A Study On Differentiation Of Benign And Malignant Pulmonary Nodules Based On Imaging Features

PART1 A PRELIMONARY STUDY ON EVALUTION OF BENIGN AND MALIGNANT PULMONARY NODULES BASED ON THIN SLICE CT IMAGING FEATURESPurpose:To establish a pulmonary node imaging—grading and reporting system(PNI-GARS)to evaluate its application value in assessing benign and malignant pulmonary nodules.Materials and Methods:A total of 200 pulmonary nodules of 180 patients were retrospectively analyzed.PNI-GARS was adopted for grading assessment,and the accuracy,sensitivity,specificity,negative predictive value,and positive predictive value of PNI-GARS grading were calculated.Results:The negative predictive values of Grade ? and Grade ? were100.0%,and 97.2%,respectively;and the positive predictive values of Grade ?a,?b,?c,and ? were 53.8%,85.7%,93.3%,and 100.0%,respectively.Grade I and II were classified as negative nodules,grade ?a and above as positive nodules,with the accuracy,sensitivity,specificity,and total positive predictive value of PNI-GARS grading being 89.5%,99.3%,68.3%,and 87.2%,respectively.Grade ?,? and ?a were classified as negative nodules,and Grade ?b to ? as positive nodules,With the accuracy,sensitivity,specificity,and total positive predictive values of PNI-GARS grading being 88.5%,89.1%,87.3%,and 93.8%,respectively.Excluding grade ?a,grade ? and ? were classified as negative nodules,and grade ?b to ? as positive nodules,With the accuracy,sensitivity,specificity,and total positive predictive values of PNI-GARS grading being 94.8%,99.2%,84.3%,and 93.8%,respectively.Conclusion:PNI-GARS can effectively classify pulmonary nodules screened out by CT,featuring a relatively high application value in evaluation of benign and malignant pulmonary nodules.PART2 COMPARATIVE STUDY OF PNI-GARS AND LUNG-RADS IN EVALUATING THE RISK OF PULMONARY SUBSOLID NODULESPurpose:To compare the application of PNI-GARS and Lung-RADS in evaluating benign and malignant pulmonary subsolid nodules.Methods:A total of 185 pulmonary subsolid nodules diagnosed by surgery and pathology in First Affiliated Hospital of Chongqing Medical University from April 2012 to November 2017 were retrospectively analyzed.PNI-GARS grading and Lung-RADS classification were used to classify those nodules.PNI-GARS grading classified grade ? and II as negative nodules,grade III to IV were classified as positive nodules.The Lung-RADS classification classified category 1,2 nodules as negative nodules,category 3 to 4 X nodules were classified as positive nodules,all cases were analyzed and compared with pathological findings.The accuracy,sensitivity,specificity,negative predictive value,positive predictive value,false positive rate,and false negative rate of PNI-GARS grading and Lung-RADS classification were calculated respectively.Results:Those subsolid nodules were graded by PNI-GARS,the negative predictive values of Grade ? and Grade ? were 100.0%,and 66.7%,respectively,and the positive predictive values of Grade ?a,?b,?c,and? were 71%,95%,97%,and 100.0%,respectively.Those subsolid nodules were graded by Lung-RADS,the negative predictive values of category 2was 21.9%,and the positive predictive values of category 3,4B,and 4X were 100%,50%,and 96.6%,respectively.The negative predictive value,positive predictive value,accuracy,sensitivity,specificity,false positive rate and false negative rate of the PNI-GARS grading and Lung-RADS classification were 71.4%,92.7%,90.3%,96.2%,55.6%,44.4% and 3.8%and 21.9%,97.2%,50.8%,43.7%,92.6%,7.4% and 56.3%,respectively.Conclusion:The negative predictive value of the PNI-GARS grading to the pulmonary subsolid nodules was obviously superior to the Lung-RADS classification,and it improved the accuracy and sensitivity of the prediction of the subsolid nodules,and can effectively reduce the missed diagnosis of malignant pulmonary subsolid nodules.