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中华胸部外科电子杂志 ›› 2024, Vol. 11 ›› Issue (03) : 167 -174. doi: 10.3877/cma.j.issn.2095-8773.2024.03.04

论著

术后病理诊断为良性肺结节323例患者临床特征分析
王宇1, 张泽锴1, 吴明胜1, 王高祥1, 孙效辉1, 王君1, 徐美青1, 李田1, 徐世斌1, 解明然1,()   
  1. 1. 230001 合肥,中国科学技术大学附属第一医院胸外科
  • 收稿日期:2024-05-28 修回日期:2024-07-28 接受日期:2024-08-08 出版日期:2024-08-28
  • 通信作者: 解明然
  • 基金资助:
    国家自然科学基金(81973643); 2023年度安徽省重点专科建设项目

Clinical characteristics of 323 patients with postoperative pathological diagnosis of benign pulmonary nodules

Yu Wang1, Zekai Zhang1, Mingsheng Wu1, Gaoxiang Wang1, Xiaohui Sun1, Jun Wang1, Meiqing Xu1, Tian Li1, Shibin Xu1, Mingran Xie1,()   

  1. 1. Department of Thoracic Surgery, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, China
  • Received:2024-05-28 Revised:2024-07-28 Accepted:2024-08-08 Published:2024-08-28
  • Corresponding author: Mingran Xie
引用本文:

王宇, 张泽锴, 吴明胜, 王高祥, 孙效辉, 王君, 徐美青, 李田, 徐世斌, 解明然. 术后病理诊断为良性肺结节323例患者临床特征分析[J]. 中华胸部外科电子杂志, 2024, 11(03): 167-174.

Yu Wang, Zekai Zhang, Mingsheng Wu, Gaoxiang Wang, Xiaohui Sun, Jun Wang, Meiqing Xu, Tian Li, Shibin Xu, Mingran Xie. Clinical characteristics of 323 patients with postoperative pathological diagnosis of benign pulmonary nodules[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2024, 11(03): 167-174.

目的

分析术后病理诊断为良性肺结节的患者临床特征,为良性结节的鉴别诊断提供依据,减少不必要的手术治疗。

方法

回顾性分析中国科学技术科大附属第一医院2021年1月至2023年6月间术后病理诊断为良性肺结节的323例患者的临床资料。通过统计分析,评估良性肺结节患者临床特征、影像学特征及术后病理结果。根据术后病理结果,将患者分为非手术指征良性结节组(113例)和手术指征良性结节组(210例),并对两组患者的影像学特征进行比较。

结果

本研究共纳入323例术后病理诊断为良性肺结节患者。结节最大直径以<20 mm为主,主要分布在右上肺叶,多为混合性磨玻璃结节(GGN)。部分结节具有恶性结节影像学特征,如形态不规则,边界模糊、分叶征、毛刺征以及胸膜牵扯征等。结节m-CT值范围–820~–116.6(–490.7±156.7)HU。术后病理类型主要为结核肉芽肿(73/323)、错构瘤(64/323)、非特异性炎症(59/323)。与手术指征良性结节组相比,非手术指征良性结节组的结节直径以<10 mm多见,且分叶征、毛刺征及胸膜牵扯征等恶性影像学特征发生率较低。

结论

手术切除的良性肺结节以混合性GGN多见,部分具有恶性结节影像学特征。术后病理类型显示结核肉芽肿和错构瘤为最常见的良性病变,非特异性炎症占第三位。对于直径<10 mm的GGN,可考虑随访观察。m-CT值可能在预测结节良恶性方面具有一定的应用价值。。

Objective

To analyze the clinical characteristics of patients with postoperative pathological diagnoses of benign pulmonary nodules, providing diagnostic insights to distinguish benign nodules and reduce unnecessary surgical interventions.

