Objective To analyze risk factors of malignancy in patients with small pulmonary nodules （diameter ≤2 cm） using univariate analysis and multivariate logistic regression，and establish a mathematical prediction model to estimatethe probability of malignancy. Methods Clinical data of 147 patients with small pulmonary nodules who underwentsurgical resection with definite postoperative pathological diagnosis from January 2005 to September 2012 in the 161st Central Hospital of PLA were retrospectively analyzed. There were 84 male and 63 female patients with their age of 31-78（56.2±10.1） years. Univariate analysis using Chi-square test or t test was performed to analyze risk factors including patientage，gender，symptoms，history and quantity of smoking，history of heavy drinking，history of tumor，tumor site，diameter，lobulation，spiculation，pleural indentation，ground-glass opacity，cavity，enlarged hilar and mediastinal lymph nodes.Independent predictors of malignancy were screened with multivariate logistic regression analysis. A mathematical predictionmodel was built to estimate the probability of malignancy and then examined. Results Univariate analysis showed that there was statistical difference in patient age（t=7.146，P＜0.001），heavy smoking history（χ2=6.169，P=0.013），nodule diameter（t=3.375，P=0.001），spiculation（χ2=5.609，P=0.018），lobulation（χ2=5.675，P=0.017），and pleural indentation（χ2=12.994，P＜0.001）between benign and malignant small pulmonary nodule groups. Multivariate logistic regression analysis showed that patient age （OR=1.110，P=0.000），nodule diameter （OR=2.050，P=0.029），lobulation （OR=1.672，P=0.045），spiculation（OR=2.054，P=0.032） and pleural indentation（OR=4.090，P=0.024）were independent predictors of malignancy in patients with small pulmonary nodules （P＜0.05） . The mathematical prediction model to estimate the probability of malignancy was：Logit （P） =ez/ （1 ＋ ez），Z=-6.657 ＋ （0.104×age） ＋ （0.718×diameter） ＋ （0.720×spiculation） ＋（0.514×lobulation） ＋ （1.409×pleural indentation），and e was natural logarithm. Both Hosmer-Lemeshow test （χ2=1.802，P=0.986） and maximum likelihood ratio test （Cox-Snell R2=0.310，Nagelkerke R2=0.443） showed satisfactory goodness of fit. The diagnostic accuracy was 85.71%，sensitivity was 87.50%，specificity was 81.40%，positive predictive value was 91.92%，and negative predictive value was 72.92% when the cut-off value was 0.58. Conclusions Patient age，nodule diameter，spiculation，lobulation and pleural indentation are independent predictors of malignancy in patients with small pulmonary nodules. The mathematical prediction model can accurately estimate the probability of malignancy for patients with small pulmonary nodules.
Abstract： Objective To explore the approach of clinical diagnosis and treatment strategy for patients with small pulmonary nodules （SPN）≤ 1.0 cm in size on CT. Methods We retrospectively analyzed the clinical records of 39 patients with SPN less than 1.0 cm in size who underwent lung resection at Nanjing Drum Tower Hospital from January 2005 to June 2011. There were 23 males and 16 females. Their age ranged from 31-74 （51.0±7.4） years. Nine patients had cough and sputum and other patients had no symptom. All the patients were found to have SPN less than 1.0（0.8±0.1）cm in size but not associated with hilum and mediastinal lymphadenectasis in chest CT and X-ray. The results of their sputum cytology and electronic bronchoscope were all negative. All the patients had no histologic evidence and underwent pulmonary function test prior to operation. Eleven patients had positron emission tomography/computer tomography （PET/CT）or single-photon emission computed tomography （SPECT）which was all negative. Thirteen patients underwent video-assisted minithoracotomy（VAMT） and 26 patients underwent video-assisted thoracoscopic surgery （VATS）. Results The average operation time was 121.0±48.0 min. Patients after partial lung resection were discharged 4～5 d postoperatively, and patients after lobectomy were discharged 7 d postoperatively. All the patients had no postoperative complications. Twenty one patients were identified as lung malignancy by postoperative pathology, including 9 patients with adenocarcinoma, 7 patients with bronchioloalveolar carcinoma, 1 patient with small cell lung carcinoma, and 4 patients with pulmonary metastasis. Eighteen patients had benign lesions including 4 patients with sclerosing hemangioma, 4 patients with inflammatory pseudotumor, 2 patients with pneumonia, 3 patients with granuloma, 2 patients with tuberculosis, and 3 patients with pulmonary lymph node hyperplasia. The SPN were located in left upper lobe in 11 patients, left lower lobe in 6 patients, right upper lobe in 14 patients, right middle lobe in 1 patient, and right lower lobe in 7 patients. Conclusion The diagnosis of SPN ≤1.0 cm in size on CT should consider malignance in the first step to avoid treatment delay. Patients may have a 3-month observation period to receive selective antibiotic treatment, chest CT and X-ray review after 2 to 4 weeks. CT- guided hook-wire fixation is useful to help in precise lesion localization for surgical resection. VATS and VAMT are common and effective methods for the diagnosis and treatment for SPN.
ObjectiveTo explore the safety and effectiveness of a precise marking method based on body surface mesh and three-dimensional (3D) image reconstruction.MethodsWe retrospectively analyzed the clinical data of 22 patients in our hospital from October 2018 to October 2019. There were 13 males and 9 females aged 58.5 (37-72) years. All patients underwent a precise marking of pulmonary nodules based on body surface mesh and 3D image reconstruction. Then, video-assisted thoracoscopic surgery (VATS) was performed to resect the nodules. The clinical data, including positioning success rate and operation time were analyzed.ResultsA total of 22 small pulmonary nodules were removed. The average diameter of small nodules was 12±3 mm, and the average distance from the visceral pleura was 17±6 mm. The localization success rate was 86.4%. The operation time was 110±43 min, and there was no surgery-related complication.ConclusionThe method of marking pulmonary nodules based on body surface mesh and 3D image reconstruction is a safe and reliable technology, which reduces the risk of hemopneumothorax caused by CT-guided lung puncture.
ObjectiveTo compare the effectiveness and safety of preoperative lung localization by microcoil and anchor with scaled suture.MethodsA total of 286 patients underwent CT-guided puncture localization consecutively between October 2019 and December 2020 in our hospital. According to the different methods of localization, they were divided into a microcoil group (n=139, including 49 males and 90 females, aged 57.92±10.51 years) and an anchor group (n=147, including 53 males and 94 females, aged 56.68±11.31 years). The clinical data of the patients were compared.ResultsA total of 173 nodules were localized in the microcoil group, and 169 nodules in the anchor group. The localization success rate was similar in the two groups. However, the anchor group was significantly better than the microcoil group in the localization time (8.15±2.55 min vs. 9.53±3.08 min, P=0.001), the pathological receiving time (30.46±14.41 min vs. 34.96±19.75 min, P=0.029), and the hemoptysis rate (10.7% vs. 30.1%, P=0.001), but the pneumothorax rate was higher in the anchor group (21.3% vs. 11.0%, P=0.006).ConclusionPreoperative localization of small pulmonary nodules using anchor with suture is practical and safe. Due to its simplicity and convenience, it is worth of promotion in the clinic.