Risk Factor Analysis for Solitary Pulmonary Nodules between Benign and Malignant_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGWei-dong ,  SHIHong-can

Medical College of Yangzhou University, Yangzhou 225001, Jiangsu, P. R. China;

Corresponding author：

SHIHong-can, Email: shihongcan@hotmail.com

Keywords：

Solitary pulmonary nodule; Early diagnosis; Lung carcinoma

DOI：

10.7507/1007-4848.20140151

Video：

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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.

Citation： ZHANGWei-dong, SHIHong-can. Risk Factor Analysis for Solitary Pulmonary Nodules between Benign and Malignant. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 532-536. doi: 10.7507/1007-4848.20140151 Copy

1.	O' Brien EJ, Tuttle WM, Ferkaney JE. The management of the pulmo-nary coin lesion. Surg Clin North Am, 1948, 28:1313-1322.
2.	Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulm-onary nodule. N Engl J Med, 2003, 348 (25):2535-2542.
3.	Igai H, Matsuura N, Tarumi S, et al. Clinicopathological study of p-T1aN0M0 non-small-cell lung cancer, as defined in the seventh edition of the TNM classification of malignant tumors. Eur J Cardiothorac Surg, 2011, 39 (6):963-967.
4.	Wiener RS, Gould MK, Woloshin SA, et al. What do you mean, a spot? a qualitative analysis of patients' reactions to discussions with their physicians about pulmonary nodules. Chest, 2013, 143(3):672-677.
5.	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.
6.	Harders SW. LUCIS:lung cancer imaging studies. Dan Med J, 2012, 59 (11):B4542.
7.	张轶, 丁嘉安.孤立性肺结节良恶性病变的危险因素分析.中国胸心血管外科临床杂志, 2006, 13 (3):162-165.
8.	Varoli F, Vergani C, Caminiti R, et al. Management of solitary pulm-onary nodule. Eur J Cardiothorac Surg, 2008, 33 (3):461-465.
9.	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.
10.	Lin NE, Wu S, Wang K, et al. Computed tomography quantitative analysis of components:a new method monitoring the growth of pulmonary nodule. Acta radiol, 2013, 54 (8):904-908.
11.	Gohagan J, Marcus P, Fagerstrom R, et al. Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs chest radiograph:the Lung Screening Study of the National Cancer Institute. Chest, 2004, 126 (1):114-121.
12.	杨德松, 李运, 刘军, 等.孤立性肺结节直径大小与临床及病理关系的初步研究.中国肺癌杂志, 2010, 13 (6):607-611.
13.	王涛, 陈宝俊, 范晓红, 等.肺微小结节的临床诊断与治疗.中国胸心血管外科临床杂志, 2012, 19 (3):274-279.
14.	Ginsberg RJ. The solitary pulmonary nodule:can we afford to watch and wait? J Thorac Cardiovasc Surg, 2003, 125 (1):25-26.
15.	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 edition). Chest, 2007, 132 (3 Suppl):94S-107S.
