Differential Diagnosis of Nonabsorbable Inflammatory and Malignant Subsolid Nodules with a Solid Component ≤5 mm

He, Xiaoqun; Li, Xian; Wu, Yan; Wu, S.L.; Luo, Tianyou; Lv, Fajin; Li, Qi

doi:10.2147/jir.s355848

Cited by 7 publications

(14 citation statements)

References 39 publications

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“…It can intuitively reflect similar or different manifestations of lesions caused by a different pathological process. Due to the exudation and fibroplasias, ill-defined boundaries and peripheral changes were more common in ILs than in MLs in our study (27)(28)(29). In contrast, more MLs in our study had lobulation and spiculation due to the variations in differentiation and growth rate of cancer cells and the contraction of internal fibers.…”

Section: Discussioncontrasting

confidence: 56%

Sensitivity and specificity of computed tomography hypodense sign when differentiating pulmonary inflammatory and malignant mass-like lesions

Fu¹,

Lv²,

Lv³

et al. 2022

Quant Imaging Med Surg

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Background: Hypodense sign (HyS) reportedly is associated with pulmonary fungal infection, while it also common in many non-fungal lesions. This study aims to determine the significance of a HyS presented on contrast-enhanced computed tomography (CECT) when distinguishing pulmonary inflammatory from malignant mass-like lesions.Methods: From January 2013 to January 2021, we retrospectively evaluated the clinical and computed tomography (CT) data of patients with pathologically confirmed pulmonary inflammatory lesions (ILs) and malignant lesions (MLs). We analyzed and compared the CT features of the HyS in MLs and ILs, and then evaluated whether the HyS helped to differentiate MLs and ILs.Results: There were significant differences in age and tumor markers between patients with ILs and MLs (both P<0.05). Compared with that in MLs, the occurrence of the HyS in ILs was higher (62.81% vs.28.81%; P<0.0001). In ILs, more HyS were single, round or oval, well-defined, and had lower enhancement (ΔCT). Logistic regression analysis revealed that an ill-defined boundary, peripheral fibrosis, presence of a well-defined HyS, and a ΔCT value of the HyS <9.5 Hounsfield units (HU) were independent indicators for predicting ILs. After including the HyS CT features, the area under the curve (AUC) of the model predicting ILs increased from 0.953 to 0.986 with a sensitivity of 96.03% and a specificity of 94.03% (P=0.0027). Conclusions:The HyS is more common in ILs than in MLs. A single, regular, and well-defined HyS with a ΔCT value of <9.5 HU on CECT is highly suggestive of ILs. Combining the HyS with other morphological features could improve the diagnosis accuracy of pulmonary mass-like lesions.

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Section: Discussioncontrasting

confidence: 56%

Sensitivity and specificity of computed tomography hypodense sign when differentiating pulmonary inflammatory and malignant mass-like lesions

Fu¹,

Lv²,

Lv³

et al. 2022

Quant Imaging Med Surg

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“…This difference may be due to the fact that the well-defined GGNs were more susceptible to be neoplastic than the ill-defined ones, and thus they were more likely to be considered in surgical treatment. 10 , 17 , 18 Therefore, it is necessary to pay more attention to differentiate the well-defined GGNs in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…[6][7][8] Specifically, GGNs with solid component (part-solid nodule, PSN), well-defined boundary, vascular convergence sign, larger diameter, lobulation, spiculation, air cavity density, or pleural traction were highly suggestive of neoplastic lesions, while those with irregular shape or ill-defined boundary were considered to be benign ones. 9,10 Although these morphological indicators for differentiating neoplastic and non-neoplastic GGNs were not completely consistent in different studies, it is generally believed that whether the boundary is clear or not is of great value for differentiation. 4,10,11 Compared with neoplastic GGNs, ill-defined boundary was more frequent in non-neoplastic ones.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Although these morphological indicators for differentiating neoplastic and non-neoplastic GGNs were not completely consistent in different studies, it is generally believed that whether the boundary is clear or not is of great value for differentiation. 4,10,11 Compared with neoplastic GGNs, ill-defined boundary was more frequent in non-neoplastic ones. 10,12 However, a considerable non-neoplastic GGNs can also be well-defined, which indicates the diversity of their boundary manifestation.…”

Section: Introductionmentioning

confidence: 99%

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Correlations Between Inflammatory Cell Infiltration and Relative Density and the Boundary Manifestation of Pulmonary Non-Neoplastic Ground Glass Nodules

