Relationship Between Imaging Findings And Clinical Pathology Of Sub-centimeter Small Pulmonary Nodules

Background : At present,the incidence of lung cancer in China is becoming increasingly severe,and the national burden is increasing.A large proportion of these patients died of metastasis of malignant sub-centimeter nodules of the lung due to lack of early diagnosis.However,as the main way of early diagnosis of lung cancer,X-ray may miss most of the early lung cancer.At the same time,the further popularization of CT and the early detection of small pulmonary nodules make CT have broad prospects in the early diagnosis of lung cancer.Therefore,it is particularly important to explore the relationship between the imaging manifestations of small pulmonary nodules obtained by CT examination and clinical pathology for the diagnosis of early lung cancer.Objective:Aiming at the problem of nodule nature in the treatment of sub-centimeter pulmonary nodules by clinicians at present,the most sensitive CT imaging technique for pulmonary nodules was used to explore the relationship between the imaging manifestations of sub-centimeter pulmonary nodules and clinical pathology.Methods:This experiment is a prospective study.The clinical data of 126 patients with sub-centimeter pulmonary nodules(less than 10 mm in diameter)who underwent surgical resection in Anhui Provincial Hospital between May 2016 and June 2017 were collected.The sex,age,living habits(smoking history,biochemical parameters and the excised nodules of all patients were recorded one by one.Advanced instruments such as GE Lightspeed 4 multi-slice spiral CT scanner were used in the study.All patients completed CT examination after admission.All CT images were double-blind read by two highly qualified chest radiologists to summarize the imaging characteristics of patients.All patients underwent surgery after puncture and positioning,and all small nodules were removed during the operation.Pathological findings were analyzed according to the classification criteria of International Association for Lung Cancer Research/American Thoracic Society/European Respiratory Society.The relationship between imaging manifestations and clinical pathology of small pulmonary nodules in all patients was analyzed.In this study,SPSS 20.0 statistical software was used for statistical analysis.The statistical data were expressed by constituent ratio(%)and 2test or Fisher exact test.The measurement data were expressed by(+s)and t test.The difference was statistically significant(P<0.05).Results:A total of 142 pulmonary nodules were detected in 126 patients,including110 single nodules(87.30%)and 16 double nodules(12.70%).Pathological diagnosis included 42 chronic inflammation(29.58%),52 cancerous nodules(36.62%)(including 46 adenocarcinomas,4 squamous carcinomas,2 poorly differentiated neuroendocrine carcinomas),48 atypical adenomatous hyperplasia(AAH),36 pure ground glass density nodules(25.3%).There were 34 solid ground-glass density nodules(23.94%)and 72 solid nodules(50.70%).There were significant differences in the boundary characteristics,burr sign,pleural indentation,ground-glass density shadow and nodule diameter of sub-centimeter nodules with different pathological characteristics(P < 0.05).The proportion of concomitant pleural indentation sign was higher than that of chronic inflammation and AHH.The proportion of nodules located in the upper lobe of lung was higher than that of chronic inflammation.The proportion of nodule diameter(> 6 mm)was higher than that of chronic inflammation,and the proportion of solid ground glass density was higher than that of chronic inflammation(P < 0.05).Conclusion:CT imaging findings of sub-centimeter pulmonary nodules are associated with clinicopathological features.CT imaging shows blurred boundary,burr sign,pleural indentation sign,and nodules with sub-solid composition and diameter greater than or equal to 6 mm.Those located in the upper lobe of the lung tend to have malignant pulmonary nodules;solid nodules with clear boundary and diameter less than 6 mm tend to have benign pulmonary nodules,while those located in the middle and lower lobes of the lung tend to have benign pulmonary nodules.Glass density pathology is more prone to AAH.