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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Abstract Full text Figures/Tables Video References Cited by

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.	張軼, 丁嘉安.孤立性肺結節良惡性病變的危險因素分析.中國胸心血管外科臨床雜志, 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.	楊德松, 李運, 劉軍, 等.孤立性肺結節直徑大小與臨床及病理關系的初步研究.中國肺癌雜志, 2010, 13 (6):607-611.
13.	王濤, 陳寶俊, 范曉紅, 等.肺微小結節的臨床診斷與治療.中國胸心血管外科臨床雜志, 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, 楊濤.肺內孤立性結節的診斷與處理.腫瘤防治雜志, 2004, 11 (7):753-757.
18.	劉瑛, 吳寧. CT三維體積測量技術在孤立性肺結節診斷中的初步應用.醫學影像學雜志, 2006, 16 (1):88-90.
19.	方振劍, 佘暉, 董芳, 等.孤立性肺結節的臨床評估.中國醫師進修雜志, 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.	龔擁軍, 包宏偉. CT像上支氣管充氣征的再分析.實用醫學影像雜志, 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, 葛英輝, 史大鵬.肺部彌漫性磨玻璃陰影的CT診斷與鑒別診斷.中國醫學影像技術, 2007, 23 (8):1147-1151.
26.	秦嶺, 施舉紅, 劉鴻瑞, 等.影像學表現為雙肺彌漫磨玻璃影的肺非霍奇金淋巴瘤的臨床特點.中華醫學雜志, 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.肺部磨玻璃影的鑒別診斷與處理.中華結核和呼吸雜志, 2009, 32 (11):808-809.
29.	李瓊, 劉士遠, 范麗, 等. 3cm以下肺惡性局灶性磨玻璃密度病變的MDCT表現.實用放射學雜志, 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.	王曉華, 馬大慶, 周新華.氣腔密度影診斷周圍型小肺癌的價值及其病理基礎.中國醫學影像學雜志, 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.	李澤堅, 王建軍, 單根法, 主編.實用臨床胸外科學.北京:科學技術文獻出版社, 2007.23-30.
35.	劉大亮, 馬大慶, 陳廣. CT的分葉征表現在肺內孤立結節影像診斷中的價值.中華放射學雜志, 2007, 41 (5):487-489.
36.	李運, 陳克終, 隋錫朝, 等.孤立性肺結節良惡性判斷數學預測模型的建立.北京大學學報:醫學版, 2011, 43 (3):450-454.
37.	王曉華, 馬大慶, 陳卉.毛刺征在CT診斷周圍型小肺癌中的價值.中國醫學影像學雜志, 2006, 14 (2):127-130.
38.	楊德松, 李運, 姜冠潮, 等.孤立性肺結節良惡性判斷數學預測模型的臨床驗證及應用.中華胸心血管外科雜志, 2012, 28 (2):82-85.
39.	王萬旗, 王志銘, 寇景全, 等. 3 cm以下周圍型肺癌瘤周毛刺的HRCT表現.中國CT和MRI雜志, 2011, 9 (1):4-6.
40.	吳華偉, 肖湘生, 劉士遠, 等.周圍型肺癌胸膜凹陷征形成的瘤內基礎及相關影響因素.中華放射學雜志, 2001, 35 (10):731-735.
41.	張開華, 張志勇, 單飛, 等.螺旋CT對良性及惡性胸膜凹陷的鑒別診斷.中華結核和呼吸雜志, 2008, 31 (5):384-386.
42.	崔云, 馬大慶, 楊靜.肺結節胸膜凹陷征診斷價值的Meta分析.首都醫科大學學報, 2007, 28 (6):709-712.
43.	黃佐良, 何望春, 周繼華, 等.血管集中征對周圍型肺癌的診斷價值.中華放射學雜志, 1999, 29 (1):47-49.
44.	韓玉成, 程紹玲, 初建國, 等.周圍型肺癌的支氣管血管集束征-CT病理表現及其形成機制.中國臨床醫學影像雜志, 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.	秦衛.孤立性肺結節的良惡性鑒別診斷進展.中國胸心血管外科臨床雜志, 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.	羅玉忠, 何巍.孤立性肺結節的評價和處理.廣西醫科大學學報, 2010, 27 (5):809-811.
49.	李運, 隋錫朝, 楊德松, 等.孤立性肺結節的危險因素.中華胸心血管外科雜志, 2010, 26 (3):161-164.
50.	陳孝平, 石應康, 邱貴興, 等主編.外科學.第2版.北京:人民衛生出版社, 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, 孫希文, 徐長青, 等.應用Lung Care軟件評估孤立性肺結節.中國醫學計算機成像雜志, 2012, 18 (4):307-311.
58.	Way TW, Hadjiiski LM, Sahiner B, et al. Computer-aided diagnosis of pulmonary nodules on CT scans:Segmentation and classification using 3D active contours. Med Phys, 2006, 33 (7):2323-2337.
