ABSTRACT
BACKGROUND@#Preoperative diagnosis and differential diagnosis of small solid pulmonary nodules are very difficult. Computed tomography (CT), as a common method for lung cancer screening, is widely used in clinical practice. The aim of this study was to analyze the clinical data of patients with malignant pulmonary nodules and intrapulmonary lymph nodes in the clinical diagnosis and treatment of <1 cm solid pulmonary nodules, so as to provide reference for the differentiation of the two.@*METHODS@#Patients with solid pulmonary nodules who underwent surgery from June 2017 to June 2020 were analyzed retrospectively. The clinical data of 145 nodules (lung adenocarcinoma 60, lung carcinoid 2, malignant mesothelioma 1, sarcomatoid carcinoma 1, lymph node 81) were collected and finally divided into two groups: lung adenocarcinoma and intrapulmonary lymph nodes, and their clinical data were statistically analyzed. According to the results of univariate analysis (χ² test, t test), the variables with statistical differences were selected and included in Logistic regression multivariate analysis. The predictive variables were determined and the receiver operating characteristic (ROC) curve was drawn to get the area under the curve (AUC) value of the area under the curve.@*RESULTS@#Logistic regression analysis showed that the longest diameter, Max CT value, lobulation sign and spiculation sign were important indicators for distinguishing lung adenocarcinoma from intrapulmonary lymph nodes, and the risk ratios were 106.645 (95%CI: 3.828-2,971.220, P<0.01), 0.980 (95%CI: 0.969-0.991, P<0.01), 3.550 (95%CI: 1.299-9.701, P=0.01), 3.618 (95%CI: 1.288-10.163, P=0.02). According to the results of Logistic regression analysis, the prediction model is determined, the ROC curve is drawn, and the AUC value under the curve is calculated to be 0.877 (95%CI: 0.821-0.933, P<0.01).@*CONCLUSIONS@#For <1 cm solid pulmonary nodules, among many factors, the longest diameter, Max CT value, lobulation sign and spiculation sign are more important in distinguishing malignant pulmonary nodules from intrapulmonary lymph nodes.
ABSTRACT
@#Objective To investigate the characteristics and influencing factors of N1 in T2 stage of the 8th TNM stage of The International Association for the Study of Lung Cancer (IASLC) (3 cm <tumor size≤5 cm) non-small cell lung cancer (NSCLC), to provide the basis for dissecting intrapulmonary lymph node more accurately during the operation. Methods We collected the clinical information of patients who underwent the pulmonary malignant tumor surgery in Dalian Central Hospital between October 2011 and November 2016. Through the inclusion and exclusion criteria, a total of 68 patients were obtained, including 48 males and 20 females, aged 48–81 (63.1±7.6) years. According to the pathological results, we invesigated the characteristics and influencing factors of N1 in T2 stage non-small cell lung cancer. Results The results showed that the highest positive rate of lymph node was 14.8% in the 12th group, 14.3% in the 13th group, and 13.9% in the 6th group, respectively. In the single factor analysis, it showed that male, T2b stage, poorly differentiated degree were the risk factors for intrapulmonary lymph node metastasis in T2 stage (P<0.05). But the intrapulmonary lymph nodes metastasis was no significant correlation with above factors according to the multivariate analysis. Conclusion It is necessary to extract the intrapulmonary lymph node of T2 stage NSCLC at utmost, especially for the No.12 and No.13 high-risk areas. T2b stage with odd ratio (OR) at 3.038 and poorly differentiated degree (OR=1.945) may be the risk factors for the intrapulmonary lymph nodes metastasis of NSCLC in T2 stage. But they are not determining factors.
ABSTRACT
Objective To explore the CT features and pathology of intrapulmonary lymph nodes (IPLNs), so as to improve the understanding and diagnosis of IPLNs. Methods A total of 38 patients (49 IPLNs) who were confirmed by the surgery and pathology were retrospectively analyzed, including 21 males and 17 females with a mean age of (56±8) years. All the patients underwent MSCT scan and 1.0 mm thin layer reconstruction before surgery. Double-blind method was used to analyze CT signs and the corresponding histopathological changes were compared. Results (1) Location: all IPLNs were located below the level of tracheal carina with 17 were on the left lung, and 32 were on the right lung. (2) Shape: 34 IPLNs were round, 15 were triangular or prism and so on. (3) Size: the maximum diameter of IPLNs ranged from 0.26 to 1.28 cm (0.66±0.23 cm), of which 45 cases were≤1.0 cm. (4) Quantity: 28 IPLNs were solitary and 10 were multiple. (5) Density: All 48 IPLNs were solid nodules with a median CT value of 43 HU (range from 19 to 106 HU), and there were no calcification, vacuoles and air bronchial signs were showed. (6) Margin and pleura: all the 48 IPLNs boundaries were clear and smooth, and 45 pieces were less than 1.0 cm from the pleura, of which 20 were close to the pleura or inter-lobar fissure. (7) Other: no"satellite focal", pleural depression syndrome, and vascular bundle sign were showed;22 peripheral fine lines of IPLNs were visible. (8) Pathology: IPLNs were dark brown or gray-black nodules with well-defined borders, coated, tough, hard, and carbon deposition could be seen in most cases. Conclusion IPLNs are benign nodules in the lung, which have certain CT features and typical pathological changes. Based on the CT performance and characteristics, it is helpful to make correct diagnosis of IPLNs before operation.