A Clinical Model To Evaluate Solitary Pulmonary Nodules

Objective：To screen the clinacal factors affecting the malignant probability ofsolitary pulmonary nodules(SPNs) with multivaate Logistic regression analysis,andTo establish a clinical prediction model, evaluate its test effectiveness in thedifferential diagnosis in SPNs.Methods：A retrospctive cohort study in our institution included182patients withfanally diagosis of solitary pulmonary nodules from Jul2008to Jun2011(groupA).Clinical data included gender,age,smoking history,quitting smoking,history oftumor,serum carcinoembryonic antigen(CEA),location,diameter,density,vacuole sign,cavity, airbronchogram, calcification, lobulation, spiculated sign, spiculation, pleuralindentation sign, vascular convergence sign, enhanced CT value, the maximumstandard uptake value(SUVmax) of positron-emission tomography (PET),pathological diagnosis were collected.The independent pridictors of malignancy wereestimated with single-factor analysis and multivariate analysis,then the clinicalprediction model to identify malignant was established.Other45SPN patients(groupB) from Jul2011to Dec2011were used to tested the value of this model.Results: Single-factor analysis showed that gender, age, lower lobe location,diameter, density, airbronchogram, calcification, lobulation, spiculation, pleuralindentation sign, vascular convergence sign, enhanced CT value, the SUVmax of PETsignificantly affecting judgment of SPNs of benign or maligant.The multivariateanalysis revealed that female(OR,3.982,95%CI1.686to9.405),age(OR,1.058,95%CI1.022to1.095), lobulation(OR,3.962,95%CI1.714to9.156), shortspiculation(OR,4.473,95%CI1.674to11.950),pleural indentation sign(OR,2.733,95%CI1.075to6.945) were the independent predictors of malignancy in patient withSPN, solid nodule(OR,0.123,95%CI0.043to0.356) suggested benign.Conclusion: As for solitary pulmonary nodules, female, age, lobulation, short spiculation and pleural indentation sign were the independent predictors ofmalignancy in patient with SPN, solid nodule suggested benign. The prediction modelis sufficient to estimate the malignancy of patient with SPN.