Kim H, Kang S J, Suh G Y, Chung M P, Kwon O J, Rhee C H, Jung K J, Kim T S, Lee K S
Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Intern Med. 2001 Dec;16(4):236-41. doi: 10.3904/kjim.2001.16.4.236.
Solitary pulmonary nodule (SPN) may show different presentation in tuberculosis (TB)-endemic countries. The aim of this study was to identify clinical and radiological predictors favoring benign or malignant SPN in TB-endemic region.
Two hundred one SPNs in 201 consecutive Korean patients were included (< 3 cm in diameter, all confirmed by pathology or bacteriology, 93 benign and 108 malignant diseases). For clinical parameters, age, sex, smoking status and amount, and past history of pulmonary tuberculosis and diabetes mellitus were investigated retrospectively. For radiological parameters, size, location, margin characteristics, presence of calcification, pleural tag, surrounding satellite nodule, cavitation, internal low attenuation, open bronchus sign, surrounding ground-glass opacity, enhancement pattern of the SPNs and mediastinal lymph node (LN) enlargement were analyzed on chest CT scans.
Patients with a older age (60.7 +/- 9.6 vs 56.2 +/- 13.1, p = 0.008) and more than 40-pack years smoking (27.8% vs 14.0%, p = 0.017) were more frequently related with malignant than benign SPN. On chest CT scans, spiculated margin, contrast enhancement more than 20 Hounsfield unit and presence of pleural tag and mediastinal LN enlargement were more frequently observed in malignant than benign SPNs. In contrast to previous studies, satellite lesions (21.5% vs 1.9%, p < 0.001) and cavitation (20.4% vs 5.6%, p = 0.001) were more frequently seen in benign than malignant SPN. Positive predictive values of benignity were 90.9% and 76.0%, respectively, when satellite lesions and cavitation were found in cases of SPN.
Satellite lesions and cavitation on chest CT scan could be useful predictors for benign SPN in TB-endemic areas.
在结核病流行国家，孤立性肺结节（SPN）可能表现出不同的特征。本研究的目的是确定在结核病流行地区有利于SPN为良性或恶性的临床和放射学预测因素。
纳入201例韩国患者的201个SPN（直径<3 cm，均经病理或细菌学证实，93例为良性疾病，108例为恶性疾病）。回顾性调查临床参数，包括年龄、性别、吸烟状况及吸烟量、既往肺结核和糖尿病病史。对于放射学参数，在胸部CT扫描上分析SPN的大小、位置、边缘特征、钙化情况、胸膜尾征、周围卫星结节、空洞形成、内部低密度影、支气管充气征、周围磨玻璃影、SPN的强化模式以及纵隔淋巴结（LN）肿大情况。
年龄较大（60.7±9.6岁对56.2±13.1岁，p = 0.008）且吸烟超过40包年（27.8%对14.0%，p = 0.017）的患者中，与SPN为恶性相关的比例高于良性。在胸部CT扫描中，恶性SPN比良性SPN更常观察到毛刺状边缘、对比增强超过20亨氏单位以及胸膜尾征和纵隔LN肿大。与既往研究不同的是，良性SPN比恶性SPN更常出现卫星灶（21.5%对1.9%，p<0.001）和空洞形成（20.4%对5.6%，p = 0.001）。当SPN病例中发现卫星灶和空洞形成时，良性的阳性预测值分别为90.9%和76.0%。
胸部CT扫描上的卫星灶和空洞形成可能是结核病流行地区SPN为良性的有用预测因素。
