高危肺结节影像学表现与术后病理及随访结果对照研究

Comparative Study on Imaging Manifestations, Postoperative Pathology and Follow-Up Results of High-Risk Pulmonary Nodules

摘要: 目的：以手术病理结果及长期影像随访结果为双重判定标准，对照分析健康体检人群高危肺结节低剂量螺旋CT (LDCT)影像学特征与病灶良恶性结局的对应关系，筛选预测高危肺结节恶性病变的独立影像学危险因素，总结不同影像指标对早期肺部良恶性病变的鉴别诊断价值，为体检早期肺癌精准筛查、高危结节随访管理提供循证参考。方法：回顾性选取2024年4月~2026年4月于本健康医学中心行胸部LDCT筛查、影像学评估为高危肺结节的196例患者为研究对象，根据最终临床结局分为良性组104例、恶性组92例。良性组包含外科手术病理证实良性26例，全程影像随访结节无增大、无形态恶变征象、持续稳定观察病例58例；恶性组均为手术病理证实肺部恶性肿瘤。首先采用卡方检验开展单因素分析，比较两组结节密度类型、最大直径、分叶征、毛刺征、胸膜牵拉征、空泡征、血管集束征等影像学特征；将单因素分析有统计学意义的指标纳入多因素Logistic回归模型，筛选恶性病变的独立危险因素，计算OR值及95%置信区间(95% CI)。结果：196例高危肺结节中，良性病变104例，恶性病变92例，恶性病变以原位腺癌、微浸润腺癌、浸润性腺癌为主。单因素分析显示：良恶性组结节密度构成、直径分层分布比较差异均有统计学意义(P < 0.05)；恶性组混合磨玻璃结节占比更高，结节直径越大恶性构成比越高。毛刺征、胸膜牵拉征、空泡征、分叶征、血管集束征组间差异无统计学意义(P > 0.05)。多因素Logistic回归分析提示，混合磨玻璃密度、结节最大直径 > 10 mm是高危肺结节恶性病变的独立危险因素。结论：高危肺结节的密度类型、病灶大小是预测结节良恶性的独立影像学危险因素，混合磨玻璃密度、大直径结节恶性风险更高；单一恶性形态学征象鉴别价值有限，良恶性病灶影像表现重叠明显。本研究结论与Lung-RADS等权威指南理念相符，采用手术病理联合长期随访的双重判定标准，贴合体检人群高危结节管理实际，可提升早期肺癌的鉴别诊断及风险分层准确性。

Abstract: Objective: To take surgical pathological results and long-term imaging follow-up outcomes as the dual judgment criteria, analyze the correlation between imaging features of high-risk pulmonary nodules detected by low-dose spiral CT (LDCT) and benign and malignant lesions in physical examination population, screen independent imaging risk factors for malignant high-risk pulmonary nodules, and summarize the differential diagnostic value of various imaging indicators, so as to provide evidence-based reference for accurate early lung cancer screening and standardized follow-up management of high-risk pulmonary nodules. Methods: A total of 196 patients with high-risk pulmonary nodules who underwent chest LDCT examination in our health medical center from April 2024 to April 2026 were retrospectively enrolled. All subjects were divided into benign group (104 cases) and malignant group (92 cases) according to final clinical outcomes. The benign group included 26 cases confirmed as benign lesions by surgical pathology, and 58 stable cases without nodule enlargement and malignant morphological changes during long-term imaging follow-up. All patients in the malignant group were diagnosed as pulmonary malignant tumors by postoperative pathology. Chi-square test was used for univariate analysis to compare the imaging features such as nodule density type, maximum diameter, lobulation sign, spiculation sign, pleural traction sign, vacuole sign, and vascular convergence sign between the two groups. Variables with statistical differences in univariate analysis were included in multivariate Logistic regression model to screen independent risk factors for malignant lesions, and odds ratio (OR) and 95% confidence interval (95% CI) were calculated. Results: Among 196 cases of high-risk pulmonary nodules, 104 cases were benign lesions and 92 cases were malignant lesions, mainly including adenocarcinoma in situ, minimally invasive adenocarcinoma and invasive adenocarcinoma. Univariate analysis showed that there were statistically significant differences in nodule density composition and diameter stratification between the two groups (P < 0.05). Mixed ground-glass nodules accounted for a higher proportion in malignant group, and the malignancy rate increased with the growth of nodule diameter. There were no significant differences in spiculation sign, pleural traction sign, vacuole sign, lobulation sign, and vascular convergence sign between groups (P > 0.05). Multivariate Logistic regression analysis showed that mixed ground-glass density and nodule diameter greater than 10 mm were independent risk factors for malignant transformation of high-risk pulmonary nodules. Conclusion: The density type and lesion size are independent imaging risk factors for judging the benign and malignant properties of high-risk pulmonary nodules. Mixed ground-glass nodules and larger nodules possess higher malignant risk. Single malignant imaging sign has limited differential diagnostic value with obvious overlap between benign and malignant lesions. The research results are consistent with authoritative guidelines such as Lung-RADS. The dual evaluation standard combined with surgical pathology and long-term follow-up is more suitable for clinical management of high-risk nodules in the physical examination population, which can effectively improve the diagnostic accuracy and risk stratification of early lung cancer.