9(2.38)	0.005	0.944

影响因素	回归系数	瓦尔德	P值	OR	95%置信区间
影响因素	回归系数	瓦尔德	P值	OR	下限	上限
年龄	0.044	10.394	0.001^a	1.045	1.017	1.073
肿瘤标志物	－0.875	9.152	0.002^a	0.417	0.237	0.735
直径	1.781	55.495	0.000^a	5.936	3.715	9.483
体积平均CT值	－0.005	53.601	0.000^a	0.995	0.994	0.997
与肺裂位置关系	1.688	44.290	0.000^a	5.410	3.291	8.895
边界	－0.845	8.741	0.003^a	0.429	0.245	0.752
分叶征	－1.366	23.244	0.000^a	0.255	0.146	0.444
胸膜凹陷征	－1.783	41.040	0.000^a	0.168	0.097	0.290
常量	－4.032	17.783	0.000^a	0.018	－	－

影响因素	回归系数	瓦尔德	P值	OR	95%置信区间
影响因素	回归系数	瓦尔德	P值	OR	下限	上限
年龄	0.044	10.394	0.001^a	1.045	1.017	1.073
肿瘤标志物	－0.875	9.152	0.002^a	0.417	0.237	0.735
直径	1.781	55.495	0.000^a	5.936	3.715	9.483
体积平均CT值	－0.005	53.601	0.000^a	0.995	0.994	0.997
与肺裂位置关系	1.688	44.290	0.000^a	5.410	3.291	8.895
边界	－0.845	8.741	0.003^a	0.429	0.245	0.752
分叶征	－1.366	23.244	0.000^a	0.255	0.146	0.444
胸膜凹陷征	－1.783	41.040	0.000^a	0.168	0.097	0.290
常量	－4.032	17.783	0.000^a	0.018	－	－

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