Evaluating the Patient With a Pulmonary Nodule

Mazzone, Peter J.; Lam, Louis

doi:10.1001/jama.2021.24287

Cited by 213 publications

(110 citation statements)

References 51 publications

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“…The maximum diameter is a key parameter to evaluate the nature of SPN 22 . However, the cutoff for a possibly malignant SPN varies among different studies and guidelines.…”

Section: Methodsmentioning

confidence: 99%

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Malignancy risk stratification for solitary pulmonary nodule: A clinical practice guideline

Chen

Hao

et al. 2022

J Evidence Based Medicine

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Clinical question:The detection rate of the solitary pulmonary nodule (SPN) is increasing with the popularization of CT scanning. Malignancy risk stratification for SPN is a major clinical difficulty.Current practice: There have been several guidelines for SPN assessment. Inconsistency of these guidelines makes the clinical application difficult and confusing.Recommendations: In this Rapid Recommendation, solid and subsolid SPNs are recommended to be evaluated respectively. Six factors, namely the combination of age with sex, smoking history, history of malignancy, family history of malignancy, and nodule size, are recommended for malignancy risk stratification for both kinds of SPNs; the border of nodules (spiculation and lobulation) is recommended for evaluating solid SPNs and the density of nodules (pure or mixed ground-glass nodule) is recommended for subsolid nodules. Among them, smoking history and radiologic features (nodule diameter, border, and density) are of relatively higher importance. A scoring system

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“…The maximum diameter is a key parameter to evaluate the nature of SPN 22 . However, the cutoff for a possibly malignant SPN varies among different studies and guidelines.…”

Section: Methodsmentioning

confidence: 99%

“…The maximum diameter is a key parameter to evaluate the nature of SPN. 22 However, the cutoff for a possibly malignant SPN varies among different studies and guidelines. In several lung cancer screening studies, such as the NLST, nodules with a diameter larger than 4 mm were considered to be likely malignant.…”

Section: Nodule Diametermentioning

confidence: 99%

Malignancy risk stratification for solitary pulmonary nodule: A clinical practice guideline

Chen

Hao

et al. 2022

J Evidence Based Medicine

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“…Most of the nodules are benign, and some studies have shown that nearly 50% of SPN will produce malignant lesions. Lung cancer is one of the malignant tumors with the highest clinical morbidity and mortality, so early diagnosis of benign and malignant SPN and treatment will help improve the prognosis of patients [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Application of CT Postprocessing Reconstruction Technique in Differential Diagnosis of Benign and Malignant Solitary Pulmonary Nodules and Analysis of Risk Factors

Chen

2022

Computational and Mathematical Methods in Medicine

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Objective. To evaluate the application of CT postprocessing reconstruction technique in differential diagnosis of benign and malignant solitary pulmonary nodules and analysis of risk factors. Methods. A total of 150 solitary pulmonary nodules (SPN) patients admitted to our hospital from January 2020 to January 2022 were selected and divided into the benign SPN group ( n = 64 ) and the malignant SPN group ( n = 86 ) according to pathological results. All subjects underwent CT plain scan and CT postprocessing reconstruction, and the general information of the subjects was collected. The diagnostic value of CT plain scan and CT postprocessing reconstruction techniques for benign and malignant SPN was compared; and the CT signs of benign and malignant SPN were compared, and the risk factors of malignant SPN were analyzed. Results. The pathological results of this study showed that there were 64 cases with benign SPN and 86 cases with malignant SPN. The sensitivity, specificity, accuracy, positive predictive rate, and negative predictive rate of CT postprocessing reconstruction technology in diagnosing malignant SPN were 73.44%, 89.53%, 82.67%, 83.39%, and 81.91%, respectively, which were higher than 56.25%, 65.12%, 61.33%, 54.55%, and 66.67% of CT plain scan, and the difference was statistically significant ( P < 0.05 ). There were no significant differences in nodule location, nodule density, vacuole sign, vessel convergence, and pleural depression sign between the two groups ( P > 0.05 ). There were statistically significant differences in age, nodule diameter, lobulation sign, burr sign, calcification components, and ground-glass components between the two groups ( P < 0.05 ). Multivariate analysis showed that age ≥ 60 years, nodule diameter ≥ 15 mm , the presence of lobulation sign, burr sign, ground-glass components, and noncalcification components were independent risk factors for malignant SPN. Conclusion. CT postprocessing reconstruction technique has high diagnostic value in the differentiation of benign and malignant SPN, age ≥ 60 years , nodule diameter ≥ 15 mm , lobulation signs, burr signs, ground-glass components, and noncalcification components are independent risk factors for malignant SPN.

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“…In recent years, the application of radiomics in identifying the invasiveness of subsolid lung cancers has been extensively studied. Studies have shown that, as an important component of TNM staging, tumor size (T staging) <6 mm tend to have a malignancy probability of <1%, while nodules between 6 and 8 mm have a malignancy probability of 1%-2% (18). Since most early-stage lung cancers often appear as lung adenocarcinomas with ground-glass components, increasing studies have shown that the solid part size is a better predictor of lung nodule invasiveness and patient prognosis than tumor size (19)(20)(21)(22).…”

Section: Discussionmentioning

confidence: 99%

A predictive nomogram for lymph node metastasis in part-solid invasive lung adenocarcinoma: A complement to the IASLC novel grading system

et al. 2022

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BackgroundThe International Association for the Study of Lung Cancer (IASLC) proposed a novel grading system for invasive lung adenocarcinoma, but lymphatic invasion was not evaluated. Meanwhile, the scope of lymph node dissection in part-solid invasive lung adenocarcinoma (PSILA) is still controversial. Therefore, this study aims to explore preoperative risk factors for lymph node metastasis in PSILA, to provide reference for intraoperative dissection of lymph nodes.MethodsFrom 2018 to 2020, clinical data of patients (stage cN0) consecutively diagnosed as PSILA were retrospectively analyzed and classified according to the novel grading system. Logistic regression was conducted to screen the clinicopathological factors of lymph node metastasis in PSILA.ResultsA large cohort of 960 patients with PSILA who underwent lobectomy or sub-lobectomy were enrolled. By logistic regression analyses, solid part size, bronchial cutoff sign, spiculation, and carbohydrate antigen 199 (CA199) were eventually identified as independent risk factors for lymph node metastasis, based on which a nomogram was built to preoperatively predict the risk of lymph node metastasis [area under the receiver operating characteristic curve (AUC)=0.858; concordance index = 0.857; best cutoff, 0.027]. This suggests that intraoperative systematic lymph node dissection is recommended when the predicted risk value exceeds 0.027. Reproducibility of the novel grading system was verified.ConclusionsThe novel IASLC grading system was applicative in real world. The nomogram for preoperative prediction of lymph node metastasis may provide reference for the lymph node dissection strategy during PSILA surgeries.

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Evaluating the Patient With a Pulmonary Nodule

Cited by 213 publications

References 51 publications

Malignancy risk stratification for solitary pulmonary nodule: A clinical practice guideline

Malignancy risk stratification for solitary pulmonary nodule: A clinical practice guideline

Application of CT Postprocessing Reconstruction Technique in Differential Diagnosis of Benign and Malignant Solitary Pulmonary Nodules and Analysis of Risk Factors

A predictive nomogram for lymph node metastasis in part-solid invasive lung adenocarcinoma: A complement to the IASLC novel grading system

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