术前误诊良性肺结节与典型恶性肺结节临床分析  

Clinical analysis of preoperative misdiagnosed benign pulmonary nodules and typical malignant pulmonary nodules

作　　者：段丽君 董鑫 潘若楠 任梦然 卢晓倩[1] 曹殿波[1] Duan Lijun;Dong Xin;Pan Ruonan;Ren Mengran;Lu Xiaoqian;Cao Dianbo(Department of Radiology,The First Hospital of Jilin University,JiLin,130021,China)

机构地区：[1]吉林大学第一医院放射科,吉林130021

出　　处：《中华肺部疾病杂志（电子版）》2024年第1期46-50,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：吉林省科技厅重点项目(20220203128SF);吉林省财政厅医疗专项(JLSWSRCZX2021-27);吉林省发展和改革委员会产业技术研究与开发项目(2023C039-2)。

摘　　要：目的 分析术前误诊为恶性的良性孤立性肺结节(solitary pulmonary nodule, SPN)与典型恶性SPN的临床特点和影像学特征,建立模型预测良恶性SPN。方法 选择2019年1月至2022年3月我院收治的术前疑似恶性SPN行手术治疗患者621例,术后病理证实为良性SPN 243例为观察组,恶性SPN 378例为对照组。收集患者临床影像资料,采用多因素Logistic回归分析筛选恶性SPN危险因素,建立模型预测良恶性SPN,验证模型预测价值。结果 观察组女129例(53.09%),平均年龄(54.66±10.52)岁,对照组女242例(64.02%),平均年龄(59.68±8.48)岁(P<0.05);观察组实性结节173例(71.19%),肺裂周围结节155例(63.79%),圆形/类圆形结节143例(58.85%),对照组实性结节184例(48.68%),肺裂周围结节77例(20.37%),圆形/类圆形结节161例(42.59%)(P<0.05)。多因素回归分析显示年龄、肿瘤标志物、直径、体积平均CT值、边界是否清楚、与肺裂位置关系、分叶、胸膜凹陷征是恶性SPN危险因素(P<0.05)。验证模型受试者工作特征曲线下面积0.815,大于PKUPH模型(0.785,P=0.776)及梅奥模型(0.502,P=0.012)。结论 术前易误诊为恶性的良性SPN女性居多,发病年龄偏小,影像学特征圆形/类圆形、肺裂周围实性成分为主。模型预测SPN性质,具有临床意义。Objective To analyze the clinical and imaging characteristics of benign solitary pulmonary nodule(SPN),misdiagnosed as malignant,and typical malignant SPN before surgery,and establish a model to predict malignant SPN.Methods A total of 621 patients with suspected malignant SPN admitted to our hospital from January 2019 to March 2022 who underwent surgical treatment before surgery were selected,243 patients with benign SPN confirmed by postoperative pathology were divided into observation group,and 378 cases with typical malignant SPN were divided into control group.The clinical image data of patients were collected,the risk factors of malignant SPN were screened by multi-factor logistic regression analysis,and the prediction model of malignant SPN was established to verify the prediction efficiency of the model.Results There were 129 females(53.09%)in the observation group,with an average age of(54.66±10.52)years,and 242 females(64.02%)in the control group,with an average age of(59.68±8.48)years(P<0.05).In the observation group,there were 173 solid nodules(71.19%),155 peripheral pulmonary cleft nodules(63.79%),and 143 circular/quasi-circular nodules(58.85%),while in the control group,184 solid nodules(48.68%),77 peripheral pulmonary cleft nodules(20.37%),and 161 circular/quasi-circular nodules(42.59%)(P<0.05).Multivariate regression analysis showed that age,tumor markers,diameter,average CT value of volume,clear boundary,relationship with pulmonary fissure location,lobed,pleural depression sign were risk factors for malignant SPN(P<0.05).The model verified that the area under the receiver operating characteristic curve was 0.815,which was larger than the PKUPH model(0.785,P=0.776)and Mayo model(0.502,P=0.012).Conclusions The majority of benign SPN women are easily misdiagnosed as malignant before surgery.The age of onset is younger.The imaging features are round/quasi-round,and the solid components around the pulmonary fissure are dominant.The model is effective in predicting malignant SPN and has clinical sign

关 键 词：孤立性肺结节 影像学特征 良性/恶性 误诊 预测模型 

分 类 号：R563[医药卫生—呼吸系统] R734.2[医药卫生—内科学]