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Comparison of Clinical,Radiological and Pathological Characteristics between Solid and Subsolid NodulesObject To explore the pathological features and compare the clinical and radiological characteristics of solid and subsolid nodules.Methods we retrospectively analyzed the 576 patients with SPNs who underwent surgical resection with a definite postoperative pathology from Jan,2012 to Dec,2015 in Department of Thoracic Surgery,Shanghai Chest Hospital,Shanghai Jiaotong University.The SPNs were classified as solid and subsolid nodules depending on whether SPNs presenting ground-glass lesion or not on thoracic CT scan.We compared the pathological constitution of solid and subsolid nodules.The clinical data included:gender,age,smoking history,cancer history.Radiological data included:the maximum diameter of lung nodule,location.The clinical and radiological data were compared by univariate analysis.Results there were 69 cases(12.0%)of benign SPNs and 507 cases(88.0%)of malignant in the 576 eligible patients,consisting of 319 solid nodules(54.%)and 257 subsolid nodules(44.6%).Among the patients with solid nodules,there were 60 cases(18.8%)of benign and 239 cases(81.2%)of malignancy.Among the subsolid nodules,there were 9 cases(3.5%)of benign and 248 cases(96.5%)of malignancy.The proportion of benign lesion in solid nodules was much higher than that of subsolid lesion(p<0.001).Adenocarcinoma was the most common subtype in both malignant solid and subsolid nodules.There was a significant difference in the subtypes of adenocarcinoma between solid and subsolid nodules.The ratio of female patients,nonsmokers and upper lobe location was much higher than solid nodules.Conclusions it is still difficult to make a judgement on the nature of solid nodules.Adenocarcinoma is the most common subtype in both malignant solid and subsolid nodules.There is a significant difference in the subtypes of adenocarcinoma between solid and subsolid nodules.The ratio of female patients,nonsmokers and upper lobe location is much higher than that of solid nodulesPart ? Establishment of a Predicting Nomogram Model to Evaluate the Probability of Malignancy or Benign in Patients with Solid Solitary Pulmonary NodulesObjective To develop a predicting model for evaluating the probability of malignancy or benign in patients with solid solitary pulmonary nodules thorough analyzing the clinical,radiologic,laboratory examination and radionuclide 18F-Fluorodeoxyglucose examinations data.Methods The data of the 203 patients(110 males and 93 females)with solid SPNs who underwent surgical resection with definite postoperative pathological diagnosis from January 2012 to December 2014 in Shanghai Chest Hospital(Group A)were retrospectively analyzed.The clinical data included age,gender,history of smoking,history of cancer;Radiologic data included diameter in lung window,location,shape,clear border,lobulation,spiculation,vascular convergence,tumor cycle blood vessel,density,calcification,pleura indentation;laboratory examination include five serum tumor markers consisting of CA125,CEA,CYFRAL21-1,NSE,SCC.18F-Fluorodeoxyglucose examinations included 18F-FDG PET-CT or SPECT.The independent predictors of malignancy were estimated thorough univariate and multivariate analysis,then the predicting model was built.Another 110 patients with solid SPN(Group B)from January 2015 to December 2015 with definite pathological diagnosis were used to validate the predictive value of the model.Results there were 159 cases of malignancy and 44 cases of benign in Group A.Logistic regression analysis showed age,clear border,spiculation,calcification and 18F-FDG examination were independent predictors of malignancy in patients with solid SPN(P<0.05).A predicting nomogram was built according to the result of the multivariate Logistic regression analysis.The area under the ROC curve was 0.890±0.038 for Group B.The cut off value was 0.708.The sensitivity in group B was 86%,specificity 80%,Accuracy 84.5%.Conclusions Age of patients,clear border,spiculation,calcification and 18F-FDG examination were independent predictors of malignancy in patients with solid SPN.The model showed good diagnosis efficiency in external validation,and can be applied to make decision for patients with solid SPN.Part ? Invasive Adenocarcinoma versus Preinvasive Lesions Appearing as Subsolid Nodules:Differentiation by using CT FeaturesObjective To explore the differentiating CT features between invasive and non-invasive lung adenocarcinoma appearing as subsolid nodules.Methods We retrospectively analyzed 162 eligible patients with subsolid SPNs who underwent surgical resection with definite postoperative pathological diagnosis from January 2012 to December 2015 in Shanghai Chest Hospital.We classified the patients as benign group,invasive adenocarcinoma group(IA),and non-invasive adenocarcinoma(NIA)group according to the result of pathology.The NIA group included AAH,AIS and MIA.We compared the difference in the tumor diameter,the consolidation diameter,the consolidation diameter of the maximum tumor diameter(consolidation/tumor,C/T),the area of consolidation of the tumor area(C/T area),location,shape,lobulation,spiculation,vascular sign,bubble sign,micro nodule sign,pleura indentation between NIAs and IAs.We explored the independent factors that distinguish NIAs from IAs by univariate and multivariate analysis.The ROC curve was analyzed to calculate the appropriate cut-off point.Results There were 7 cases(4.3%)of benign,48 cases(29.6%)of NIA and 107 cases of IA among the 169 eligible patients.The multivariate analysis showed that the tumor diameter,consolidation diameter were the independent factors that distinguished NIAs from IAs.The best cut-off point for tumor diameter was 16mm and the area under the ROC curve was 0.786±0.037.The best cut-off point for consolidation diameter was 3.5mm and the area under the ROC curve was 0.847±0.031.Conclusions Tumor diameter and consolidation diameter were the independent factors that distinguished NIAs from IAs for subsolid nodules.Tumor diameter less than 16mm and consolidation diameter less than 3.5mm might be a optimal cut-off point for NIAs.Part ? Analysis of the Risk Factors for Lymph Node Metastasis in Clinical Stage Ia Lung CancerObjective Retrospectively analyzing the clinical,radiological,laboratory examination and pathological data of clinical stage Ia lung cancer and trying to find the risk factors for lymph node metastasis.Methods We retrospectively analyzed 248 clinical stage Ia lung cancer patients who underwent surgical resection with systemic lymph node dissection from January 2012 to December 2015 in Shanghai Chest Hospital.The clinical data included age,gender,smoking history and cancer history.The radiological data included location,size in lung window,size of consolidation component,the area of the nodule,the area of consolidation,C/T area,lobulation,spiculation,pleura indentation.The laboratory examination included CA125,CEA,Cyfra21-1,NSE,SCC.Univariate and multivariate analysis of clinical,radiological,laboratory examination and pathological data were performed to explore the independent risk factors that associated with lymph node metastasis for clinical stage Ia lung cancer.Results Of the 248 eligible patients,there are 195 cases(78.6%)of pathological N stage 0(pN0),and 18 cases(7.3%)of pathological stage 1(pN1)and 35 cases(14.1%)of pathological stage 2(pN2).The univariate analysis showed that location,C/T area,lobulation,spiculation,and blood tumor marker CEA had statistical significance between the patients with lymph nodes metastasis and no lymph node metastasis.The distribution of lymph node status in different lung adenocarcinoma subtypes was statistically different.The result of multivariate analysis showed that C/T area>50%and blood tumor markers CEA>5ng/ml were the independent risk factors that associated with lymph node metastasis of clinical stage Ia lung cancer.Conclusions The status of lymph nodes metastasis of clinical stage Ia lung cancer was associated with the lobulation,spiculation,C/T area and CEA level.Among them,C/T area>50%and blood tumor marker CEA>5ng/ml were the independent risk factors that associated with lymph node metastasis of clinical stage Ia lung cancer. |
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