Objective To analyze the imaging features of solitary pulmonary nodules ( SPNs) , and compare the two types of lung cancer prediction models in distinguishing malignancy of SPNs.Methods A retrospective study was performed on the patients admitted to Ruijin Hospital between 2002 and 2009 with newly discovered SPNs. The patients all received pathological diagnosis. The clinical and imaging characteristics were analyzed. Then the diagnostic accuracy of two lung cancer prediction models for distinguishing malignancy of SPNs was evaluated and compared.Results A total of 90 patients were enrolled, of which 32 cases were with benign SPNs, 58 cases were with malignant SPNs. The SPNs could be identified between benign and maligant by the SPN edge features of lobulation ( P lt;0. 05) . The area under ROC curve of VA model was 0. 712 ( 95% CI 0. 606 to 0. 821) . The area under ROC curve of Mayo Clinic model was 0. 753 ( 95% CI 0. 652 to 0. 843) , which was superior to VA model. Conclusions It is meaningful for the identification of benign and maligant SPNs by the obulation sign in CT scan. We can integrate the clinical features and the lung cancer predicting models to guide clinical work.
Diagnosis and treatment of solitary pulmonary nodule (SPN, less than 30 mm in diameter) has been a formidable problem in clinical work. It is often detected in medical examination or other disease examinations by chance. There are no corresponding signs and symptoms of SPN except those on the imaging, so it is difficult to make a correct diagnosis as early as possible. Literature shows that there is a certain probability of malignant SPN, so early correct diagnosis is the key factor in deciding the prognosis and appropriate treatment. With the accumulation of clinical experiences, the development of new fiberoptic bronchoscopy, highresolution CT, and videoassisted thoracoscopic surgery, as well as the evolution of some invasive examination technologies, it is less difficult in distinguishing benign from malignant SPN than ever before. In this article, we will make a comprehensive review on the development in the aspect of differential diagnosis of SPN.
Objective To investigate the risk factors, diagnosis and treatment of solitary pulmonary nodule （diameter≤3cm）. Methods From Jan. 2001 to Dec. 2002, the clinical data of 297 patients with solitary pulmonary nodule were reviewed. Chi-square or t-test were used in univariate analysis of age, gender, symptom, smoking history, the size, location and radiological characteristics of nodule, and logistic regression in multivariate analysis. Results Univariate analysis revealed that malignancy was significantly associated with age （P=0. 000）, smoking history （P=0. 001）, the size （P=0. 000） and radiological characteristics （P=0. 000） of nodule. In multivariate analysis （logistic regression）, it was significantly associated with age （OR = 1. 096）, the size （OR = 2. 329） and radiological characteristics （OR=0. 167） of nodule. Conclusion Age and the size of nodule could be risk factors. Radiological findings could help distinguish from malignant nodules.
Objective To evaluate the value of incremental dynamic enhanced computer tomography (CT) in diagnosis of solitary pulmonary nodules (SPN). Methods The data of 42 cases with SPN who had undergone pulmonary lobectomy were collected retrospectively to find the relationship between character of preoperative dynamic enhanced CT image and postoperative pathologic result. Results All bronchogenic carcinoma showed significant enhancement after intravenous 100 ml iodinated contrast material. The average degree of enhancement of bronchogenic carcinoma during the time 85s and 135s after infusion was significantly different from that of tuberculoma and other benign lesions(Plt;0.05). Conclusion Dynamic enhanced CT is valuable in identifying the malignant nodules from benign nodules. Emphasis should be paid to the lymph nodes in the relative field with dynamic enhanced CT, which is beneficial to the diagnosis of SPN and it is an important predictor of the result of surgical treatment.
