| Objective:To investigate the clinical characteristics and differences of patients with solitary and multiple pulmonary nodules,and to analyze the consistency between the prediction of benign and malignant pulmonary nodules in multidisciplinary clinic and the postoperative pathological results.Methods:According to the relevant screening criteria developed by the research methods,a total of 1656 patients with pulmonary nodules were collected from the multi-disciplinary treatment(MDT)outpatient department and the thoracic surgery inpatient department of Northern Jiangsu People’s Hospital from November 2018 to November 2020.910 patients did not undergo further percutaneous lung biopsy(PTLB)or surgical treatment after the MDT outpatient department,746 patients undergo further percutaneous lung biopsy(PTLB)or surgical treatment pathological and obtained results.Among them,622 patients were admitted to the thoracic surgery inpatient ward by the thoracic surgery outpatient department for PTLB or surgical treatment,and 124 patients were admitted to the MDT outpatient department for PTLB or surgical treatment.The proportion of solitary and multiple pulmonary nodules and the gender distribution of solitary and multiple pulmonary nodules in 1656 patients were calculated.Meanwhile,the proportion of benign and malignant pulmonary nodules in 746 patients was calculated.According to the number of nodules,746 patients were divided into solitary group and multiple group.The solitary group and multiple group were further divided into benign group and malignant group according to the pathological results.The differences of gender,age,nodule diameter,ground glass change,spiculation sign,vascular bundle sign,bronchial inflation sign,lobulation sign,serum CEA,CA125,CA199,Pro GRP,NSE,CYFRA21-1,nodule location and pathological type among the groups were analyzed.the relationship between smoking history and lung adenocarcinoma in patients with malignant solitary and multiple pulmonary nodules were analyzed.At the same time,kappa test was used to analyze the consistency between the prediction of benign and malignant pulmonary nodules in MDT clinic and the postoperative pathological results.Results:In 1656 cases of pulmonary nodules,385 cases(23.25%)were solitary pulmonary nodules,including 176 cases(45.71%)in males,209 cases(54.29%)in females.1271 cases(76.75%)were multiple pulmonary nodules,including 587 cases(46.18%)in males and 684 cases(53.82%)in females.among 746 cases with pathological results,109 cases(14.61%)were benign and 637 cases(85.39%)were malignant.According to the number of nodules,the patients were divided into solitary group and multiple group,187 cases(25.07%)in solitary group and 559 cases(74.93%)in multiple group.According to the postoperative pathological results,the solitary group and multiple group were further divided into benign group and malignant group respectively.By comparing the differences of gender,age,nodule diameter,ground glass change,spiculation sign,vascular bundle sign,bronchial inflation sign,lobulation sign,serum CEA,CA125,CA199,Pro GRP,NSE,CYFRA21-1,nodule location and pathological type among the groups,we can find the following results:in patients with solitary pulmonary nodule,ground glass nodule change has guiding significance for differentiating benign and malignant nodules(X~2=13.757,P<0.001);in patients with multiple pulmonary nodule,ground glass nodule change(X~2=23.812,P<0.001),vascular bundle sign(X~2=9.111,P=0.002)and the increasing of serum CEA(X~2=4.161,P=0.047)have guiding significance for differentiating benign and malignant nodules.The older of the patients with multiple pulmonary nodules are,the greater the chance of malignant nodules(t=6.372,P=0.012).In this study,the most common pathological type of malignant solitary pulmonary nodules was microinvasive adenocarcinoma(41.48%),followed by invasive adenocarcinoma(36.36%),the most common sites were right upper lobe(33.33%),followed by left upper lobe(24.53%).the most common pathological type of malignant multiple pulmonary nodules was invasive adenocarcinoma(50.80%),followed by microinvasive adenocarcinoma(25.58%),The most common sites were right upper lobe(31.59%),followed by left upper lobe(27.41%).In malignant solitary pulmonary nodules,female nonsmokers were more likely to have lung adenocarcinoma(X~2=7.568,P=0.046).In malignant multiple pulmonary nodules,female nonsmokers(X~2=5.574,P=0.049)and male smokers(X~2=5.377,P=0.015)were more likely to have lung adenocarcinoma.Further analysis showed that there was a good consistency between the prediction of benign and malignant nodules in MDT clinic and the postoperative pathological results(kappa value>0.70,P<0.001).Conclusions:(1)the incidence rate of multiple pulmonary nodules is higher than that of solitary pulmonary nodules.The incidence rate of female pulmonary nodules is higher than that of men in both solitary and multiple pulmonary nodules.The older of the patients with multiple pulmonary nodules are,the greater the chance of malignant nodules.The nodules of female patients with multiple pulmonary nodules are more likely to be malignant.In patients with malignant solitary pulmonary nodules,female nonsmokers are more likely to have lung adenocarcinoma.In patients with malignant multiple pulmonary nodules,female nonsmokers and male smokers are more likely to have lung adenocarcinoma.(2)The most common sites of malignant solitary pulmonary nodules and malignant multiple pulmonary nodules are located in the upper lobe of the right lung.ground glass changes of nodules are guiding significance in differentiating benign and malignant nodules both solitary pulmonary nodules and multiple pulmonary nodules.vascular bundle sign and the increasing of serum CEA are of guiding significance in differentiating benign and malignant multiple pulmonary nodules.the most common pathological type of pulmonary nodules after operation is lung adenocarcinoma,of which microinvasive adenocarcinoma is the most common type of malignant solitary pulmonary nodule,while the most common postoperative pathological type of malignant multiple pulmonary nodule was invasive adenocarcinoma.(3)There was a good consistency between the prediction of benign and malignant nodules in MDT clinic and the postoperative pathological results. |