Liu¹,

Lv²,

Fu³

et al. 2023

JIR

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Purpose To investigate the influence factors for the various boundary manifestations of pulmonary non-neoplastic ground glass nodules (GGNs) on computed tomography (CT). Materials and Methods From January 2015 to March 2022, a total of 280 patients with 318 non-neoplastic GGNs were enrolled. The correlations between degree of inflammatory cell infiltration and relative density (ΔCT) and the boundary manifestations of lesions were evaluated, respectively. Results Nongranulomatous nodules (283, 89.0%) with fibrous tissue proliferation and/or inflammatory cells as the predominant pathological findings were the most common non-neoplastic GGNs, followed by granulomatous nodules (28, 8.8%). Among nongranulomatous GGNs, cases with more and less/no inflammatory cells were 15 (10.9%) and 122 (89.1%) in 137 well-defined ones with smooth margin, 16 (24.6%) and 49 (75.4%) in 65 well-defined ones with coarse margin, 43 (91.5%) and 4 (8.5%) in 47 ill-defined ones with higher ΔCT (>151HU), and 4 (11.8%) and 30 (88.2%) in 34 ill-defined ones with lower ΔCT (< 151HU). The proportion of cases with more inflammatory cells in well-defined nodules was similar to that in ill-defined ones with lower ΔCT (P = 0.587) but significantly lower than that in ill-defined ones with higher ΔCT (P < 0.001). Among the granulomatous nodules, ill-defined cases with higher ΔCT (16, 57.1%) were the most common, and they (7/8, 87.5%) frequently had changes during short-term follow-up. Conclusion Nongranulomatous nodules are the most common non-neoplastic GGNs, their diverse boundary manifestations closely correlate with degree of inflammatory cell infiltration and density difference.

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Differentiation of pulmonary solid nodules attached to the pleura detected by thin-section CT

Jiang,

Lv,

Tao

et al. 2023

Insights Imaging

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Background Pulmonary solid pleura-attached nodules (SPANs) are not very commonly detected and thus not well studied and understood. This study aimed to identify the clinical and CT characteristics for differentiating benign and malignant SPANs. Results From January 2017 to March 2023, a total of 295 patients with 300 SPANs (128 benign and 172 malignant) were retrospectively enrolled. Between benign and malignant SPANs, there were significant differences in patients’ age, smoking history, clinical symptoms, CT features, nodule-pleura interface, adjacent pleural change, peripheral concomitant lesions, and lymph node enlargement. Multivariate analysis revealed that smoking history (odds ratio [OR], 2.016; 95% confidence interval [CI], 1.037–3.919; p = 0.039), abutting the mediastinal pleura (OR, 3.325; 95% CI, 1.235–8.949; p = 0.017), nodule diameter (> 15.6 mm) (OR, 2.266; 95% CI, 1.161–4.423; p = 0.016), lobulation (OR, 8.922; 95% CI, 4.567–17.431; p < 0.001), narrow basement to pleura (OR, 6.035; 95% CI, 2.847–12.795; p < 0.001), and simultaneous hilar and mediastinal lymph nodule enlargement (OR, 4.971; 95% CI, 1.526–16.198; p = 0.008) were independent predictors of malignant SPANs, and the area under the curve (AUC) of this model was 0.890 (sensitivity, 82.0%, specificity, 77.3%) (p < 0.001). Conclusion In patients with a smoking history, SPANs abutting the mediastinal pleura, having larger size (> 15.6 mm in diameter), lobulation, narrow basement, or simultaneous hilar and mediastinal lymph nodule enlargement are more likely to be malignant. Critical relevance statement The benign and malignant SPANs have significant differences in clinical and CT features. Understanding the differences between benign and malignant SPANs is helpful for selecting the high-risk ones and avoiding unnecessary surgical resection. Key points • The solid pleura-attached nodules (SPANs) are closely related to the pleura. • Relationship between nodule and pleura and pleural changes are important for differentiating SPANs. • Benign SPANs frequently have broad pleural thickening or embed in thickened pleura. • Smoking history and lesions abutting the mediastinal pleura are indicators of malignant SPANs. • Malignant SPANs usually have larger diameters, lobulation signs, narrow basements, and lymphadenopathy. Graphical Abstract

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Differential Diagnosis of Nonabsorbable Inflammatory and Malignant Subsolid Nodules with a Solid Component ≤5 mm

Cited by 7 publications

References 39 publications

Sensitivity and specificity of computed tomography hypodense sign when differentiating pulmonary inflammatory and malignant mass-like lesions

Sensitivity and specificity of computed tomography hypodense sign when differentiating pulmonary inflammatory and malignant mass-like lesions

Correlations Between Inflammatory Cell Infiltration and Relative Density and the Boundary Manifestation of Pulmonary Non-Neoplastic Ground Glass Nodules

Differentiation of pulmonary solid nodules attached to the pleura detected by thin-section CT

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