Correlation Analysis Between The Diameter Of Pulmonary Nodules And Their Invasiveness

Objective The prognosis for lung cancer patients is typically bad at advanced stages,and the disease still has high rates of morbidity and mortality worldwide.However,early surgical treatment of lung cancer can significantly improve patient prognosis.The precise biological activity of pulmonary nodules is still unknown,and the best time for surgery frequently depends on a thorough clinical evaluation.Even though surgery entails risks and numerous postoperative problems,and premature surgery may amount to overtreatment,it has a recurrence-free survival probability of about 100% at 5 years following surgery when malignant pulmonary nodules are treated surgically before they become invasive.The goal of this study was to offer clinicians with more information about the relationship between pulmonary nodule diameter,its aggressiveness,and lymph node metastasis.Methods From January 2021 to April 2022,we conducted a retrospective analysis of the data pertaining to surgically treating pulmonary nodules at our hospital.We separated the invasive group into invasive and non-invasive groups based on pathological findings,and we further divided the invasive group into two subgroups based on the presence or absence of lymph node metastasis.Demographic and imaging data were compared between the groups.The relationship between pulmonary nodule diameter and its likelihood of invasion and lymph node metastasis was investigated was evaluated by multivariate logistic regression,correlation analysis and hierarchical analysis,then the generalized additive model and plane curve fitting were further tested.And subject work(ROC)curves to explore the critical value of nodule diameter and diagnostic performance.Results This study comprised 1290 cases with pulmonary nodule data in total.333 cases of benign nodules,288 cases of carcinoma in situ,299 cases of microinvasive carcinoma,and 370 cases of infiltrative carcinoma were found in the postoperative pathology.Nodule diameters for each group were 9.4(6.7,13.1)mm for benign tumors,9.2(7.4,11.4)mm for carcinoma in situ,13.1(10.4,15.9)mm for microinvasive carcinoma,and 18.2(14.2,23.0)mm for infiltrative carcinoma;the difference between benign lesions and carcinoma in situ was not statistically significant(P>0.05),and the differences between the other groups were not statistically significant either.Statistics showed that there were differences between the other groups(P<0.01).Multi-factor logistic regression suggested that age,male,solid nodes,vacuolar sign,lobular sign,and vascular sign were risk factors for aggressive tumors,and the differences were statistically significant(P<0.05).Age,male gender,solid nodes,vacuolar sign,lobular sign,and vascular sign were all found to be risk factors for aggressive tumors according to multi-factor logistic regression,and the differences were statistically significant(P<0.05).The likelihood of tumor aggressiveness and lymph node metastasis were positively correlated with nodule diameter,according to the results of the generalized summation model plane curve fitting.The analysis of the threshold effect and saturation effect revealed that as pulmonary nodule diameter increased above 10.6 mm,the risk of invasive pulmonary nodules increased as well;when nodule diameter exceeded 18.4mm,the risk of lymph node metastasis of invasive pulmonary nodules did not increase with nodule diameter.The best nodal diameter cut-off for lymph node metastases,according to subject operating characteristic(ROC)curve analysis,was 12.35 mm(AUC=0.817,95% CI: 0.794-0.84,sensitivity: 73.7%,specificity: 74.4%).The best nodal diameter cut-off for detecting lymph node metastases was 15.55 mm(AUC=0.747,95% CI: 0.686-0.808,sensitivity: 93.5% specificity: 52%).Conclusion(1)There was no significant variability in pulmonary nodule diameter between benign lesions and carcinoma in situ,and among malignant nodules,there was significant variability between pulmonary nodules with different degrees of invasiveness.(2)There was no statistically significant difference between gender in assessing the aggressiveness of pulmonary nodules and the risk of lymph node metastasis,and there was a correlation between age,subsolid nodules,vacuolar sign,vascular sign,and lobar sign and the aggressiveness of pulmonary nodules,which can be used as a factor in assessing the aggressiveness of pulmonary nodules.(3)The likelihood that a pulmonary nodule would be aggressive increases with its diameter,and aggressive pulmonary nodes are more likely to metastasize to lymph nodes.When the diameter of pulmonary nodules is more than 10.6 mm,the risk of invasion increases by 10% for each 1mm increase in the diameter of nodules.When the diameter of pulmonary nodules is more than 12.35 mm,the risk of invasiveness is high;when the diameter of nodules is greater than 15.55 mm,the risk of lymph node metastasis in invasive pulmonary nodules is high,which can be used as a reference when evaluating the timing of surgery.