高度疑似恶性的良性肺结节临床及病理特征的回顾性队列研究  

Clinical and pathological characteristics analysis of benign pulmonary nodules clinically highly suspected as malignant:A retrospective cohort study

作　　者：潘高涧 耿国军[2] 朱晓雷 刘鸿鸣[2] 李宁[2] 潘剑云 叶冠志 姜杰[2] PAN Gaojian;GENG Guojun;ZHU Xiaolei;LIU Hongming;LI Ning;PAN Jianyun;YE Guanzhi;JIANG Jie(Department of Thoracic Surgery,The First Affiliated Hospital of Xiamen University,School of Medicine,Xiamen University,Xiamen,361003,Fujian,P.R.China;Department of Thoracic Surgery,The First Affiliated Hospital of Xiamen University,Xiamen,361003,Fujian,P.R.China)

机构地区：[1]厦门大学附属第一医院胸外二科厦门大学医学院,福建厦门361003 [2]厦门大学附属第一医院胸外二科,福建厦门361003

出　　处：《中国胸心血管外科临床杂志》2025年第2期194-200,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：福建省自然科学基金项目(2022J05301,2021J05284);厦门市卫生指导性项目(3502Z20214ZD3011)。

摘　　要：目的探讨临床上高度怀疑为恶性但病理证实为良性肺结节的主要病理类型和影像学特征。方法回顾性分析2020年12月—2023年4月期间在厦门大学附属第一医院治疗前高度疑似恶性但病理证实为良性病变患者的临床资料。根据术前讨论结果将患者分为两组,即良性组和可疑恶性组。比较两组患者的临床资料和影像学特征。结果纳入232例肺结节患者,其中男112例、女120例,平均年龄(50.7±12.0)岁。良性组127例、可疑恶性组105例。两组患者年龄、性别、症状、吸烟史、肿瘤史等指标差异无统计学意义(P>0.05),而两组的结节密度、CT值、边缘、形状、恶性征象差异有统计学意义(P<0.05)。在可疑恶性组中实性结节主要以胶原结节及纤维组织增生(33.3%)、结核(20.4%)、真菌感染(18.5%)为主,非实性结节主要以胶原结节及纤维组织增生(41.2%)、非典型腺瘤样增生(17.7%)为主。结论疑似恶性的良性肺结节病理类型以胶原结节及纤维组织增生、结核、非典型腺瘤样增生和真菌感染为主。在影像学特征上通常表现为非实性结节,并伴有毛刺征、分叶征、空洞征、胸膜牵拉征等恶性征象。Objective To discuss the main pathological types and imaging characteristics of pulmonary nodules that are highly suspected to be malignant in clinical practice but are pathologically confirmed to be benign.Methods A retrospective analysis was performed on the clinical data of patients with pulmonary nodules who were initially highly suspected of malignancy but were subsequently pathologically confirmed to be benign.These patients were treated at the First Affiliated Hospital of Xiamen University from December 2020 to April 2023.Based on the outcomes of preoperative discussions,the patients were categorized into a benign group and a suspicious malignancy group.The clinical data and imaging characteristics of both groups were compared.Results A total of 232 patients were included in the study,comprising 112 males and 120 females,with a mean age of(50.7±12.0)years.Among these,127 patients were classified into the benign group,while 105 patients were categorized into the suspicious malignancy group.No statistically significant differences were observed between the two groups regarding age,gender,symptoms,smoking history,or tumor history(P>0.05).However,significant differences were noted in nodule density,CT values,margins,shapes,and malignant signs(P<0.05).Further analysis revealed that in the suspicious malignancy group,solid nodules were predominantly characterized by collagen nodules and fibrous tissue hyperplasia(33.3%),followed by tuberculosis(20.4%)and fungal infections(18.5%).In contrast,non-solid nodules were primarily composed of collagen nodules and fibrous tissue hyperplasia(41.2%)and atypical adenomatous hyperplasia(17.7%).Conclusion Benign pulmonary nodules that are suspected to be malignant are pathologically characterized by the presence of collagen nodules,fibrous tissue hyperplasia,tuberculosis,atypical adenomatous hyperplasia,and fungal infections.Radiologically,these nodules typically present as non-solid lesions and may exhibit features suggestive of malignancy,including spiculation,lobulation,c

关 键 词：疑似恶性肺结节 病理特征 影像学特征 

分 类 号：R73[医药卫生—肿瘤]