Clinical and pathological characteristics analysis of benign pulmonary nodules clinically highly suspected as malignant: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PAN Gaojian ¹ , GENG Guojun ² , ZHU Xiaolei ² , LIU Hongming ² , LI Ning ² , PAN Jianyun ¹ ,  YE Guanzhi ² ,  JIANG Jie ²

1. Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, 361003, Fujian, P. R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, Fujian, P. R. China;

Corresponding author：

YE Guanzhi, Email: ygz23230286@163.com; JIANG Jie, Email: jiangjie06@126.com

Keywords：

Suspected malignant pulmonary nodules; pathological characteristics; imaging features

DOI：

10.7507/1007-4848.202312012

Video：

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Objective To discuss the main pathological types and imaging characteristics of pulmonary nodules that are highly suspected to be malignant in clinical practice but are pathologically confirmed to be benign. Methods A retrospective analysis was performed on the clinical data of patients with pulmonary nodules who were initially highly suspected of malignancy but were subsequently pathologically confirmed to be benign. These patients were treated at the First Affiliated Hospital of Xiamen University from December 2020 to April 2023. Based on the outcomes of preoperative discussions, the patients were categorized into a benign group and a suspicious malignancy group. The clinical data and imaging characteristics of both groups were compared. Results A total of 232 patients were included in the study, comprising 112 males and 120 females, with a mean age of (50.7±12.0) years. Among these, 127 patients were classified into the benign group, while 105 patients were categorized into the suspicious malignancy group. No statistically significant differences were observed between the two groups regarding age, gender, symptoms, smoking history, or tumor history (P>0.05). However, significant differences were noted in nodule density, CT values, margins, shapes, and malignant signs (P＜0.05). Further analysis revealed that in the suspicious malignancy group, solid nodules were predominantly characterized by collagen nodules and fibrous tissue hyperplasia (33.3%), followed by tuberculosis (20.4%) and fungal infections (18.5%). In contrast, non-solid nodules were primarily composed of collagen nodules and fibrous tissue hyperplasia (41.2%) and atypical adenomatous hyperplasia (17.7%). Conclusion Benign pulmonary nodules that are suspected to be malignant are pathologically characterized by the presence of collagen nodules, fibrous tissue hyperplasia, tuberculosis, atypical adenomatous hyperplasia, and fungal infections. Radiologically, these nodules typically present as non-solid lesions and may exhibit features suggestive of malignancy, including spiculation, lobulation, cavitation, and pleural retraction.

