Correlation Between Clinical Characteristics And CT Features And Pathological Property In Sub-centimeter SPN

Objectives:1?Identify the clinical characteristics and CT imaging features of sub-centimeter SPN,explore the features that are relevant to pathological property,screen out the independent influencing factors for malignant sub-centimeter SPN.2?Identify the CT imaging features of sub-centimeter lung adenocarcinoma,explore the features that are relevant to sub-centimeter invasive adenocarcinoma.Methods:Cases of 142 patients with sub-centimeter SPN who underwent surgical treatment in the Department of Thoracic Surgery of Yunnan Cancer Hospital from October 2017 to December 2018 were collected.General clinical data,CT imaging data and pathological data of these patients were collected.The general clinical data included sex,age,family history of malignant tumors,clinical symptoms,smoking history and history of lung diseases;CT imaging data included the location of nodules,type of nodules,vascular perforation sign,pleural traction sign,vacuole sign,spiculation sign and lobulation sign.In the first part,the general clinical features and CT imaging features of benign and malignant sub-centimeter SPN patients were analyzed by univariate analysis,and the characteristics related to benign and malignant sub-centimeter SPN were analyzed.Then,the characteristics related to sub-centimeter SPN were included in the binary logistic regression for multifactor analysis,and the independent risk factors of malignant sub-centimeter SPN were screened for.In the second part,the patients with adenocarcinoma were divided into preinvasive lesions and invasive lesions according to the pathological results after operation.The CT imaging characteristics were analyzed,and the imaging characteristics related to the infiltration degree of sub-centimeter lung adenocarcinoma were discussed.Statistical data analysis was carried out by SPSS 23.0 software.Chi-square test was used to analyze the relationship between clinical features,CT imaging characteristics and the benign and malignant nature of sub-centimeter SPN,and the relationship between CT imaging characteristics and the infiltration degree of sub-centimeter adenocarcinoma.Bi-classification logistic regression analysis was used to screen the independent influencing factors of benign and malignant nature of sub-centimeter SPN.Results:1.Among 142 cases of sub-centimeter SPN,benign nodules accounted for 40.85%(58/142),and malignant nodules accounted for 59.15%(84/142),of which 82 cases were lung adenocarcinoma,accounting for 97.62%of malignant nodules.In malignant pulmonary nodules,There were 3 cases of atypical adenomatoid hyperplasia(3.57%),One case had a pathological stage of T1aN1M0 ?A(1.19%),The pathological stage of 19 cases of adenocarcinoma in situ was TisNOMO 0(22.62%),The pathological stage of the remaining cases was T1aNOMO IA1(72.62%).2.Univariate analysis for clinical features and CT imaging features of benign and malignant sub-centimeter SPN patients were carried out,and the result showed that statistical difference for the malignant rate of sub-centimeter SPN was observed in following aspects:gender(40.35%VS 71.76%,P=0.000),family history of malignant tumors(73.68%VS 53.85%,P=0.033),type of nodules(31.03%VS 78.57%,P=0.000),vascular perforation sign(70.53%VS 36.17%,P=0.000).pleural traction sign(74.36%VS 53.40%,P=0.023),vacuole sign(81.48%VS 53.91%,P=0.009).However,no statistical difference for the malignant rate of sub-centimeter SPN was observed in following aspects:age(55.88%VS 60.19%,P=0.656),smoking history(48.65%VS 62.86%,P=0.131),clinical symptoms(57.14%VS 59.50%,P=0.839),lung disease history(41.67%VS 62.71%,P=0.056),different lobes(60.87%VS 58.62%VS 69.77%VS 60.00%VS 40.74%,P=0.212),spiculation sign(67.58%VS 56.19%,P=0.107),lobulation sign(69.57%VS 57.14%,P=0.267).3.Binary logistic regression analysis was carried out between univariate analysis and six characteristics associated with benign and malignant nature of sub-centimeter SPN which included sex,family history of malignant tumors,nodule type,vascular perforation sign,pleural traction sign and vacuole sign.The results showed that female(OR=6.913,P=0.000),vascular perforation sign(OR=4.120,P=0.004),pleural traction sign(OR=6.385,P=0.005).Subsolid pulmonary nodules(OR=6.913,P=0.000)were independent risk factors for malignant sub-centimeter SPN.However,family history of malignant tumors(OR=1.195,P=0.746),vacuole sign(OR=1.342,P=0.662)can not be classified as independent influencing factors of malignant sub-centimeter SPN.4.Among 84 cases of malignant sub-centimeter SPN,82 cases were adenocarcinomas,of which 22 were pre-invasive lesions(AAH+AIS)and 60 were invasive lesions(MIA+IA).The proportion of infiltrating lesions in solid nodules was higher than that in pure ground glass nodules(88.89%VS 47.83%,P=0.016),and that in mixed ground glass nodules was higher than that in pure ground glass nodules(80.49%VS 47.83%,P=0.015).There was a significant difference in the proportion of infiltrating lesions in sub-centimeter adenocarcinoma with or without vascular perforation sign(2=20.919,P=0.000).The proportion of invasive lesions in pleural traction sign(74.07%VS 72.73%,P=0.897),vacuole sign(85.71%VS 68.85%,P=0.223),burr sign(79.17%VS 70.69%,P=0.431),lobulation sign(93.33%VS 68.66%,P=0.104)had no significant difference.Conclusion:1.The malignant rate of sub-centimeter SPN is high,The malignant rate is 59.15%,and adenocarcinoma is the main type,the proportion can even reach 97.62%.The main pathological stages of malignant sub-centimeter SPN are stage 0 and IA1.2.Sex,family history of malignant tumors,nodule type,vascular perforation sign,pleural traction sign and vacuole sign are correlated with the benign and malignant nature of sub-centimeter SPN.Female,sub-solid nodules,accompanied by vascular perforation sign and pleural traction sign are independent risk factors for judging malignant sub-centimeter SPN.3.The type of nodules and vascular perforation sign are correlated with the degree of invasion of sub-centimeter adenocarcinoma.Solid or mixed ground glass nodules with vascular perforation sign suggest that sub-centimeter adenocarcinoma is an invasive lesion.