Correlation Study Of Imaging Features Of Small Pulmonary Nodules With Pathology And Lymph Node Metastasis And Exploration Of Surgical Methods

Objectives:Through the correlation between the high-resolution CT imaging features of small pulmonary nodules and pathological types,pathological subtypes of lung adenocarcinoma,pathological typing of lung adenocarcinoma,and lymph node metastasis,explore the scientific clinical treatment of pulmonary nodules and the choice of surgical methods.Methods:A total of 303 patients admitted to the Department of Geriatric Thoracic Surgery of the First Affiliated Hospital of Kunming Medical University from September 2017 to January 2019 were collected.All patients were diagnosed with small pulmonary nodules by high-resolution CT.and confirms the pathological diagnosis by CT-guided percutaneous biopsy or surgical resection.Record the basic information of each patient(name,gender,age,place of origin,smoking history),various imaging characteristics(nodule size,calcium,solid components,lobulation,spiculation,vascular bundle sign,pleural traction Signs,aerated bronchus sign,vacuole and verge conditions),pathological types(benign,adenocarcinoma,squamous cell carcinoma,other types of tumors),pathological subtypes of adenocarcinoma(Atypical adenomatous hyperplasia(AAH),Adenocarcinoma in situ(AIS),(Minimally invasive adenocarcinoma(MIA),Invasive adenocarcinoma(IPA)),pathological classification of adenocarcinoma(Solid predominant adenocarcinoma,Micropapillary predominant adenocarcinoma,Papillary predominant adenocarcinoma,Lepidic predominant adenocarcinoma,and Acinar predominant adenocarcinoma)and lymph node metastasis.The correlation is obtained through statistical analysis.Results:1.Basic situation:Of the 303 patients,184 were male(60.7%),119 were female(39.3%).Average age 55 years.216 were solid nodules(71.3%),and 87 were GGO(28.7%).Among the GGO,84 were malignant,3 were benign(all mixed ground-glass shadow nodules).95(31.4%)had a history of smoking or previous smoking,208(68.6%)had never smoked.Among the patients who smoked,91 were males(95.8%);52(17.1%)in Qujing Xuanwei,and 96 in Kunming(31.7%),155(51.1%)in other regions;204 cases(67.3%)of lung adenocarcinoma,8 cases(2.6%)of squamous cell carcinoma,15 cases(5.0%)of other malignant tumors,76 cases of benign(25.1%).In lung adenocarcinoma,153 cases of IPA(76.9%),30 cases of MIA(15.1%),7 cases of AIS(3.5%),9 cases of AAH(4.5%).In the pathological classification of IPA,76 cases were Acinar predominant adenocarcinoma(49.7%),47 cases were Lepidic predominant adenocarcinoma(30.7%),15 cases were Papillary predominant adenocarcinoma(9.8%),14 cases were Solid predominant adenocarcinoma(9.2%),and 1 was Micropapillary predominant adenocarcinoma(0.7%).213 patients underwent systemic lymph node dissection and 20 patients with metastases(all solid nodules).There were 84 cases of malignant GGO with a malignancy rate of 96.6%.The proportions of IPA in pGGO,mGGO,and SPN were:46.8%,81.8%,and 95.5%;the lymph node metastasis rates were:0%,0%,and 14.7%.2.Correlation between pulmonary nodule imaging and benign and malignant The univariate analysis showed that benign pulmonary nodules,squamous cell carcinoma,adenocarcinoma,and other malignant tumors is Significant differences in the gender,age,smoking history,nodule size,calcium,solid components,lobulation,vascular bundle sign,pleural traction Signs,aerated bronchus sign,vacuole and verge conditions.Based on the results of logistic multivariate analysis,taking benign nodules as the reference group,age was an independent risk factor for lung squamous cell carcinoma;whether calcification,lobulation,irregular verge,and vascular bundle sign were significantly associated with lung adenocarcinoma.Smoking history and lobulation were significantly associated with other malignancies.3.Correlation between pulmonary nodule imaging and pathological subtypes:The pathological subtypes of lung adenocarcinoma AAH,AIS,MIA,IPA have significant performance in age,smoking history,nodule size,solid components,lobulation,spiculation,pleural traction sign,aerated bronchus sign and verge conditions difference.Among the pathological subtypes of lung adenocarcinoma,there was no significant correlation between AAH,AIS,MIA and imaging features.IPA was significantly associated with age,nodule size,and solid components.The results of the ROC curve suggest that the critical size of the nodule infiltration and infiltrating lesions is 8.5mm,the sensitivity is 83.1%,the specificity