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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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, 吴一龙, 马胜林, 等.原发性肺癌诊疗规范(2011年版).中国肺癌杂志, 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.
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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.	吴江, 朱虹, 常林凤, 等. 18F-脱氧葡萄糖PET/CT诊断恶性孤立性肺结节的Meta分析.医学研究生学报, 2011, 24(1):39-42.
16.	常栋, 龚民, 胡健, 等.外周型孤立性肺结节的诊断和外科治疗.中国肿瘤临床与康复, 2010, 17(2):115-117.
17.	朱峰, 于在诚.孤立性肺结节的良恶性鉴别及外科治疗.安徽医科大学学报, 2012, 47(10):1269-1272.
18.	王利伟, 王自正, 顾建平, 等.孤立性肺结节的影像学研究进展.国外医学(放射医学核医学分册), 2005, 29(6):248-251.
19.	王光锁, 王正, 林少霖, 等.胸腔镜手术在孤立性肺结节诊断和治疗的应用.临床肺科杂志, 2009, 14(9):1239-1240.
20.	申屠阳, 程华, 李伟, 等.孤立性肺结节在法国的诊断.循证医学, 2009, 9(2):33-35.
21.	中国抗癌协会肺癌专业委员会吴一龙, 蒋国樑, 廖美琳, 等.孤立性肺结节的处理.循证医学, 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, 吴一龙, 马胜林, 等.原发性肺癌诊疗规范(2011年版).中国肺癌杂志, 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.肺癌的病因学和流行病学.第2版.北京:人民卫生出版社, 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. 吴江, 朱虹, 常林凤, 等. 18F-脱氧葡萄糖PET/CT诊断恶性孤立性肺结节的Meta分析.医学研究生学报, 2011, 24(1):39-42.
16. 常栋, 龚民, 胡健, 等.外周型孤立性肺结节的诊断和外科治疗.中国肿瘤临床与康复, 2010, 17(2):115-117.
17. 朱峰, 于在诚.孤立性肺结节的良恶性鉴别及外科治疗.安徽医科大学学报, 2012, 47(10):1269-1272.
18. 王利伟, 王自正, 顾建平, 等.孤立性肺结节的影像学研究进展.国外医学(放射医学核医学分册), 2005, 29(6):248-251.
19. 王光锁, 王正, 林少霖, 等.胸腔镜手术在孤立性肺结节诊断和治疗的应用.临床肺科杂志, 2009, 14(9):1239-1240.
20. 申屠阳, 程华, 李伟, 等.孤立性肺结节在法国的诊断.循证医学, 2009, 9(2):33-35.
21. 中国抗癌协会肺癌专业委员会吴一龙, 蒋国樑, 廖美琳, 等.孤立性肺结节的处理.循证医学, 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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