ObjectiveTo elucidate the relationship between clinical characteristics and pathology findings of solitary pulmonary nodules (SPN). MethodsA retrospective cohort study was carried out on 231 SPN patients pathologically confirmed between January 2009 and December 2013 in Nanjing General Hospital of Fuzhou Military Command and Fuzhou Second Hospital. Using pathological results as reference standard, the sex, age, smoking history, smoking amount, quit smoking history, and extrapulmonary malignant tumor history were compared between the SPN patients with different pathological type. ResultsFemale and age were positively correlated with the probability of malignancy in SPN with correlation coefficients as 1.090 and 0.063 respectively. Extrapulmonary malignant tumor history, smoking history, smoking amount, quit smoking history did not show significant relationship. Gender was a factor that affects pathological types of SPN. Female patients were in higher risk than male patients to have precancerous lesions, pulmonary aspergillosis, pulmonary sclerosing hemangioma, adenocarcinoma. Male patients had higher risk suffering from pulmonary tuberculosis, pulmonary cryptococcosis, squamous cell carcinoma, adenosquamous carcinoma, inflammatory pseudotumor and metastases. Distribution of SPN pathologic types in each age group was similar. Most patients who had precancerous lesions, pulmonary hamartoma, pulmonary aspergillosis, pulmonary sclerosing hemangioma, adenocarcinoma and inflammatory pseudotumor were not smokers. ConclusionsGender and age are valuable in distinguishing benign SPN from malignant SPN. Pathologic types of SPN are related to patients' gender and smoking history.
With widespread utilization of multi-slice helical computed tomography (CT) and low-dose CT in lung cancer screening, significantly greater incidence of patients with solitary pulmonary nodules (SPN) has been found. Once SPN is discovered, it is very difficult to immediately determine whether it is benign or malignant in clinical practice. In this review, SPN etiology, epidemiological characteristics of SPN patients, nodule size, morphology, location and growth rate, mathematical models for predicting malignancy of SPN, and diagnostic value of positron emission tomography (PET) and positron emission tomography-computed tomography (PET/CT) are summarized to provide reference for differential diagnosis of SPN. Current management strategies for SPN are also discussed in this review. According to whether SPN diameter is greater than 8 mm, whether SPN patients are advanced aged, have smoking or malignancy history, different follow-up and treatment strategies can be chosen. The diagnostic and treatment value of video-assisted thoracoscopic surgery for SPN is also discussed.
More and more solitary pulmonary nodules (SPN) are discovered with the development of imaging technology. Early and appropriate evaluation of SPN is of great importance for following treatment and patients' prognosis, as early differentiation between benign and malignant is difficult, while its possibility of being malignant does exist. In this review, we make a comprehensive evaluation about diagnostic value of some risk factors of solitary pulmonary nodules, including age, nodule diameter, doubling time, nodule location, air bronchogram, ground-glass opacitie, vacuole, lobulation, spiculation, vascular convergence, pleural indentation, nodule calcification, past medical history, smoking history, past symptoms and nodule density. Future perspective of diagnostic strategies is also discussed.
ObjectiveTo investigate differential diagnosis between benign and malignant of solitary pulmonary nodules (SPN)and surgical strategies. MethodsWe retrospectively analyzed clinical and pathological data of 151 SPN patients who underwent surgical resection in Provincial Hospital Affiliated to Shandong University between November 2010 and March 2012. There were 89 male and 62 female patients with their age of 30-80 (57.99±0.86)years. Differential factors between benign and malignant SPN were analyzed. ResultsThere were 29 patients with benign SPN and 122 patients with malignant SPN. Among the 122 malignant SPN patients, there were 58 patients in stage ⅠA, 30 patients in stage ⅠB, 7 patients in stage ⅡA, 25 patients in stage ⅢA and 2 patients in stage Ⅳ. Mean diameter of malignant SPN was significantly larger than that of benign SPN (2.03 cm vs 1.77 cm, P=0.039). Malignant rate of SPN larger than 2 cm was significantly higher than that of SPN smaller than 2 cm (90.3% vs. 74.2%, P=0.013). Patients with malignant SPN was significantly older than patients with benign SPN (60.39 years vs. 47.90 years, P < 0.01). Malignant rate of patients over 45 years was significantly higher than that of patients younger than 45 years (86.4% vs. 38.9%, P < 0.01).There was no statistical difference in malignant rate between male and female, with and without clinical symptoms, smoking and nonsmo-king, smoking index≤400 and > 400 and among different lobes. Conclusions Differential factors of SPN include patients' medical history, age, diameter and shape of nodules, which should be considered comprehensively and dynamically. Gender, clinical symptoms, smoking history, smoking index and SPN location are not helpful for differential diagnosis of SPN.
