Risk of Lung Cancer in Peripheral Pulmonary Nodules

IF 3.8 2区 医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Academic Radiology Pub Date : 2024-12-01 DOI:10.1016/j.acra.2024.06.021
Mark M. Hammer MD, Andetta R. Hunsaker MD
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Abstract

Purpose

To determine the risk of lung cancer and inter-observer agreement for small pulmonary nodules either touching or near the pleura.

Methods

Nodules were derived from two cohorts: patients from the National Lung Screening Trial with a solid nodule measuring 6–9.5 mm; and patients with incidental pulmonary nodules in our healthcare system with a solid nodule measuring 1–8 mm. Only the dominant nodule was evaluated for each patient. All malignant nodules as well as a random sample of 200 benign nodules from each cohort were included. Two fellowship-trained thoracic radiologists independently reviewed each case to record nodule morphology (compatible with lymph node or not) and nodule location (pleural-based, septal connection to the pleura, or neither). One radiologist measured the distance to the pleura.

Results

After exclusion criteria were applied, a total of 434 nodules were included, of which 45 were lung cancers. Considering all pleural-based nodules with lymph node morphology as benign, 0–7% of cancers were misclassified as benign, specificity 33%, and κ = 0.69. Considering subpleural nodules and those with septal connection to the pleura, 7–11% of cancers were misclassified (p = 0.16–0.25 versus pleural-based), specificity 40–52% (p < .0001), and κ = 0.60. Considering nodules with lymph node morphology ≤ 2 mm from the pleura, 2–7% of cancers were misclassified (p = 1 versus pleural-based), specificity 41–36% (p < .0001), and κ = 0.78.

Conclusion

Considering nodules with lymph node morphology with septal connection, or those ≤ 2 mm from the pleura, as benign does not lead to significant misclassification of lung cancers as benign.
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外周肺结节罹患肺癌的风险。
目的:确定肺部小结节触及或靠近胸膜时罹患肺癌的风险以及观察者之间的一致性:结节来自两个队列:全国肺部筛查试验(National Lung Screening Trial)中实性结节直径为 6-9.5 毫米的患者;以及我们医疗系统中偶然发现的肺部结节患者,实性结节直径为 1-8 毫米。每位患者只对主要结节进行评估。所有恶性结节以及从每个队列中随机抽取的 200 个良性结节均被纳入其中。两名接受过研究培训的胸腔放射科医生对每个病例进行独立审查,记录结节形态(是否与淋巴结相容)和结节位置(基于胸膜、隔膜与胸膜相连或两者皆非)。一位放射科医生测量了与胸膜的距离:采用排除标准后,共纳入 434 个结节,其中 45 个为肺癌。考虑到所有胸膜结节且淋巴结形态为良性,0-7%的癌症被误诊为良性,特异性为33%,κ=0.69。考虑到胸膜下结节和隔膜与胸膜相连的结节,7%-11%的癌症被误诊为良性(与胸膜结节相比,P = 0.16-0.25),特异性为 40%-52%(P 结论:胸膜下结节和隔膜与胸膜相连的结节被误诊为良性,特异性为 33%,κ = 0.69):将具有隔膜连接淋巴结形态的结节或距离胸膜≤2 mm的结节视为良性不会导致肺癌被误诊为良性。
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来源期刊
Academic Radiology
Academic Radiology 医学-核医学
CiteScore
7.60
自引率
10.40%
发文量
432
审稿时长
18 days
期刊介绍: Academic Radiology publishes original reports of clinical and laboratory investigations in diagnostic imaging, the diagnostic use of radioactive isotopes, computed tomography, positron emission tomography, magnetic resonance imaging, ultrasound, digital subtraction angiography, image-guided interventions and related techniques. It also includes brief technical reports describing original observations, techniques, and instrumental developments; state-of-the-art reports on clinical issues, new technology and other topics of current medical importance; meta-analyses; scientific studies and opinions on radiologic education; and letters to the Editor.
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