16.	Macmahon H, Austin JH, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans:a statement from the Fleischner Society. Radiology, 2005, 237 (2):395-400.
17.	王德江, 李希波, 杨涛.肺内孤立性结节的诊断与处理.肿瘤防治杂志, 2004, 11 (7):753-757.
18.	刘瑛, 吴宁. CT三维体积测量技术在孤立性肺结节诊断中的初步应用.医学影像学杂志, 2006, 16 (1):88-90.
19.	方振剑, 佘晖, 董芳, 等.孤立性肺结节的临床评估.中国医师进修杂志, 2013, 36 (7):17-21.
20.	Swensen SJ, Yamashita K, Mccollough CH, et al. Lung nodules:Dual-kilovolt peak analysis with CT-Multicenter study. Radiology, 2000, 214 (1):81-85.
21.	Winer-Muram HT, Jennings SG, Tarver RD, et al. Volumetric growth rate of stage I lung cancer prior to treatment:serial CT scanning. Radiology, 2002, 223 (3):798-805.
22.	Swensen SJ, Silverstein MD, Ilstrup DM, et al. The probability of malignancy in solitary pulmonary nodules. Application to small radio-logically indeterminate nodules. Arch Intern Med, 1997, 157 (8):849-855.
23.	龚拥军, 包宏伟. CT像上支气管充气征的再分析.实用医学影像杂志, 2009, 10 (1):21-23, 57.
24.	Austin JH, Müller NL, Friedman PJ, et al. Glossary of terms for CT of the lungs:recommendations of the Nomenclature Committee of the Fleischner Society. Radiology, 1996, 200 (2):327-331.
25.	雷志丹, 葛英辉, 史大鹏.肺部弥漫性磨玻璃阴影的CT诊断与鉴别诊断.中国医学影像技术, 2007, 23 (8):1147-1151.
26.	秦岭, 施举红, 刘鸿瑞, 等.影像学表现为双肺弥漫磨玻璃影的肺非霍奇金淋巴瘤的临床特点.中华医学杂志, 2010, 90 (46):3283-3286.
27.	Lim HJ, Ahn S, Lee KS, et al. Persistent pure ground-glass opacity lung nodules>=10 mm in diameter at CT scan histopathologic compa-risons and prognostic implications. Chest, 2013, 144 (4):1291-1299.
28.	宋勇, 展平.肺部磨玻璃影的鉴别诊断与处理.中华结核和呼吸杂志, 2009, 32 (11):808-809.
29.	李琼, 刘士远, 范丽, 等. 3cm以下肺恶性局灶性磨玻璃密度病变的MDCT表现.实用放射学杂志, 2011, 27 (5):689-693.
30.	Macdonald K, Searle J, Lyburn I. The role of dual time point FDG PET imaging in the evaluation of solitary pulmonary nodules with an initial standard uptake value less than 2.5. Clin Radiol, 2011, 66 (3):244-250.
31.	王晓华, 马大庆, 周新华.气腔密度影诊断周围型小肺癌的价值及其病理基础.中国医学影像学杂志, 2005, 13 (6):427-430.
32.	Aoki T, Nakata H, Watanabe H, et al. Evolution of peripheral lung adenocarcinomas:CT findings correlated with histology and tumor doubling time. AJR Am J Roentgenol, 2000, 174 (3):763-768.
33.	Wang JC, Sone S, Feng L, et al. Rapidly growing small peripheral lung cancers detected by screening CT:correlation between radiological appearance and pathological features. Br J Radiol, 2000, 73 (873):930-937.
34.	李泽坚, 王建军, 单根法, 主编.实用临床胸外科学.北京:科学技术文献出版社, 2007.23-30.
35.	刘大亮, 马大庆, 陈广. CT的分叶征表现在肺内孤立结节影像诊断中的价值.中华放射学杂志, 2007, 41 (5):487-489.
36.	李运, 陈克终, 隋锡朝, 等.孤立性肺结节良恶性判断数学预测模型的建立.北京大学学报:医学版, 2011, 43 (3):450-454.