ObjectiveTo explore clinical strategies of early diagnosis and treatment of solitary pulmonary nodules (SPN), and define the importance of biological tumor markers, preoperative CT-guided localization with the combination of methylene blue and hookwire system, and video-assisted thoracoscopic surgery (VATS)for early diagnosis and treatment of SPN. MethodsWe retrospectively analyzed clinical records of 70 SPN patients in Department of Thoracic Surgery of Taixing People's Hospital from January 2011 to February 2014. There were 33 male and 37 female patients with their age of 32-87 (59.74±2.04)years. Preoperatively, patients' medical history, heart, lung, liver and kidney function, sputum cytology and bronchoscopic biopsy results were combined with biological tumor markers to make a preliminary differential diagnosis between benign or malignant SPN and surgical risk evaluation. For SPN less than 1 cm or too small for accurate intraoperative localization, CT-guided localization with the combination of methylene blue and hookwire system was routinely performed half an hour before the operation. For SPN large enough for accurate intraoperative localization, wedge resection of SPN and surrounding lung tissue was directly performed with VATS. Intraoperative frozen-section examination of resected lung specimens was preformed. If the pathological diagnosis was malignant, conventional VATS lobectomy/segmentectomy and lymphadenectomy were performed. If the pathological diagnosis was benign, the operation was then completed. Long-term follow-up was performed for SPN patients, especially patients with early-stage lung cancer. ResultsThere was no in-hospital death or postoperative bronchopleural fistula in this study. Postoperatively, there were 2 patients with pneumonia, 3 patients with pneumothorax and 1 patient with wound infection, who were all cured or improved after proper treatment. Among the 70 patients, 11 patients acquired pathological diagnosis via preoperative lung needle biopsy. Among the other 59 patients, 12 patients with eccentric SPN acquired pathological diagnosis via intraoperative biopsy, and 47 patients underwent SPN resection with VATS. Pathological diagnosis included adenocarcinoma in 19 patients, squamous cell carcinoma in 9 patients, bronchioloalveolar carcinoma in 3 patients, adenosquamous carcinoma in 2 patients, inflammatory pseudotumor in 11 patients, tuberculoma in 4 patients, granuloma in 5 patients, sclerosing hemangioma in 2 patients, lung metastasis from breast cancer in 1 patient, lung metastasis from colon cancer in 1 patient, lung metastasis from thyroid cancer in 1 patient, and lung metastasis from stomach cancer in 1 patient. All the 70 patients (100%)were followed up for a mean duration of 2-34 months, and there was no late death during follow-up. One patient with adenocarcinoma of the right upper lobe had cerebral metastasis 18 months after operation, and had been receiving radiotherapy. All the other patients had a good quality of life. ConclusionAbove clinical strategies are accurate for early diagnosis and minimally invasive treatment of SPN with good postoperative recovery and short-term outcomes.
ObjectiveTo compare solitary pulmonary nodule resection via thoracoscopic 3D mode or 2D mode and to further evaluate the clinical application value of thoracoscopic 3D mode. MethodsWe retrospectively analyzed the clinical data of 120 patients with solitary pulmonary nodule between March 2013 and March 2014 in the First Hospital Affiliated to Xiamen University. The patients were allocated into two groups including a 3D-VATS group (50 patients) and a 2D-VATS group (70 patients). Pulmonary partial resection was performed firstly. Pulmonary lobectomy would be conducted or not on the basis of intra operative rapid pathological results. ResultsTwenty three patients were performed 3D-VATS in the 3D-VATS group. Twenty-nine patients were diagnosed as pathological malignancy underwent lobectomy plus partial dissection. There were statistical differences between the 3D-VATS group and the 2D-VATS group in operative time (t=1.967, P<0.05), intra operative blood loss (t=7.85, P<0.05), drainage volume 24 h after operation (t=6.18, P<0.05), postoperative chest tube retention time (t=7.1, P<0.05), and postoperative hospital stay (t=2.35, P<0.05). Following-up time in the 3D-VATS group was 6.3 (2-12) months. Complications occurred in 3 patients, including 2 patients with postoperative pneumonia and 1 patient with paroxysmal atrial fibrillation in the 3D-VATS group. The following-up time in the 2D-VATS group was 8.2 (2-15) months. Complications occurred in 4 patients, including 1 patient with chylous hydrothorax, 2 patients with pneumothorax, 1 patient with delayed pulling up the chest closed drainage in the 2D-VATS group. The patients in both groups with complications were cured by appropriate treatment. Conclusion3D-VAST for SPN is a new operation mode choice. It is safe and feasible with low incidence of postoperative complications. Surgery vision, stereo feeling, the operation of adaptation, and postoperative recovery have certain advantages. It is worthy popularizing.