Jiang Jin, Lv Fa-Jin, Tao Yang, Fu Bin-Jie, Li Wang-Jia, Lin Rui-Yu, Chu Zhi-Gang
Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
Insights Imaging. 2023 Sep 12;14(1):146. doi: 10.1186/s13244-023-01504-8.
Pulmonary solid pleura-attached nodules (SPANs) are not very commonly detected and thus not well studied and understood. This study aimed to identify the clinical and CT characteristics for differentiating benign and malignant SPANs.
From January 2017 to March 2023, a total of 295 patients with 300 SPANs (128 benign and 172 malignant) were retrospectively enrolled. Between benign and malignant SPANs, there were significant differences in patients' age, smoking history, clinical symptoms, CT features, nodule-pleura interface, adjacent pleural change, peripheral concomitant lesions, and lymph node enlargement. Multivariate analysis revealed that smoking history (odds ratio [OR], 2.016; 95% confidence interval [CI], 1.037-3.919; p = 0.039), abutting the mediastinal pleura (OR, 3.325; 95% CI, 1.235-8.949; p = 0.017), nodule diameter (> 15.6 mm) (OR, 2.266; 95% CI, 1.161-4.423; p = 0.016), lobulation (OR, 8.922; 95% CI, 4.567-17.431; p < 0.001), narrow basement to pleura (OR, 6.035; 95% CI, 2.847-12.795; p < 0.001), and simultaneous hilar and mediastinal lymph nodule enlargement (OR, 4.971; 95% CI, 1.526-16.198; p = 0.008) were independent predictors of malignant SPANs, and the area under the curve (AUC) of this model was 0.890 (sensitivity, 82.0%, specificity, 77.3%) (p < 0.001).
In patients with a smoking history, SPANs abutting the mediastinal pleura, having larger size (> 15.6 mm in diameter), lobulation, narrow basement, or simultaneous hilar and mediastinal lymph nodule enlargement are more likely to be malignant.
The benign and malignant SPANs have significant differences in clinical and CT features. Understanding the differences between benign and malignant SPANs is helpful for selecting the high-risk ones and avoiding unnecessary surgical resection.
• The solid pleura-attached nodules (SPANs) are closely related to the pleura. • Relationship between nodule and pleura and pleural changes are important for differentiating SPANs. • Benign SPANs frequently have broad pleural thickening or embed in thickened pleura. • Smoking history and lesions abutting the mediastinal pleura are indicators of malignant SPANs. • Malignant SPANs usually have larger diameters, lobulation signs, narrow basements, and lymphadenopathy.
肺部实性胸膜附着结节（SPANs）并不常见，因此对其研究和了解不足。本研究旨在确定鉴别良性和恶性SPANs的临床及CT特征。
回顾性纳入2017年1月至2023年3月期间共295例患有300个SPANs的患者（128个良性，172个恶性）。在良性和恶性SPANs之间，患者的年龄、吸烟史、临床症状、CT特征、结节-胸膜界面、相邻胸膜改变、外周伴随病变及淋巴结肿大存在显著差异。多因素分析显示，吸烟史（比值比[OR]，2.016；95%置信区间[CI]，1.037 - 3.919；p = 0.039）、贴近纵隔胸膜（OR，3.325；95% CI，1.235 - 8.949；p = 0.017）、结节直径（> 15.6 mm）（OR，2.266；95% CI，1.161 - 4.423；p = 0.016）、分叶（OR，8.922；95% CI，4.567 - 17.431；p < 0.001）、胸膜基底窄（OR，6.035；95% CI，2.847 - 12.795；p < 0.001）以及同时出现肺门和纵隔淋巴结肿大（OR，4.971；95% CI，1.526 - 16.198；p = 0.008）是恶性SPANs的独立预测因素，该模型的曲线下面积（AUC）为0.890（敏感性，82.0%，特异性，77.3%）（p < 0.001）。
有吸烟史、贴近纵隔胸膜、尺寸较大（直径> 15.6 mm）、有分叶、胸膜基底窄或同时出现肺门和纵隔淋巴结肿大的SPANs更有可能是恶性的。
良性和恶性SPANs在临床及CT特征上有显著差异。了解良性和恶性SPANs之间的差异有助于筛选高危病例并避免不必要的手术切除。
• 实性胸膜附着结节（SPANs）与胸膜密切相关。• 结节与胸膜的关系及胸膜改变对鉴别SPANs很重要。• 良性SPANs常伴有广泛胸膜增厚或嵌入增厚的胸膜中。• 吸烟史及贴近纵隔胸膜的病变是恶性SPANs的指标。• 恶性SPANs通常直径较大、有分叶征、胸膜基底窄且有淋巴结病。
