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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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, 王欣悅, 等. 亞實性肺結節CT征象在良惡性鑒別及腺癌惡性侵襲程度評估中的價值. 中國肺癌雜志, 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.	Tammem?gi 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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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. 低劑量螺旋CT在肺部結節篩查中的應用價值研究. 影像研究與醫學應用, 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.	張承剛. 毛刺征在CT診斷周圍型小肺癌中的價值. 影像研究與醫學應用, 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, 嚴肅, 單海榮, 等. 肺磨玻璃結節CT影像學特征分析. 中國醫學裝備, 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.	章智榮, 毛友生. 孤立性肺結節病變的診斷與處理策略. 中國肺癌雜志, 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.	張東軍, 劉麗偉, 劉洋, 等. 胸膜凹陷征在胸膜下磨玻璃結節診斷中的價值. 東南大學學報(醫學版), 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.	肖壽勇, 吳四云, 趙煒杰, 等. 浸潤性肺腺癌高分辨率CT征象與病理亞型的對照研究. 臨床放射學雜志, 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, 王欣悅, 等. 亞實性肺結節CT征象在良惡性鑒別及腺癌惡性侵襲程度評估中的價值. 中國肺癌雜志, 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. Tammem?gi 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. 低劑量螺旋CT在肺部結節篩查中的應用價值研究. 影像研究與醫學應用, 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. 張承剛. 毛刺征在CT診斷周圍型小肺癌中的價值. 影像研究與醫學應用, 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, 嚴肅, 單海榮, 等. 肺磨玻璃結節CT影像學特征分析. 中國醫學裝備, 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. 章智榮, 毛友生. 孤立性肺結節病變的診斷與處理策略. 中國肺癌雜志, 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. 張東軍, 劉麗偉, 劉洋, 等. 胸膜凹陷征在胸膜下磨玻璃結節診斷中的價值. 東南大學學報(醫學版), 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. 肖壽勇, 吳四云, 趙煒杰, 等. 浸潤性肺腺癌高分辨率CT征象與病理亞型的對照研究. 臨床放射學雜志, 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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