The Analysis Of The Properties Of Subsolid Pulmonary Nodules And Establishment Of A Mathematical Prediction Model Of Benign And Malignant

Part I Comparison of Properties between Solid Nodules and Subsolid NodulesObjective:Through the retrospective analysis of the clinical,imaging,tumor markers and pathological data of 742 patients with pulmonary nodules,the differences in the properties of solid nodules and subsolid nodules were discussed,and the independent influencing factors for the identification of subsolid pulmonary nodules were screened.Methods:A retrospective analysis was made on the case data of 742 patients with pulmonary nodules diagnosed and admitted to jiangsu subei people's hospital from January 2014 to December 2018 with definite pathological results.Clinical data included:age,gender,smoking history,previous tumor history,and history of pulmonary underlying diseases.Image data included:diameter,location,morphology,boundary,spiculation,lobulation,calcification,cavitation,vascularity,cavity,bronchioles,pleural depression.Tumor markers:carcinoembryonic antigen,alpha fetoprotein,carbohydrate antigen 125,carbohydrate antigen 129 and neuron-sPecific enolase.Pulmonary nodules were divided into solid nodules and subsolid nodules according to the existence of ground glass lesions on CT.The differences between solid nodules and subsolid nodules in clinical,imaging,tumor markers and pathology were compared,and the independent influencing factors for the identification of subsolid pulmonary nodules were screened.Results:The results of univariate analysis showed that age,gender,smoking history,nodule diameter,boundary,spiculation,lobulation pleural depression and CEA were statistically significant factors,and the results of multivariate analysis showed that smoking history,nodule diameter,boundary,spiculation and lobulation were independent influencing factors to judge subsolid nodules.There were 107 cases(14.4%)of benign nodules and 635 cases(85.6%)of malignant nodules among 742 patients with pulmonary nodules.There were 46 cases(15.4%)of benign nodules and 253 cases(84.6%)of malignant nodules among 299 cases(40.3%)of solid nodules.There were 61 cases(13.8%)of benign nodules and 382 cases(86.2%)of malignant nodules among 443 cases(59.7%)of subsolid nodules.The proportion of pathological malignancy in subsolid nodules was higher than that in solid nodules.The inflammatory lesions in benign nodules occupied the main part.The proportion of inflammatory lesions in solid pulmonary nodules was 67.4%,and the proportion of inflammatory lesions in subsolid pulmonary nodules was 70.5%.The most common histological types of malignant lesions in solid nodules and subsolid nodules were adenocarcinoma,and the proportion of adenocarcinoma in subsolid nodules(100.0%)was significantly higher than that in solid nodules(78.3%).Conclusion:There were significant differences in clinical,imaging,tumor markers and pathology between solid nodules and subsolid nodules.Smoking history,nodule diameter,boundary,spiculation and lobulation were independent influencing factors for judging benign and malignant lesions of subsolid pulmonary nodules.The proportion of pathological malignancy in subsolid nodules was higher than that in solid nodules.Inflammatory lesions occupied the major part in benign nodules.Adenocarcinoma was the most common histological type in malignant lesions of solid nodules and subsolid nodules.The proportion of adenocarcinoma in subsolid nodules was significantly higher than that in solid nodules.There were also obvious differences in the subtypes of adenocarcinoma.Subsolid nodules represented the entire histological classification of adenocarcinoma and solid nodules only showed the invasive lesions.Part ? Establishment of a Mathematical Predicting Model for Benign and Malignancy in Subsolid Pulmonary NodulesObjective:By studying the clinical data,imaging features and tumor markers of 443 patients with subsolid pulmonary nodules,the independent risk factors for benign and malignant lesions of subsolid pulmonary nodules were analyzed,and the prediction model of the probability of malignancy was established.Methods:A retrospective analysis was done based on the data of 443 patients with subsolid pulmonary nodules,admitted to jiangsu subei people's hospital from January 2014 to December 2018 with definite pathological results.The clinical data included:age,gender,smoking history,previous tumor history,and history of pulmonary basic diseases.The imaging data included:nodule diameter,diameter of solid parts,the consolidation diameter of the maximum tumor diameter ratio(consolidation/tumor,C/T),location,morphology,boundary,spiculation,lobulation,calcification,cavitation,cavity,vascular cluster,bronchioles,and pleural depression.Tumor markers include carcinoembryonic antigen,alpha fetoprotein,carbohydrate antigen 125,carbohydrate antigen 199,and neuron-specific enolase.The total cases were randomly divided into two groups,including the modeling group A of 296 cases,accounting for about 2/3,and the verification group B of 147 cases,accounting for about 1/3.The clinical,imaging and tumor marker examination results of group A patients were analyzed by univariate analysis,and the results of univariate analysis with statistical significance were analyzed by multivariate analysis.Independent risk factors for malignant nodules were screened to establish the benign and malignancy prediction model of subsolid pulmonary nodules and draw the receiver-operating characteristic curve.The data of the verification group were substituted into the model in this study,Mayo model,VA model,Brock model and PKUPH model to draw ROC curves for each model and conduct comparative verification among the models.Results:Among 296 patients of A group with subsolid pulmonary nodules,255 were pathologically malignant(86.1%)and 41 were benign(13.9%).Univariate analysis showed age,gender,nodule diameter,maximum diameter of solid components,CTR,morphology,boundary,spiculation,lobulation,calcification,pleural depression,and CEA werestatistically significant(P<0.05).Multivariate analysis showed that gender,CTR,boundary,spiculation,lobulation and CEA were judged to independent risk factors for benign and malignant lesions of subsolid pulmonary nodules.Based on this,a benign and malignant probability prediction model of subsolid pulmonary nodules was established:malignant probability=ex/(1+ex),X=0.018+(1.436 × gender)+(2.068 × CTR)+(-1.976 ×boundary)+(2.082 × spiculation)+(1.277 × lobulation)+(2.296 × CEA).Based on the validation group data,the area under the ROC curve of the model in our study was 0.857(95%CI:0.794-0.920),which was significantly higher than the area under the ROC curve of the Mayo,VA,Brock and PKUPH models,indicating that the prediction effect was satisfactory.Conclusion:Patients' gender,CTR,boundary,spiculation,lobulation and CEA were judged to independent risk factors for benign and malignant lesions of subsolid pulmonary nodules.Compared with Mayo,VA,Brock,and PKUPH models,the benign and malignant probability prediction model of subsolid pulmonary nodules established in this study was more ideal in diagnosis and more conducive to the evaluation of benign and malignant of solid pulmonary nodules in clinical work.