Citation： PAN Gaojian, GENG Guojun, ZHU Xiaolei, LIU Hongming, LI Ning, PAN Jianyun, YE Guanzhi, JIANG Jie. Clinical and pathological characteristics analysis of benign pulmonary nodules clinically highly suspected as malignant: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(2): 194-200. doi: 10.7507/1007-4848.202312012 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med, 2020, 382(6): 503-513.
3.	Archer JM, Mendoza DP, Hung YP, et al. Surgical resection of benign nodules in lung cancer screening: Incidence and features. JTO Clin Res Rep, 2023, 4(12): 100605.
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7.	Tammemägi MC, Church TR, Hocking WG, et al. Evaluation of the lung cancer risks at which to screen ever- and never-smokers: Screening rules applied to the PLCO and NLST cohorts. PLoS Med, 2014, 11(12): e1001764.
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11.	Mazzone PJ, Lam L. Evaluating the patient with a pulmonary nodule: A review. JAMA, 2022, 327(3): 264-273.
12.	石峰, 王昕, 王全用, 等. 低剂量螺旋CT在肺部结节筛查中的应用价值研究. 影像研究与医学应用, 2021, 5(23): 84-85.Shi F, Wang X, Wang QY, et al. Study on the application value of low-dose spiral CT in the screening of pulmonary nodules. Imag Res Med Appl, 2021, 5(23): 84-85.
13.	张承刚. 毛刺征在CT诊断周围型小肺癌中的价值. 影像研究与医学应用, 2020, 4(12): 124-125.Zhang CG. The value of spicule sign in CT diagnosis of peripheral small lung cancer. Imag Res Med Appl, 2020, 4(12): 124-125.
14.	Meisinger QC, Klein JS, Butnor KJ, et al. CT features of peripheral pulmonary carcinoid tumors. AJR Am J Roentgenol, 2011, 197(5): 1073-1080.
15.	周程敏, 严肃, 单海荣, 等. 肺磨玻璃结节CT影像学特征分析. 中国医学装备, 2022, 19(9): 19-22.Zhou CM, Yan S, Shan HR, et al. Analysis of CT imaging features of pulmonary ground-glass nodules. Chin Med Equip, 2022, 19(9): 19-22.
16.	章智荣, 毛友生. 孤立性肺结节病变的诊断与处理策略. 中国肺癌杂志, 2013, 16(9): 499-508.Zhang ZR, Mao YS. Diagnosis and management strategies for solitary pulmonary nodules. Chin J Lung Cancer, 2013, 16(9): 499-508.
17.	Truong MT, Ko JP, Rossi SE, et al. Update in the evaluation of the solitary pulmonary nodule. Radiographics, 2014, 34(6): 1658-1679.
18.	张东军, 刘丽伟, 刘洋, 等. 胸膜凹陷征在胸膜下磨玻璃结节诊断中的价值. 东南大学学报(医学版), 2020, 39(3): 297-300.Zhang DJ, Liu LW, Liu Y, et al. The value of the pleural indentation sign in the diagnosis of subpleural ground-glass nodules. J Southeast Univ (Medical Edition), 2020, 39(3): 297-300.
19.	Hu H, Wang Q, Tang H, et al. Multi-slice computed tomography characteristics of solitary pulmonary ground-glass nodules: Differences between malignant and benign. Thorac Cancer, 2016, 7(1): 80-87.
20.	Shi CZ, Zhao Q, Luo LP, et al. Size of solitary pulmonary nodule was the risk factor of malignancy. J Thorac Dis, 2014, 6(6): 668-676.
21.	肖寿勇, 吴四云, 赵炜杰, 等. 浸润性肺腺癌高分辨率CT征象与病理亚型的对照研究. 临床放射学杂志, 2022, 41(1): 75-80.Xiao SY, Wu SY, Zhao WJ, et al. Correlation study between high-resolution CT signs and pathological subtypes of invasive lung adenocarcinoma. J Clin Radiol, 2022, 41(1): 75-80.
22.	Duan X, Ouyang Z, Bao S, et al. Factors associated with overdiagnosis of benign pulmonary nodules as malignancy: A retrospective cohort study. BMC Pulm Med, 2023, 23(1): 454.
23.	Grogan EL, Weinstein JJ, Deppen SA, et al. Thoracic operations for pulmonary nodules are frequently not futile in patients with benign disease. J Thorac Oncol, 2011, 6(10): 1720-1725.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med, 2020, 382(6): 503-513.
3. Archer JM, Mendoza DP, Hung YP, et al. Surgical resection of benign nodules in lung cancer screening: Incidence and features. JTO Clin Res Rep, 2023, 4(12): 100605.
4. Mazzone PJ, Silvestri GA, Souter LH, et al. Executive summary: Screening for lung cancer: Chest guideline and expert panel report. Chest, 2021, 160(5): 1959-1980.
5. Mazzone PJ, Silvestri GA, Souter LH, et al. Screening for lung cancer: CHEST guideline and expert panel report. Chest, 2021, 160(5): e427-e494.