37.	王晓华, 马大庆, 陈卉.毛刺征在CT诊断周围型小肺癌中的价值.中国医学影像学杂志, 2006, 14 (2):127-130.
38.	杨德松, 李运, 姜冠潮, 等.孤立性肺结节良恶性判断数学预测模型的临床验证及应用.中华胸心血管外科杂志, 2012, 28 (2):82-85.
39.	王万旗, 王志铭, 寇景全, 等. 3 cm以下周围型肺癌瘤周毛刺的HRCT表现.中国CT和MRI杂志, 2011, 9 (1):4-6.
40.	吴华伟, 肖湘生, 刘士远, 等.周围型肺癌胸膜凹陷征形成的瘤内基础及相关影响因素.中华放射学杂志, 2001, 35 (10):731-735.
41.	张开华, 张志勇, 单飞, 等.螺旋CT对良性及恶性胸膜凹陷的鉴别诊断.中华结核和呼吸杂志, 2008, 31 (5):384-386.
42.	崔云, 马大庆, 杨静.肺结节胸膜凹陷征诊断价值的Meta分析.首都医科大学学报, 2007, 28 (6):709-712.
43.	黄佐良, 何望春, 周继华, 等.血管集中征对周围型肺癌的诊断价值.中华放射学杂志, 1999, 29 (1):47-49.
44.	韩玉成, 程绍玲, 初建国, 等.周围型肺癌的支气管血管集束征-CT病理表现及其形成机制.中国临床医学影像杂志, 2001, 12 (2):93-97.
45.	Gould MK, Ananth L, Barnett PG, et al. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest, 2007, 131 (2):383-388.
46.	秦卫.孤立性肺结节的良恶性鉴别诊断进展.中国胸心血管外科临床杂志, 2011, 18 (2):153-156.
47.	Harders SW, Madsen HH, Rasmussen TR, et al. High resolution spiral CT for determining the malignant potential of solitary pulmonary nodules:refining and testing the test. Acta radiol, 2011, 52 (4):401-409.
48.	罗玉忠, 何巍.孤立性肺结节的评价和处理.广西医科大学学报, 2010, 27 (5):809-811.
49.	李运, 隋锡朝, 杨德松, 等.孤立性肺结节的危险因素.中华胸心血管外科杂志, 2010, 26 (3):161-164.
50.	陈孝平, 石应康, 邱贵兴, 等主编.外科学.第2版.北京:人民卫生出版社, 2010. 430-439.
51.	Veronesi G, Bellomi M, Spaggiari L, et al. Low dose spiral computed tomography for early diagnosis of lung cancer:results of baseline screening in 5, 000 high-risk volunteers; ASCO Annual Meeting Proceedings Part I. J Clin Oncol, 2006, 24 (18 Suppl):7029.
52.	Mery CM, Pappas AN, Bueno R, et al. Relationship between a history of antecedent cancer and the probability of malignancy for a solitary pulmonary nodule. Chest, 2004, 125 (6):2175-2181.
53.	Soubani AO. The evaluation and management of the solitary pulmonary nodule. Postgrad Med J, 2008, 84 (995):459-466.
54.	Zhan P, Shen XK, Qian Q, et al. Expression of caveolin-1 is correlated with disease stage and survival in lung adenocarcinomas. Oncol Rep, 2012, 27 (4):1072-1078.
55.	Gould MK, Fletcher J, Iannettoni MD, et al. Evaluation of patients with pulmonary nodules:when is it lung cancer?:ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132 (3 Suppl):108S-130S.
56.	Swensen SJ, Silverstein MD, Edell ES, et al. Solitary pulmonary nodules:clinical prediction model versus physicians. Mayo Clin Proc, 1999, 74 (4):319-329.
57.	王垚青, 孙希文, 徐长青, 等.应用Lung Care软件评估孤立性肺结节.中国医学计算机成像杂志, 2012, 18 (4):307-311.
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59.	Jeong YJ, Yi CA, Lee KS. Solitary pulmonary nodules:Detection, characterization, and guidance for further diagnostic workup and treatment. AJR Am J Roentgenol, 2007, 188 (1):57-68.