is 62.5%,and the area under the ROC curve is 74.6%.4.Correlation between pulmonary nodule imaging and pathological typing:The highest proportion of the five pathological types of IPA is significantly different from the performance of gender,smoking history,solid components,lobulation,spiculation,and aerated bronchus sign.In the pathological classification of IPA,Papillary predominant adenocarcinoma is significantly related to nodule size and gender,Acinar predominant adenocarcinoma is significantly related to age and vacuole,and the spiculation is an independent risk factor for IPA based on the mural type.Solid predominant adenocarcinoma has no significant correlation with imaging,and the number of Micropapillary predominant adenocarcinoma is too less for effective statistical analysis.5.Correlation of pulmonary nodule imaging and pathology with lymph node metastasis:There were statistically significant differences in lymph node metastasis between smoking history,calcification,solid compoaents,spiculation,pleural traction sign,and aerated bronchus sign.The size of the nodule is an independent risk factor for lymph node metastasis,and the Lepidic predominant adenocarcinoma is a negative predictor of lymph node metastasis.The results of the ROC curve suggest that the critical value of the presence or absence of lymph node metastasis is 17.5mm,the sensitivity is 80.0%,the specificity is 72.5%,and the area under the ROC curve is 81.2%.Conclusions:1.benign pulmonary nodules,squamous cell carcinoma,adenocarcinoma,and other malignant tumors is Significant differences in the gender,age,smoking history,nodule size,calcium,solid components,lobulation,vascular bundle sign,pleural traction Signs,aerated bronchus sign,vacuole and verge conditions.Age is an independent risk factor for lung squamous cell carcinoma calcium,lobulation,irregular verge,and aerated bronchus sign are significantly associated with lung adenocarcinoma.Nodule size,smoking history,and lobulation are significantly associated with other malignancies.2.The pathological subtypes of lung adenocarcinoma have significant differences in age,smoking history,nodule size,solid components,lobulation,spiculation,pleural traction sign,aerated bronchus sign and verge conditions.The degree of invasion is related to age,nodule size,and solid components.The older patients,larger solid nodules are more suggestive of invasive lung adenocarcinoma.3.GGO have a high malignancy rate,and the proportion of invasive lesions is significantly higher than that of pre-infiltration lesions.The treatment of GGO should be more aggressive.4.Whether GGO are subjected to lobectomy should be combined with imaging and intraoperative freezing Lungectomy is still the gold standard when intraoperative freezing cannot determine the infiltration.Sub-lobarectomy should be avoided as much as possible.For solid nodules,Regardless of size,anatomical lobectomy is the gold standard.5.The highest proportion of the five pathological types of IPA is significantly different from the performance of gender,smoking history,solid components,lobulation,spiculation,and aerated bronchus sign.Papillary predominant adenocarcinoma is significantly related to nodule size and gender,Acinar predominant adenocarcinoma is significantly related to age and vacuole,while spiculation is an independent risk factor for Lepidic predominant adenocarcinoma and Solid predominant adenocarcinoma No significant correlation was found in imaging.Each subtype has statistically significant differences in lymph node metastasis.The Lepidic predominant adenocarcinoma is a negative predictor of lymph node metastasis.6.There were statistically significant differences in lymph node metastasis between smoking history,calcium,solid components,spiculation,pleural traction sign,and aerated bronchus sign.Nodule size is an independent risk factor for lymph node metastasis.In all of GGO,the probability of lymph node metastasis is extremely low(0%),no lymph node dissection is required.F or solid nodules,especially solid nodules larger than 17 mm,systemic lymph node dissection should be strictly performed during the operation.For solid nodules,especially solid nodules larger than 17.5 mm,systemic lymph node dissection should be strictly performed during the operation.7.The optimal cut-off value for the maximum diameter of non-invasive lung adenocarcinoma and invasive lung adenocarcinoma is 8.5mm;the maximum cut-off value of whether the lung nodules are lymph node metastasis is 17.5mm.