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. 張軼, 丁嘉安.孤立性肺結節良惡性病變的危險因素分析.中國胸心血管外科臨床雜志, 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. 楊德松, 李運, 劉軍, 等.孤立性肺結節直徑大小與臨床及病理關系的初步研究.中國肺癌雜志, 2010, 13 (6):607-611.
13. 王濤, 陳寶俊, 范曉紅, 等.肺微小結節的臨床診斷與治療.中國胸心血管外科臨床雜志, 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, 楊濤.肺內孤立性結節的診斷與處理.腫瘤防治雜志, 2004, 11 (7):753-757.
18. 劉瑛, 吳寧. CT三維體積測量技術在孤立性肺結節診斷中的初步應用.醫學影像學雜志, 2006, 16 (1):88-90.
19. 方振劍, 佘暉, 董芳, 等.孤立性肺結節的臨床評估.中國醫師進修雜志, 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. 龔擁軍, 包宏偉. CT像上支氣管充氣征的再分析.實用醫學影像雜志, 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, 葛英輝, 史大鵬.肺部彌漫性磨玻璃陰影的CT診斷與鑒別診斷.中國醫學影像技術, 2007, 23 (8):1147-1151.
26. 秦嶺, 施舉紅, 劉鴻瑞, 等.影像學表現為雙肺彌漫磨玻璃影的肺非霍奇金淋巴瘤的臨床特點.中華醫學雜志, 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.肺部磨玻璃影的鑒別診斷與處理.中華結核和呼吸雜志, 2009, 32 (11):808-809.
29. 李瓊, 劉士遠, 范麗, 等. 3cm以下肺惡性局灶性磨玻璃密度病變的MDCT表現.實用放射學雜志, 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. 王曉華, 馬大慶, 周新華.氣腔密度影診斷周圍型小肺癌的價值及其病理基礎.中國醫學影像學雜志, 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. 李澤堅, 王建軍, 單根法, 主編.實用臨床胸外科學.北京:科學技術文獻出版社, 2007.23-30.
35. 劉大亮, 馬大慶, 陳廣. CT的分葉征表現在肺內孤立結節影像診斷中的價值.中華放射學雜志, 2007, 41 (5):487-489.
36. 李運, 陳克終, 隋錫朝, 等.孤立性肺結節良惡性判斷數學預測模型的建立.北京大學學報:醫學版, 2011, 43 (3):450-454.
37. 王曉華, 馬大慶, 陳卉.毛刺征在CT診斷周圍型小肺癌中的價值.中國醫學影像學雜志, 2006, 14 (2):127-130.
38. 楊德松, 李運, 姜冠潮, 等.孤立性肺結節良惡性判斷數學預測模型的臨床驗證及應用.中華胸心血管外科雜志, 2012, 28 (2):82-85.
39. 王萬旗, 王志銘, 寇景全, 等. 3 cm以下周圍型肺癌瘤周毛刺的HRCT表現.中國CT和MRI雜志, 2011, 9 (1):4-6.
40. 吳華偉, 肖湘生, 劉士遠, 等.周圍型肺癌胸膜凹陷征形成的瘤內基礎及相關影響因素.中華放射學雜志, 2001, 35 (10):731-735.
41. 張開華, 張志勇, 單飛, 等.螺旋CT對良性及惡性胸膜凹陷的鑒別診斷.中華結核和呼吸雜志, 2008, 31 (5):384-386.
42. 崔云, 馬大慶, 楊靜.肺結節胸膜凹陷征診斷價值的Meta分析.首都醫科大學學報, 2007, 28 (6):709-712.
43. 黃佐良, 何望春, 周繼華, 等.血管集中征對周圍型肺癌的診斷價值.中華放射學雜志, 1999, 29 (1):47-49.
44. 韓玉成, 程紹玲, 初建國, 等.周圍型肺癌的支氣管血管集束征-CT病理表現及其形成機制.中國臨床醫學影像雜志, 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. 秦衛.孤立性肺結節的良惡性鑒別診斷進展.中國胸心血管外科臨床雜志, 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. 羅玉忠, 何巍.孤立性肺結節的評價和處理.廣西醫科大學學報, 2010, 27 (5):809-811.
49. 李運, 隋錫朝, 楊德松, 等.孤立性肺結節的危險因素.中華胸心血管外科雜志, 2010, 26 (3):161-164.
50. 陳孝平, 石應康, 邱貴興, 等主編.外科學.第2版.北京:人民衛生出版社, 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, 孫希文, 徐長青, 等.應用Lung Care軟件評估孤立性肺結節.中國醫學計算機成像雜志, 2012, 18 (4):307-311.
58. Way TW, Hadjiiski LM, Sahiner B, et al. Computer-aided diagnosis of pulmonary nodules on CT scans:Segmentation and classification using 3D active contours. Med Phys, 2006, 33 (7):2323-2337.
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.

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