Methods

A retrospective analysis was conducted on the clinical data of 323 patients diagnosed with benign pulmonary nodules postoperatively at the First Affiliated Hospital of the University of Science and Technology of China from January 2021 to June 2023. Statistical analysis was used to evaluate the clinical features, imaging characteristics, and postoperative pathological results of these patients. Based on the postoperative pathological results, the patients were divided into a non-surgical indication benign nodule group (113 cases) and a surgical indication benign nodule group (210 cases) , and the imaging characteristics of the two groups were compared.

Results

A total of 323 patients with benign pulmonary nodules diagnosed postoperatively were included in this study. The maximum diameter of the nodules was predominantly less than 20 mm, mostly located in the right upper lobe, and mainly presented as mixed ground-glass nodules. Some nodules exhibited imaging characteristics of malignant nodules, such as irregular shape, blurred borders, lobulation, spiculation, and pleural indentation. The m-CT value of the nodules ranged from –820 to –116.6 (–490.7±156.7) HU. The postoperative pathological types were mainly tuberculoma (73/323) , hamartoma (64/323) , and nonspecific inflammation (59/323) . Compared with the surgical indication benign nodule group, the non-surgical indication benign nodule group had more nodules with diameters less than 10 mm, and the incidences of malignant imaging characteristics such as lobulation, spiculation, and pleural indentation were lower.

Conclusions

Benign pulmonary nodules resected surgically were predominantly mixed ground-glass nodules, with some exhibiting imaging characteristics of malignant nodules. Postoperative pathological types indicated that tuberculoma and hamartoma were the most common benign lesions, followed by nonspecific inflammation. For ground-glass nodules with diameters less than 10 mm, follow-up observation may be considered. The m-CT value may have some application value in predicting the benign or malignant nature of nodules.

图1 良性肺结节患者术后病理类型构成图
表1 良性肺结节患者病理类型
表2 良性肺结节患者一般资料
表3 良性肺结节患者影像学资料
表4 非手术指征组良性结节组与手术指征组良性结节组影像学资料比较
影像学资料 非手术指征良性结节组(n=113) 手术指征良性结节组(n=210) χ2/Z/t P
结节部位[例(%)]     7.599 0.107
右上叶 37(32.7) 69(32.9)    
右中叶 11(9.7) 8(3.8)    
右下叶 24(21.2) 66(31.4)    
左上叶 15(13.3) 26(12.4)    
左下叶 26(23.0) 41(19.5)    
结节类型[例(%)]     13.333 0.001
纯磨玻璃结节 31(27.4) 24(11.4)    
混合性磨玻璃结节 74(65.5) 167(79.5)    
纯实性结节 8(7.1) 19(9.0)    
形态[例(%)]     1.056 0.304
圆形或类圆形 46(40.7) 98(46.7)    
不规则 67(59.3) 112(53.3)    
边界[例(%)]     2.193 0.157
清晰 42(37.2) 96(45.7)    
模糊 71(62.8) 114(54.3)    
分叶征[例(%)]     3.9 0.048
21(18.6) 60(28.6)    
92(81.4) 150(71.4)    
毛刺征[例(%)]     4.877 0.027
23(20.4) 67(31.9)    
90(79.6) 143(68.1)    
空泡征[例(%)]     0.106 0.745
8(7.1) 17(8.1)    
105(92.9) 193(91.9)    
血管集束征[例(%)]     0.027 0.87
7(6.2) 14(6.7)    
106(93.8) 196(93.3)    
钙化[例(%)]     0.174 0.677
6(5.3) 9(4.3)    
107(94.7) 201(95.7)    
胸膜牵扯征[例(%)]     10.284 0.001
32(28.3) 98(46.7)    
81(71.7) 112(53.3)    
结节最大径[例(%)]     34.54 <0.001
≤10 mm 78(69.0) 74(35.2)    
>10~20 mm 23(20.4) 102(48.6)    
>20~30 mm 12(10.6) 34(16.2)    
m-CT值(HU) −490.0±161.7 −491.1±154.4 0.06 0.952
CTR 0.55±0.37 0.66±0.31 −2.73 0.07
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