6. 郭芳芳, 李欣菱, 王欣悦, 等. 亚实性肺结节CT征象在良恶性鉴别及腺癌恶性侵袭程度评估中的价值. 中国肺癌杂志, 2018, 21(6): 451-457.Guo FF, Li XL, Wang XY, et al. The value of CT signs of subsolid pulmonary nodules in the differentiation of benign and malignant nodules and the assessment of malignancy and invasiveness of adenocarcinoma. Chin J Lung Cancer, 2018, 21(6): 451-457.
7. Tammemägi MC, Church TR, Hocking WG, et al. Evaluation of the lung cancer risks at which to screen ever- and never-smokers: Screening rules applied to the PLCO and NLST cohorts. PLoS Med, 2014, 11(12): e1001764.
8. Horeweg N, van der Aalst CM, Vliegenthart R, et al. Volumetric computed tomography screening for lung cancer: Three rounds of the NELSON trial. Eur Respir J, 2013, 42(6): 1659-1667.
9. Patz EF, Pinsky P, Gatsonis C, et al. Overdiagnosis in low-dose computed tomography screening for lung cancer. JAMA Intern Med, 2014, 174(2): 269-274.
10. Jiang Y, Deng T, Huang Y, et al. Developing a multi-institutional nomogram for assessing lung cancer risk in patients with 5-30 mm pulmonary nodules: A retrospective analysis. PeerJ, 2023, 11: e16539.
11. Mazzone PJ, Lam L. Evaluating the patient with a pulmonary nodule: A review. JAMA, 2022, 327(3): 264-273.
12. 石峰, 王昕, 王全用, 等. 低剂量螺旋CT在肺部结节筛查中的应用价值研究. 影像研究与医学应用, 2021, 5(23): 84-85.Shi F, Wang X, Wang QY, et al. Study on the application value of low-dose spiral CT in the screening of pulmonary nodules. Imag Res Med Appl, 2021, 5(23): 84-85.
13. 张承刚. 毛刺征在CT诊断周围型小肺癌中的价值. 影像研究与医学应用, 2020, 4(12): 124-125.Zhang CG. The value of spicule sign in CT diagnosis of peripheral small lung cancer. Imag Res Med Appl, 2020, 4(12): 124-125.
14. Meisinger QC, Klein JS, Butnor KJ, et al. CT features of peripheral pulmonary carcinoid tumors. AJR Am J Roentgenol, 2011, 197(5): 1073-1080.
15. 周程敏, 严肃, 单海荣, 等. 肺磨玻璃结节CT影像学特征分析. 中国医学装备, 2022, 19(9): 19-22.Zhou CM, Yan S, Shan HR, et al. Analysis of CT imaging features of pulmonary ground-glass nodules. Chin Med Equip, 2022, 19(9): 19-22.
16. 章智荣, 毛友生. 孤立性肺结节病变的诊断与处理策略. 中国肺癌杂志, 2013, 16(9): 499-508.Zhang ZR, Mao YS. Diagnosis and management strategies for solitary pulmonary nodules. Chin J Lung Cancer, 2013, 16(9): 499-508.
17. Truong MT, Ko JP, Rossi SE, et al. Update in the evaluation of the solitary pulmonary nodule. Radiographics, 2014, 34(6): 1658-1679.
18. 张东军, 刘丽伟, 刘洋, 等. 胸膜凹陷征在胸膜下磨玻璃结节诊断中的价值. 东南大学学报(医学版), 2020, 39(3): 297-300.Zhang DJ, Liu LW, Liu Y, et al. The value of the pleural indentation sign in the diagnosis of subpleural ground-glass nodules. J Southeast Univ (Medical Edition), 2020, 39(3): 297-300.
19. Hu H, Wang Q, Tang H, et al. Multi-slice computed tomography characteristics of solitary pulmonary ground-glass nodules: Differences between malignant and benign. Thorac Cancer, 2016, 7(1): 80-87.
20. Shi CZ, Zhao Q, Luo LP, et al. Size of solitary pulmonary nodule was the risk factor of malignancy. J Thorac Dis, 2014, 6(6): 668-676.
21. 肖寿勇, 吴四云, 赵炜杰, 等. 浸润性肺腺癌高分辨率CT征象与病理亚型的对照研究. 临床放射学杂志, 2022, 41(1): 75-80.Xiao SY, Wu SY, Zhao WJ, et al. Correlation study between high-resolution CT signs and pathological subtypes of invasive lung adenocarcinoma. J Clin Radiol, 2022, 41(1): 75-80.
22. Duan X, Ouyang Z, Bao S, et al. Factors associated with overdiagnosis of benign pulmonary nodules as malignancy: A retrospective cohort study. BMC Pulm Med, 2023, 23(1): 454.
23. Grogan EL, Weinstein JJ, Deppen SA, et al. Thoracic operations for pulmonary nodules are frequently not futile in patients with benign disease. J Thorac Oncol, 2011, 6(10): 1720-1725.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical and pathological characteristics analysis of benign pulmonary nodules clinically highly suspected as malignant: A retrospective cohort study

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