1. O' Brien EJ, Tuttle WM, Ferkaney JE. The management of the pulmo-nary coin lesion. Surg Clin North Am, 1948, 28:1313-1322.
2. Ost D, Fein AM, Feinsilver SH. Clinical practice. The solitary pulm-onary nodule. N Engl J Med, 2003, 348 (25):2535-2542.
3. Igai H, Matsuura N, Tarumi S, et al. Clinicopathological study of p-T1aN0M0 non-small-cell lung cancer, as defined in the seventh edition of the TNM classification of malignant tumors. Eur J Cardiothorac Surg, 2011, 39 (6):963-967.
4. Wiener RS, Gould MK, Woloshin SA, et al. What do you mean, a spot? a qualitative analysis of patients' reactions to discussions with their physicians about pulmonary nodules. Chest, 2013, 143(3):672-677.
5. 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.
6. Harders SW. LUCIS:lung cancer imaging studies. Dan Med J, 2012, 59 (11):B4542.
7. 张轶, 丁嘉安.孤立性肺结节良恶性病变的危险因素分析.中国胸心血管外科临床杂志, 2006, 13 (3):162-165.
8. Varoli F, Vergani C, Caminiti R, et al. Management of solitary pulm-onary nodule. Eur J Cardiothorac Surg, 2008, 33 (3):461-465.
9. 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.
10. Lin NE, Wu S, Wang K, et al. Computed tomography quantitative analysis of components:a new method monitoring the growth of pulmonary nodule. Acta radiol, 2013, 54 (8):904-908.
11. Gohagan J, Marcus P, Fagerstrom R, et al. Baseline findings of a randomized feasibility trial of lung cancer screening with spiral CT scan vs chest radiograph:the Lung Screening Study of the National Cancer Institute. Chest, 2004, 126 (1):114-121.
12. 杨德松, 李运, 刘军, 等.孤立性肺结节直径大小与临床及病理关系的初步研究.中国肺癌杂志, 2010, 13 (6):607-611.
13. 王涛, 陈宝俊, 范晓红, 等.肺微小结节的临床诊断与治疗.中国胸心血管外科临床杂志, 2012, 19 (3):274-279.
14. Ginsberg RJ. The solitary pulmonary nodule:can we afford to watch and wait? J Thorac Cardiovasc Surg, 2003, 125 (1):25-26.
15. 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 edition). Chest, 2007, 132 (3 Suppl):94S-107S.
16. Macmahon H, Austin JH, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans:a statement from the Fleischner Society. Radiology, 2005, 237 (2):395-400.
17. 王德江, 李希波, 杨涛.肺内孤立性结节的诊断与处理.肿瘤防治杂志, 2004, 11 (7):753-757.
18. 刘瑛, 吴宁. CT三维体积测量技术在孤立性肺结节诊断中的初步应用.医学影像学杂志, 2006, 16 (1):88-90.
19. 方振剑, 佘晖, 董芳, 等.孤立性肺结节的临床评估.中国医师进修杂志, 2013, 36 (7):17-21.
20. Swensen SJ, Yamashita K, Mccollough CH, et al. Lung nodules:Dual-kilovolt peak analysis with CT-Multicenter study. Radiology, 2000, 214 (1):81-85.
21. Winer-Muram HT, Jennings SG, Tarver RD, et al. Volumetric growth rate of stage I lung cancer prior to treatment:serial CT scanning. Radiology, 2002, 223 (3):798-805.
22. Swensen SJ, Silverstein MD, Ilstrup DM, et al. The probability of malignancy in solitary pulmonary nodules. Application to small radio-logically indeterminate nodules. Arch Intern Med, 1997, 157 (8):849-855.
23. 龚拥军, 包宏伟. CT像上支气管充气征的再分析.实用医学影像杂志, 2009, 10 (1):21-23, 57.
24. Austin JH, Müller NL, Friedman PJ, et al. Glossary of terms for CT of the lungs:recommendations of the Nomenclature Committee of the Fleischner Society. Radiology, 1996, 200 (2):327-331.
25. 雷志丹, 葛英辉, 史大鹏.肺部弥漫性磨玻璃阴影的CT诊断与鉴别诊断.中国医学影像技术, 2007, 23 (8):1147-1151.
26. 秦岭, 施举红, 刘鸿瑞, 等.影像学表现为双肺弥漫磨玻璃影的肺非霍奇金淋巴瘤的临床特点.中华医学杂志, 2010, 90 (46):3283-3286.
27. Lim HJ, Ahn S, Lee KS, et al. Persistent pure ground-glass opacity lung nodules>=10 mm in diameter at CT scan histopathologic compa-risons and prognostic implications. Chest, 2013, 144 (4):1291-1299.
28. 宋勇, 展平.肺部磨玻璃影的鉴别诊断与处理.中华结核和呼吸杂志, 2009, 32 (11):808-809.
