临床因素与CT影像学特征对判断孤立性肺结节良、恶性的价值

Value of Clinical Factors and CT Imaging Features in the Diagnosis of Benign and Malignant Solitary Pulmonary Nodules

目的分析临床因素与CT影像学特征在判断孤立性肺结节良、恶性中的应用价值。方法回顾性分析2015年1月至2018年9月在宁夏医科大学总医院普胸外科行手术切除并获得明确病理诊断的213例SPN患者的临床资料及影像学资料。结果病理诊断结果显示,213例SPN患者中恶性127例(59.7%),其中腺癌104例,鳞癌12例,小细胞癌5例,转移癌6例;良性86例(40.3%),其中结核瘤19例,炎性假瘤32例,错构瘤19例,硬化性血管瘤3例,腺瘤样增生3例,肺泡细胞瘤3例,机化性肺炎2例,肺内淋巴结、神经鞘瘤、肉芽肿、平滑肌瘤、囊肿各1例。良、恶性SPN患者临床和影像学特征分析结果显示,年龄、结节最大直径、结节类型、结节边界、毛刺、分叶在良、恶性SPN组间差异均有统计学意义(P均<0.05)。多因素分析结果显示:年龄(OR=1.051,95%CI=1.015~1.088)、结节最大直径(OR=1.173,95%CI=1.095~1.256)、结节类型(实性结节OR=0.043,95%CI=0.010~0.191;亚实性结节OR=0.195,95%CI=0.049~0.776)、毛刺(OR=3.546,95%CI=1.483~8.482)、分叶(OR=7.591,95%CI=3.160~18.237)是良、恶性SPN的影响因素。结论患者年龄越大、结节直径越大、纯磨玻璃结节、毛刺、分叶提示SPN为恶性结节的可能较性越大,对于SPN的良恶性评估具有重要参考价值。

Objective To summarize,analyze and discuss the value of clinical factors and CT imaging features in the diagnosis of benign and malignant solitary pulmonary nodules.Methods The clinical and imaging data of 213 patients with SPN who underwent thoracic surgery from January 2015 to September 2018 in General Hospital of Ningxia Medical University were retrospectively analyzed.Results Pathological results showed that 127 cases(59.7%)of 213 SPN patients were malignant,including 104 cases of adenocarcinoma,12 cases of squamous cell carcinoma,5 cases of small cell carcinoma and 6 cases of metastatic carcinoma;86 cases(40.3%)of benign SPN patients,including 19 cases of tuberculoma,32 cases of inflammatory pseudotumor,19 cases of hamartoma,3 cases of sclerosing hemangioma,3 cases of adenomatoid hyperplasia,3 cases of alveolar cell tumor,2 cases of organic pneumonia,intrapulmonary lymph nodes,schwannoma and granuloma,swelling,leiomyoma and cyst were found in 1 case respectively.The clinical and imaging characteristics of benign and malignant SPN patients showed that there were significant differences between benign and malignant SPN in age,maximum diameter of nodule,type of nodule,clear boundary of nodule,burr,lobulation(P all<0.05).Multiple factor analysis showed age(OR=1.051,95%CI=1.015~1.088),nodule maximum diameter(OR=1.173,95%CI=1.095~1.256),nodule type(solid nodule OR=0.043,95%CI=0.010~0.191;solid nodule OR=0.195,95%CI=0.049~0.776),burr(OR=3.546,95%CI=1.483~8.482),lobulation(OR=7.591,95%CI=3.160~18.237)were the influence factor of SPN.Conclusion The older,long diameter of nodule,pure ground glass nodule,burr and lobulation suggest that SPN is a malignant nodule,which has important reference value for the benign and malignant evaluation of SPN.