Differential Diagnosis between Benign and Malignant Solitary Pulmonary Nodules_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGHua , PENGZhong-min , GAOJin-ping , WANGXiao-hang , LIUYing , WANGGong-chao

Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Jinan 250021, P. R. China;

Corresponding?author：

Keywords：

Solitary pulmonary nodule; Diagnosis; Surgery

DOI：

10.7507/1007-4848.20140225

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Objective To investigate differential diagnosis between benign and malignant of solitary pulmonary nodules (SPN)and surgical strategies. Methods We 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. Results There 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. Conclusion s 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.

Citation： JIANGHua, PENGZhong-min, GAOJin-ping, WANGXiao-hang, LIUYing, WANGGong-chao. Differential Diagnosis between Benign and Malignant Solitary Pulmonary Nodules. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(6): 788-791. doi: 10.7507/1007-4848.20140225 Copy

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16.	常棟, 龔民, 胡健, 等.外周型孤立性肺結節的診斷和外科治療.中國腫瘤臨床與康復, 2010, 17(2):115-117.
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18.	王利偉, 王自正, 顧建平, 等.孤立性肺結節的影像學研究進展.國外醫學(放射醫學核醫學分冊), 2005, 29(6):248-251.
19.	王光鎖, 王正, 林少霖, 等.胸腔鏡手術在孤立性肺結節診斷和治療的應用.臨床肺科雜志, 2009, 14(9):1239-1240.
20.	申屠陽, 程華, 李偉, 等.孤立性肺結節在法國的診斷.循證醫學, 2009, 9(2):33-35.
21.	中國抗癌協會肺癌專業委員會吳一龍, 蔣國樑, 廖美琳, 等.孤立性肺結節的處理.循證醫學, 2009, 9(4):243-246.

1. Tuddenham WJ. Glossary of terms for thoracic radiology:Recommendations of the Nomenclature Committee of the Fleischner Society. Am J Roentgenol, 1984, 143:509-517.
2. Jeong YJ, Yi CA, Lee KS. Solitary pulmonary nodules:Detection, characterization, and guidance for further diagnostic workup and treatment. Am J Roentgenol, 2007, 188(1):57-68.
3. Smith MA, Battafarano RJ, Meyers BF, et al. Prevalence of benign disease in patients undergoing resection for suspected lung cancer. Ann Thorac Surg, 2006, 81(5):1824-1829.
4. Li Y, Chen KZ, Wang J. Development and validation of a clinical prediction model to estimate the probability of malignancy in solitary pulmonary nodules in Chinese people. Clin Lung Cancer, 2011, 12(5):313-319.
5. Vazquez M, Carter D, Brambilla EA, et al. Solitary and multiple resected adenocarcinomas after CT screening for lung cancer:Histopathologic features and their prognostic implications. Lung Cancer, 2009, 64(2):148-154.
6. Varoli F, Vergani C, Caminiti R, et al. Management of solitary pulmonary nodule. Eur J Cardiothoracic Surg, 2008, 33(3):461-465.
7. 支修益, 吳一龍, 馬勝林, 等.原發性肺癌診療規范(2011年版).中國肺癌雜志, 2012, 15(12):677-688.
8. Doll R, Hill AB. A study of the etiology of carcinoma of the lung. Br Med J, 1952, 2:1271.
9. Levin ML, Goldstein H, Gerhardt PR. Cancer Tobacco Smoking:a Preliminary Report. JAMA, 1950, 143:336.
10. Doll R, Peto R. Mortality in relation to smoking:20 years'observations on male British doctors. Br Med J, 1976, 2:1525.
11. Rogot E, Murray JL. Smoking and causes of death among US veterans:16 years of observation. Public Health Rep, 1980, 15:213.
12. Schottengeld D, Chief editor.肺癌的病因學和流行病學.第2版.北京:人民衛生出版社, 2002.335-353.
13. Soubani AO. The evaluation and management of the solitary pulmonary nodule. Postgrad Med J, 2008, 84(995):459-466.
14. Wahidi MM, Govert JA, Goudar RK, et al. Evidence for the treatment of patients with pulmonary nodules:when is it lung cancer?ACCP evidence-based clinical practice guidelines(2nd ed). Chest, 2007, 132:945-1075.
15. 吳江, 朱虹, 常林鳳, 等. 18F-脫氧葡萄糖PET/CT診斷惡性孤立性肺結節的Meta分析.醫學研究生學報, 2011, 24(1):39-42.
16. 常棟, 龔民, 胡健, 等.外周型孤立性肺結節的診斷和外科治療.中國腫瘤臨床與康復, 2010, 17(2):115-117.
17. 朱峰, 于在誠.孤立性肺結節的良惡性鑒別及外科治療.安徽醫科大學學報, 2012, 47(10):1269-1272.
18. 王利偉, 王自正, 顧建平, 等.孤立性肺結節的影像學研究進展.國外醫學(放射醫學核醫學分冊), 2005, 29(6):248-251.
19. 王光鎖, 王正, 林少霖, 等.胸腔鏡手術在孤立性肺結節診斷和治療的應用.臨床肺科雜志, 2009, 14(9):1239-1240.
20. 申屠陽, 程華, 李偉, 等.孤立性肺結節在法國的診斷.循證醫學, 2009, 9(2):33-35.
21. 中國抗癌協會肺癌專業委員會吳一龍, 蔣國樑, 廖美琳, 等.孤立性肺結節的處理.循證醫學, 2009, 9(4):243-246.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Differential Diagnosis between Benign and Malignant Solitary Pulmonary Nodules

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