Analysis Of Clinical Characteristics And Benign And Malignant Factors Of Multiple Pulmonary Nodules

Objective:The patients with multiple pulmonary nodules were divided into groups by postoperative pathology to explore the correlation between the basic data,serum tumor indexes and imaging features of benign and malignant pulmonary nodules,and to analyze the clinical features and influencing factors of multiple pulmonary nodules.Methods:In strict accordance with the inclusion and exclusion criteria of this study,patients who underwent surgery for multiple pulmonary nodules in the Department of Thoracic surgery of the second affiliated Hospital of Xi’an Jiaotong University(Northwest Hospital)from January 2020 to January2022 were selected for data collection,statistics and analysis.A total of 276patients were collected and divided into benign group and malignant group according to the postoperative pathological results.firstly,the first clinical symptoms,distribution location and the proportion of pathological types in each group were counted.Secondly,the differences of sex,age,clinical symptoms,smoking history,chronic lung history,family tumor history,carcinoembryonic antigen(CEA),neuron specific enolase(NSE),cytokeratin19 fragment(CYFRA21-1),distribution location,diameter,shape,boundary,lobulation sign,burr sign,pleural indentation sign and vascular convergence sign between the two groups were analyzed and compared.The statistically significant indexes were analyzed by multivariate Logistic regression analysis,and finally the independent risk factors of malignant multiple pulmonary nodules were screened out.Results:1.276 patients with multiple pulmonary nodules were divided into benign group(n=85)and malignant group(n=191,191).Benign pulmonary nodules were mostly found in the right upper lobe(34.1%)and were found in asymptomatic physical examination(57.6%).Granulomatous inflammation was the most common pathological type after operation(40.0%).Malignant pulmonary nodules also occurred in the upper lobe of the right lung(32.5%),mainly found by asymptomatic physical examination(55.5%).The most common postoperative pathological type was adenocarcinoma of the lung(84.0%).2.Basic data:Basic data:there were 40 females and 45 males in the benign group,with an average age of 52.41±11.17(years),and 83 females and 108 males in the malignant group(mean age 56.16±10.72).There was significant difference in age between benign and malignant groups(P<0.05).There was no significant difference in sex,first clinical symptoms,smoking history,chronic lung history and family tumor history between the two groups.3.The average level of serum tumor markers:The average level of serum carcinoembryonic antigen was 3.56±1.47(ug/L)in benign group and6.22±5.03(ug/L)in malignant group(P<0.05).There was no significant difference in the average levels of serum neuron-specific enolase and cytokeratin 19 between benign and malignant groups.4.Imaging features:There were significant differences between benign and malignant groups in boundary(X~2=73.020 P<0.001),lobulation sign(X~2=46.107 P<0.001),spiculation sign(X~2=21.120 P<0.001),pleural indentation sign(X~2=91.165 P<0.001)and vascular convergence sign(X~2=65.201 P<0.001),but there was no significant difference in mean diameter,location and shape of nodules between benign and malignant groups.5.Multivariate Logistic regression analysis showed that age,blurred boundary,lobulation sign,spiculation sign,pleural indentation sign and vascular convergence sign were the risk factors of malignant pulmonary nodules.Conclusion:1.The common pathological type of malignant multiple pulmonary nodules is lung adenocarcinoma,and the common pathological type of benign multiple pulmonary nodules is granulomatous inflammation;both malignant and benign multiple pulmonary nodules are often found in the upper lobe of the right lung and are often found asymptomatically.2.Age,serum carcinoembryonic antigen,boundary,lobulation sign,spiculation sign,pleural indentation sign and vascular convergence sign have certain guiding value in judging the benign and malignant of multiple pulmonary nodules.3.The results of multivariate Logistic regression analysis showed that patients’age,spiculation sign,lobulation sign,pleural indentation sign and vascular convergence sign were independent risk factors of malignant multiple pulmonary nodules.