29. 李琼, 刘士远, 范丽, 等. 3cm以下肺恶性局灶性磨玻璃密度病变的MDCT表现.实用放射学杂志, 2011, 27 (5):689-693.
30. Macdonald K, Searle J, Lyburn I. The role of dual time point FDG PET imaging in the evaluation of solitary pulmonary nodules with an initial standard uptake value less than 2.5. Clin Radiol, 2011, 66 (3):244-250.
31. 王晓华, 马大庆, 周新华.气腔密度影诊断周围型小肺癌的价值及其病理基础.中国医学影像学杂志, 2005, 13 (6):427-430.
32. Aoki T, Nakata H, Watanabe H, et al. Evolution of peripheral lung adenocarcinomas:CT findings correlated with histology and tumor doubling time. AJR Am J Roentgenol, 2000, 174 (3):763-768.
33. Wang JC, Sone S, Feng L, et al. Rapidly growing small peripheral lung cancers detected by screening CT:correlation between radiological appearance and pathological features. Br J Radiol, 2000, 73 (873):930-937.
34. 李泽坚, 王建军, 单根法, 主编.实用临床胸外科学.北京:科学技术文献出版社, 2007.23-30.
35. 刘大亮, 马大庆, 陈广. CT的分叶征表现在肺内孤立结节影像诊断中的价值.中华放射学杂志, 2007, 41 (5):487-489.
36. 李运, 陈克终, 隋锡朝, 等.孤立性肺结节良恶性判断数学预测模型的建立.北京大学学报:医学版, 2011, 43 (3):450-454.
37. 王晓华, 马大庆, 陈卉.毛刺征在CT诊断周围型小肺癌中的价值.中国医学影像学杂志, 2006, 14 (2):127-130.
38. 杨德松, 李运, 姜冠潮, 等.孤立性肺结节良恶性判断数学预测模型的临床验证及应用.中华胸心血管外科杂志, 2012, 28 (2):82-85.
39. 王万旗, 王志铭, 寇景全, 等. 3 cm以下周围型肺癌瘤周毛刺的HRCT表现.中国CT和MRI杂志, 2011, 9 (1):4-6.
40. 吴华伟, 肖湘生, 刘士远, 等.周围型肺癌胸膜凹陷征形成的瘤内基础及相关影响因素.中华放射学杂志, 2001, 35 (10):731-735.
41. 张开华, 张志勇, 单飞, 等.螺旋CT对良性及恶性胸膜凹陷的鉴别诊断.中华结核和呼吸杂志, 2008, 31 (5):384-386.
42. 崔云, 马大庆, 杨静.肺结节胸膜凹陷征诊断价值的Meta分析.首都医科大学学报, 2007, 28 (6):709-712.
43. 黄佐良, 何望春, 周继华, 等.血管集中征对周围型肺癌的诊断价值.中华放射学杂志, 1999, 29 (1):47-49.
44. 韩玉成, 程绍玲, 初建国, 等.周围型肺癌的支气管血管集束征-CT病理表现及其形成机制.中国临床医学影像杂志, 2001, 12 (2):93-97.
45. Gould MK, Ananth L, Barnett PG, et al. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest, 2007, 131 (2):383-388.
46. 秦卫.孤立性肺结节的良恶性鉴别诊断进展.中国胸心血管外科临床杂志, 2011, 18 (2):153-156.
47. Harders SW, Madsen HH, Rasmussen TR, et al. High resolution spiral CT for determining the malignant potential of solitary pulmonary nodules:refining and testing the test. Acta radiol, 2011, 52 (4):401-409.
48. 罗玉忠, 何巍.孤立性肺结节的评价和处理.广西医科大学学报, 2010, 27 (5):809-811.
49. 李运, 隋锡朝, 杨德松, 等.孤立性肺结节的危险因素.中华胸心血管外科杂志, 2010, 26 (3):161-164.
50. 陈孝平, 石应康, 邱贵兴, 等主编.外科学.第2版.北京:人民卫生出版社, 2010. 430-439.
51. Veronesi G, Bellomi M, Spaggiari L, et al. Low dose spiral computed tomography for early diagnosis of lung cancer:results of baseline screening in 5, 000 high-risk volunteers; ASCO Annual Meeting Proceedings Part I. J Clin Oncol, 2006, 24 (18 Suppl):7029.
52. Mery CM, Pappas AN, Bueno R, et al. Relationship between a history of antecedent cancer and the probability of malignancy for a solitary pulmonary nodule. Chest, 2004, 125 (6):2175-2181.
53. Soubani AO. The evaluation and management of the solitary pulmonary nodule. Postgrad Med J, 2008, 84 (995):459-466.
54. Zhan P, Shen XK, Qian Q, et al. Expression of caveolin-1 is correlated with disease stage and survival in lung adenocarcinomas. Oncol Rep, 2012, 27 (4):1072-1078.
55. Gould MK, Fletcher J, Iannettoni MD, et al. Evaluation of patients with pulmonary nodules:when is it lung cancer?:ACCP evidence-based clinical practice guidelines (2nd edition). Chest, 2007, 132 (3 Suppl):108S-130S.
56. Swensen SJ, Silverstein MD, Edell ES, et al. Solitary pulmonary nodules:clinical prediction model versus physicians. Mayo Clin Proc, 1999, 74 (4):319-329.
57. 王垚青, 孙希文, 徐长青, 等.应用Lung Care软件评估孤立性肺结节.中国医学计算机成像杂志, 2012, 18 (4):307-311.
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